Orphans

The report, “Home Truths: Facing the Facts on Children, AIDS, and Poverty” calls for fundamental shifts in global, regional and national responses to the epidemic’s impact on children, their families and communities.
Credit: JLICA

The global response to AIDS must be significantly reoriented to address the unmet needs of millions of children and their families in the worst affected countries, according to a new report by the independent Joint Learning Initiative on Children and HIV/AIDS (JLICA).

The report, “Home Truths: Facing the Facts on Children, AIDS, and Poverty” summarizes two years of research and analysis of AIDS policies, programmes and funding and calls for fundamental shifts in global, regional and national responses to the epidemic’s impact on children, their families and communities.

"Families are at the heart of the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “Policies, programmes and funding must focus on providing universal access to HIV prevention, treatment, care and support for the family as a unit to ensure that both children and the adults who care for them get the essential services they need.”

The JLICA report outlines a clear and achievable action agenda to improve the scope and impact of services for children, their families and communities. Yet, experts point out that, while these JLICA-endorsed approaches are clearly supported by evidence and experience, setting a new direction for policy on children affected by HIV and AIDS will demand major shifts in both thinking and action.

Among the key recommendations highlighted in the report are the need to focus on children’s needs, not their orphan or HIV status when designing and implementing policies and programmes. More than 60% of children in southern Africa live in poverty. Singling out those directly affected by HIV is not only inefficient, but can also have undesirable effects -- such as stigmatization and abuse of those in need of help.

Health and social services, such as expanded access to HIV testing and treatment, should reach out to families as a whole. An effective response to AIDS requires the delivery of integrated, family-centred services in health, education and social welfare that are well-resourced and linked to communities.

The report also states that basic economic security can help families invest in children’s health and education, increase their use of available services, and pay for essentials such as food, medicine and transport to health facilities. Income transfer efforts, which place funds directly in the hands of families that need them, have demonstrated impressive results in improving child and family well-being in several African countries.

According to the report, urgent action is needed to address the social conditions and norms that render women and adolescent girls highly vulnerable to HIV infection. Therefore, the report calls for increased efforts to tackle behaviours and attitudes that protect or promote sexual abuse of women and girls.

JLICA is an independent alliance of researchers, implementers, policy-makers, activists and people living with HIV. JLICA partners and supporters include the Association François-Xavier Bagnoud – FXB International; Bernard van Leer Foundation; Bill & Melinda Gates Foundation; FXB Center for Health and Human Rights, Harvard University; Global Equity Initiative, Harvard University; Human Sciences Research Council, South Africa; Irish Aid; Netherlands Ministry of Foreign Affairs; UK Department for International Development; UNAIDS; and UNICEF, among many others.

The report, titled Children and AIDS: Third stocktaking report, was jointly prepared by UNICEF, the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Population Fund (UNFPA).

Early diagnosis and treatment can significantly improve the prospects for survival of newborn babies exposed to HIV, according to a report released today by four United Nations agencies.

The report, titled Children and AIDS: Third stocktaking report, was jointly prepared by UNICEF, the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Population Fund (UNFPA).

This report is the third review of progress on how AIDS affects children and young people since the Unite for Children, Unite against AIDS campaign was launched in October 2005 by UNICEF, UNAIDS and other partners with a commitment to be accountable for results.

Unite for Children, Unite against AIDS is a call to action around the impact of HIV and AIDS on children. It focuses on the needs of children in four key areas, known as the “Four Ps”: Preventing mother-to-child transmission of HIV; Provision of paediatric treatment; protection and support of children affected by AIDS; and prevention of infection among adolescents and young people.

This 2008 Stocktaking Report examines data on progress, emerging evidence, and current knowledge and practice for children as they relate to the four programme areas. The report also calls for actions in the next one to three years that can significantly improve prospects for children and women affected by AIDS. These initiatives involve changes in thinking, as well as concrete actions.

Prevention of mother-to-child transmission of HIV
Most pregnant women diagnosed with HIV do not have access to essential care and treatment, including antiretroviral therapy for their own health, to further reduce HIV transmission and prevent orphaning, according to the new report. Far too few pregnant women know their HIV status. In 2007, only 18% of pregnant women in low- and middle-income countries where data were available were tested for HIV, and of those who tested positively for HIV, only 12% were further screened to determine the status of the HIV disease and the type of treatment they require. Addressing mothers’ needs for diagnosis and treatment will improve not only their own overall health but their children’s survival.

Providing paediatric treatment and care
The report found that children under the age of one are not getting diagnosed and are missing out on treatment. As a result, large numbers of very young children are dying every year due to AIDS-related illnesses. Recent evidence found mortality levels reduced by up to 75% when infants were tested early and treated within the first 12 weeks of life. In 2007, however, only 10% of children born to HIV-positive women were tested before they were two months old. Therefore, the report advocates for increased testing to enable appropriate treatments to begin as early as possible.

Protection and care for children affected by AIDS
There is growing evidence in support of programming that addresses the wider context of children’s vulnerability as the basis to assist those children, families and communities directly affected by AIDS. The stocktaking report highlights that responses should be AIDS-sensitive and not AIDS-exclusive. While support to strengthen family and community responses to the epidemic remains a high priority, there is recognition of the need to support national protection systems, including government capacity to address child welfare generally.

Preventing infection among adolescent and young people
Significant numbers of young people continue to be infected with HIV each year, and girls in sub-Saharan Africa, in particular, remain vulnerable – 45% of all new infections occur in the 15–24 year-old age group. The new report argues that urgent attention is needed to address the greater HIV risks to girls of multiple concurrent partnerships, intergenerational sex, transactional sex and gender-based violence.

In countries with low-prevalence and concentrated epidemics, HIV prevention responses focused on adolescent risk behaviours – including injecting drug use, unprotected sex between males, and sex in exchange for gifts and money – are a priority. There is strong consensus that combination prevention programmes – integrating behavioural, structural and biomedical approaches – work.

This year’s report is accompanied by ‘Children and AIDS: Country Fact Sheets’, which present key statistical data on the “Four Ps” for 157 countries.

200 delegates from 42 countries met in Dublin, Ireland on the 6th and 7th October 2008 for the 4th Global Partners Forum on Children affected by HIV and AIDS.
Credit: UNAIDS

In order to review progress, set global priorities, and make commitments for children affected by HIV, 200 delegates from 42 countries including leaders in government, civil society and UN agencies met in Dublin, Ireland on the 6th and 7th October 2008 for the 4th Global Partners Forum on Children affected by HIV and AIDS.

The Global Partners Forum was established in 2003 to build momentum in fulfilling global commitments for children affected by HIV as was stated in the United Nations General Assembly 2001 Declaration of Commitment on HIV/AIDS and the Millennium Development Goals.

The current definition of children affected by HIV (UNICEF and UNAIDS) are those under 18 years of age who are living with HIV or have lost one or both parents due to AIDS or whose survival, well-being or development is threatened or altered by HIV. However, in hyperendemic countries where HIV prevalence exceeds 15% most children are directly or indirectly affected by AIDS.

According to the latest UNAIDS report on the global AIDS epidemic, the number of children living with HIV has increased from 1.6 million in 2001 to 2 million in 2007, 90% of which live in sub-Saharan Africa where nearly 12 million children under 18 have lost one or both parents to AIDS.

The 4th Global Partners Forum, co-hosted by the Government of Ireland, UNICEF and UNAIDS, aimed to renew the commitment of international partners to accelerate support for the protection and care of children affected by HIV, report progress and highlight good practices identified since the 3rd Global Partners Forum in 2006, as well as to produce a participant-endorsed communiqué defining priorities for the next two years.

The meeting was opened by the Minister of State for Overseas Development, Peter Power, T.D. and a keynote address was given by An Taoiseach Brian Cowen, the Prime Minister. Other keynote speakers included the First Lady of Honduras Xiomara Castro de Xelaya, and HIV activist and singer/songwriter Annie Lennox. The meeting differed from many others by the presence and active contribution of children from western and eastern Europe, Asia, Africa, and Latin America, including some infected and affected by HIV.

Despite efforts to care and protect vulnerable children, exclusion, stigma, and discrimination of children affected by HIV continue to be common challenges in most countries.
Credits: UNAIDS

Children’s vulnerability to the epidemic was captured in the evidence-based synthesis paper presented at the forum by UNICEF to promote awareness and to inform the discussions. Priority issues were further elaborated during panel discussions addressing topics such as family-centered care, strengthening national responses for the most vulnerable children, and quality programming at the community level. Although it was acknowledged that there has been progress in global efforts for children affected by HIV, it was also recognized the severe remaining constraints which make it impossible for some children to realize their human rights.

Evidence from the synthesis paper and discussions at the forum, including contributions from the children, highlighted that despite efforts to care and protect vulnerable children, exclusion, stigma, and discrimination of children affected by HIV continue to be common challenges in most countries. Stigma has been cited as a reason for children not being enrolled in school, receiving care, or being adequately served by programmatic responses.

Attending school is essential to the development of skills and acquisition of knowledge to enable young people to reach economic and social fulfillment. Schools also have the protective effect of educating children about HIV and how to avoid infection. However, HIV poses several constraints that prevent children from going to school or forces them to an early drop out. For instances, many children become responsible for the care of their siblings and other family members when parents are debilitated by poor health. The need to provide food or generate income prevents these children from attending school while at the same time increasing their vulnerability to HIV. This vulnerability represents part of a vicious cycle: their circumstances put them at high risk for exploitation and abuse, and therefore exposure to HIV.

Schools also have the protective effect of educating children about HIV and how to avoid infection. Credit: UNAIDS

Evidence presented at the 4th Global Partners Forum showed that families are bearing the bulk of the costs for infected children. Therefore, families under stress through chronic poverty, labor constrains and facing the impact of illness and death, need external assistance. In response to these challenges, a number of countries are beginning to scale up cash transfers, as part of a social protection package, to alleviate poverty and to increase access to essential services. Such social protection has been shown to be feasible even in resource-constrained countries with high HIV burdens.

Even though the main mode of HIV transmission, and the extent of HIV-related vulnerability among children may differ from region to region, the response challenges were seen to be the same, such as fear of HIV testing by parents, lack of access to treatment for children, and lack of social and psychological support.

The messages of the meeting and the action points were summarized by a communiqué which was presented, debated and adopted during the plenary. It recognized that more information and data were now available and the reality on the ground is better understood to inform action. Based on the evidence presented, the communiqué highlighted four priority action points: the well-being of children and parents infected by HIV; strengthening families and communities as units of prevention, treatment, care and support; increasing effectiveness of programs, services and resources; and human rights for vulnerable children.

Participants committed themselves to implementing the action points of the communiqué, to monitor their progress, and to hold themselves accountable to children affected by HIV. UNAIDS committed to work with governments, the UN family and civil society to put children and families at the heart of the response to HIV through efforts at global, regional and country level.

For millions of children, AIDS has starkly altered the experience of growing up. In 2007, it was estimated that 2.1 million children under age 15 were living with HIV and 15 million children had lost one or both parents to the virus . Millions more have experienced deepening poverty, school dropout and discrimination as a result of the epidemic.

Nonetheless, important progress has been made in reducing the spread of AIDS since UNICEF and UNAIDS issued a Call to Action to Unite for Children, Unite against AIDS in October 2005, according to the new ‘Children and AIDS: Second stocktaking report’.

The report, co-authored by UNICEF, UNAIDS and WHO reviews progress made on children and AIDS in four key areas: Preventing mother-to-child transmission of HIV; Provision of paediatric treatment; protection and support of children affected by AIDS; and prevention of infection among adolescents and young people.

Prevention mother-to-child transmission of HIV

The ‘Children and AIDS: Second stocktaking report’ highlights that improvement in preventing mother-to-child transmission of HIV (PMTCT) has seen the most significant gains. In 2005, only 11% of women living with HIV received drugs to prevent transmission of the virus to their children; however by the end of 2006 that figure had risen to 31%.

In 2006, Botswana reported that only 7% of infants born to HIV-positive mothers became infected with HIV, compared to 35–40% before the PMTCT programme began.

However, most of the 2.1 million children under 15 living with HIV in 2007 were infected before their birth, during delivery or while breastfeeding.

Provision of paediatric treatment

Advances in paediatric care have been equally dramatic. In 2005, only 70,000 children were receiving antiretroviral drugs (ARVs) but in 2006, that number had risen to 127,000 – a 70% increase in one year.

In South Africa , mortality was reduced by 75% in HIV-positive infants who were treated before they reached 12 weeks of age.

Protection and support of children affected by AIDS

The stocktaking report also show progress on the protection and care for children affected by AIDS in many countries and on their access to social services. Progress has also been made in school enrolment rates for children who have lost both parents to the disease, although children affected by HIV are still more likely to fall behind in school and to live in poorer households.

Prevention of HIV infection among adolescents and young people

The report highlights the urgent need for better evidence-based information on the behaviours of adolescents and young people to improve and focus HIV prevention efforts to where they will be most effective. It also outlines the importance of involving young people in the design, implementation and monitoring of HIV prevention programmes for young people.

In Latin America and the Caribbean, MTV has been working with UNICEF to produce ‘Sexpress Yourself’, a one-hour special in which young people talk openly and honestly about sex, sexuality, gender roles and HIV.

In India, focused peer outreach programmes, youth-friendly health services and communication activities in 43 high-prevalence districts are helping to reach adolescents, young people and especially girls at high risk.

While the news is mixed, the report argues that achieving an AIDS-free generation is possible. For that, the report calls for action to strengthen communities and families whose role is crucial to every aspect of a child-centred approach to AIDS; reinforce health, education and social welfare systems to support children affected by AIDS; integrate services for PMTCT programmes; and consolidate data in order to document advances and shortfalls and strengthen commitment.

Dawn has just broken in Cairo, Egypt, but Ahmed is already out on the street. But unlike other children Ahmed is not on his way to school. Ahmed is 12 years old and left home when he was just six because his father in law didn’t want him in the house. After wandering from one house to another, he found that it was easier for him to live on the streets. At that time he didn’t realise that it was far more dangerous too. When the social workers of Hope Village found him, he had been beaten up, robbed many times and raped twice. Hope Village provided him with a safe place to stay and offered him much needed shelter, care and support. “We also enrolled him in an HIV session where he learned how HIV is transmitted,” said Nawara a sociologist at the Hope Village. “After what’s happened to him he is very worried that he could be positive himself,” she added.

Hope Village Society was initially created to provide shelter and support to orphaned children from one of Cairo’s poorer neighbourhoods. However, a fter two years, they realized that the local street children also needed a safe place to go where they could receive care and support so they opened a day care center. The inauguration of this centre in the Shubra district of Cairo was soon followed by many others including one in the district of Sayeda Zeinab where Ahmed and other young boys come to seek refuge and comfort when the streets of Cairo become too much for them.

Twenty three year old Nawara has been working at Hope Village for about a year. She said that although her job is very tough it is also very rewarding, “these boys really need our help” she said. “The most difficult case I encountered, she recalled, was one of an 11 year old boy whose father threw him off the window because he was being too loud. I go with the kids when they have their medical examinations and I am shocked by what I see on their bodies–– bruises, cuts, infected wounds––It’s difficult to imagine what these kids go through,” she said.

Khalid Dawoud has been working with Hope Village for the past 17 years. He set up the Sayeda Zeinab day care centre. “I know the story inside out and I know what those kids are subjected to,” he said. 

During his experience with Hope Village, Khalid noted how interested the children were in knowing more about HIV because of the dangers they face, from sexual assaults to drugs, violence and prostitution. Sex, both forced and voluntary often takes place at and other deserted places. The girls are usually more at risk because they are abused by the older street boys, by the police and others. Some girls accept to have sex for a sandwich, others do it to ensure protection in return. “It’s critical…” said Khalid “…that they know how to protect themselves from HIV. When we announced that we would open a testing centre soon, all of the kids wanted to be tested to make sure they are not infected with HIV.”

With help from UNICEF and other sponsors, the Hope Village Society undertakes a wide range of activities from providing boys and girls with care and shelter to offering them psychological support, training and behavorial skills to help them reintergrate into society.

“Working with such initiatives is one of our priorities in Egypt,” said Maha Aon, UNAIDS Country Coordinator in Egypt. “We know how important and effective it is to focus interventions on people who are most likely to be exposed to HIV infection. One of the ways to protect street children is to help them understand where the risks are and how they can protect themselves in a way that they understand and which helps them care for and respect themselves.”

UNICEF, in collaboration with UNAIDS provides training on AIDS issues for the social workers at Hope Village . Nawara, who did the course in March said that the information she received and the methods of participatory teaching helped her a lot with the children. “We learned to use games to communicate information about HIV and about the dangers of life on the street, from an HIV perspective,” she said. AIDS awareness has become an integral part of the work carried out by Hope Village to help the children.

Dr Erma Manoncourt, Chair of the expanded Theme Group on HIV and UNICEF representative in Cairo said, “We need to mainstream HIV into existing programmes and develop programmes and interventions which focus on reducing the vulnerability of marginalized groups, including HIV prevention and impact mitigation,” she added. “We are reaching out to the private sector and other civil society entities and working with NGOs and community-based organisations, and at the same time, we collaborate with and support the Government. All these efforts are needed to make a difference for those who have no one else to care about them,” she concluded.

“He is clapping from wherever he is,” Maria Lucia Araujo said emotionally of what her son, Cazuza’s reaction would be to the children’s home “Viva Cazuza” which was founded in his name.

Cazuza, one of Brazil's best-known solo artists, died in 1990 of an AIDS-related illness in Rio de Janeiro at the age of 32. Today, 65 children living with HIV are being supported by Sociedade Viva Cazuza, a non-profit organization dedicated to helping children living with HIV which is funded by royalties from his songs.

In February 1989, Cazuza became the first Brazilian celebrity to announce publicly that he was HIV positive. In the October after his death, Maria Lucia Araujo founded the home for children living with HIV.

Lucia Araujo didn’t know anything about HIV or AIDS when she learnt of her son’s diagnosis. “When he first told me that he was HIV positive I assumed that he would recover within the year,” she said. Her son’s death transformed her life. Married to a wealthy husband she had no need to work, but she had to do something. “I would have gone mad,” she said. “I couldn’t have slept if I hadn’t done anything.”

So she opened the home, the first of its kind in Rio. Since its opening, the organization has helped 67 children. As the availability of antiretroviral drugs has improved so has the children’s health. “The children go to local schools and have an active life just like any of the other children in the area,” said Lucia Araujo.

UNAIDS estimates that globally there are around 2.3 million children under 15 years old infected with HIV and according to a recent report by UNICEF, some 15.2 million children under the age of 18 have lost one or both parents to AIDS.

“There is a real need to support children living with HIV in Brazil,” said Dr. Laurent Zessler, UNAIDS Country Coordinator in Brazil. “We must make sure these children are not discriminated against. Children living with HIV are able to stay in school and live full and active lives, HIV shouldn’t be allowed to take away their childhoods,” he added. 

“Since my son died the nature of the virus has changed a great deal; it is no longer a gay man’s disease, now more and more women are affected. They often have no idea that they are HIV positive and pass it to their children without knowing,” Maria Lucia said.

Children come to the house through many different avenues. One of the 24 children currently living in the house is 15-year-old Danielle who arrived 10 years ago with her sister after her mother died and her father was unable to cope. During her stay she has built up a good relationship with her father and hopes to live with him again someday.

Paraguayan Jose was found at the age of three abandoned and very sick in a hospital on the Paraguayan border. Now, nine-year-old Jose wants to be a film director.

The organisation also supports young adults who have left the home. Once a week, the home’s clinic is open for HIV positive adults to collect their antiretroviral drugs. As with all Brazilians who are HIV positive, antiretroviral treatment is provided free of charge by the government.

Besides material support, Sociedade Viva Cazuza also operates a Web site where people can ask experts about AIDS issues. The experts receive around 12,000 questions a month. Maria Lucia is shocked by the questions still being asked 20 years after AIDS first arrived in Brazil. “The most common questions are still – how do I contract the disease? How can I protect myself from contracting the disease?” she said. “It is not like Cancer where the experts still are not sure what causes it or how to prevent it – to prevent AIDS it’s simple – use a condom.”

Maria Lucia has become a prominent spokesperson on AIDS appearing regularly on television. She believes her son’s heritage is not only ‘his beautiful songs’ but also the home, by being open about HIV and appearing in public as the illness progressed. “He did a lot to educate people and help reduce discrimination against people living with HIV,” she said.

Photo credits : UNICEF

Just over a year ago, UNIC EF, UNAIDS and other partners launched Unite for Children, Unite against AIDS initiative to highlight the missing face of the child in the AIDS response.

On Tuesday, 16 th January 2007 UNICEF released the “Children and AIDS: A Stocktaking” report summarizing progress on children and AIDS since the initiative was launched in October 2005 and highlighting important breakthroughs and progress noted in the global response to Children and AIDS since the campaign launch. Such achievements include real progress noted in some countries in preventing HIV transmission from mothers to children and providing treatment for children living with AIDS.

“There is an urgent need to help children impacted by AIDS,” UNICEF Executive Director Ann M. Veneman said. “Unite for Children, Unite against AIDS is focused on ensuring treatment for HIV-positive children, prevention of mother-to-child transmission and assisting children who have been orphaned by AIDS. We must build momentum to achieve positive results for children.”

Within the UNICEF report, findings are presented on four key areas: preventing mother-to-child transmission, access to AIDS treatment, preventing new HIV infections and support to orphans and vulnerable children.

Preventing mother-to-child transmission

The stocktaking report finds that there are signs of considerable progress in the area of preventing transmission of HIV from mother to child (PMTCT). Some high-prevalence countries in Eastern and Southern Africa have shown particularly encouraging results. In Namibia for example, the percentage of HIV-infected pregnant women who received treatment for preventing HIV transmission to their infants increased from six per cent in 2004 to 29 per cent in 2005. In South Africa the percentage increased from 22 per cent in 2004 to 30 per cent in 2005.

However, despite these gains, the report details how the overall percentage of pregnant women receiving treatment for preventing transmission remains extremely low. In 2005, it was estimated that only nine per cent of pregnant women with HIV in low- and middle-income countries were receiving treatment for preventing HIV transmission to their children.

Access to AIDS treatment

The report also notes particular momentum in the provision of treatment to children living with AIDS, a result of improved testing, better health worker skills, lower drug prices and simpler formulations. Several countries – including Botswana, India, Rwanda, South Africa and Thailand – have been able to scale up HIV treatment for children by integrating it into treatment sites for adults.

Globally, still only one in ten children needing antiretroviral treatment receives it. However, prices of antiretroviral drugs for children have come down dramatically over the past 12-18 months. The report notes that in 2006, the Clinton Foundation HIV/AIDS Initiative negotiated a reduction in the cost of paediatric AIDS treatment to less than $0.16 per day, or $60 per year, helping to spur competition in the development of paediatric formulations.

Preventing new HIV infections

HIV Prevention responses are displaying renewed attention on the need to focus strategies on adolescents and young people most at risk, according to the report. The report notes that young women should be specially targeted since globally, a higher number of young women are being infected than men.

New evidence suggests that declining HIV prevalence in Kenya, urban areas of Cote d’Ivoire, Malawi and Zimbabwe, and in rural areas of Botswana, has resulted from the adoption of safer sexual behaviour by young people. In more than 70 countries surveyed, testing and use of counselling services increased from roughly 4 million people in 2001 to 16.5 million in 2005.

Supporting orphans and vulnerable children

The disparity between orphans and non-orphans in access to education is being significantly reduced in several countries, partly due to the abolition of school fees, according to the report.

The report notes that collecting and disaggregating data by age group and gender is one of the most vital, simple and effective ways of putting children on the AIDS agenda. This report uses for the first time a baseline against which new and existing data can be measured in order to identify discernible trends regarding children and AIDS.

In times gone by, the ‘KaGogo’ (literally ‘grandmother’s house’) was an integral part of every Swazi homestead – a place of refuge or a neutral site for discussing family matters and resolving disputes. Now the spirit of ‘KaGogo’ is being revived as a way of mobilizing communities in the response to HIV.

Heralded as an example of ‘best practice’ by UNAIDS, KaGogo social centres are being constructed across the country to serve as a meeting place for orphaned children where HIV prevention, care and support activities can take place. Often centres are doubling up as ‘Neighbourhood Care Points’, where education and food are provided.

“Using KaGogo social centres as part of the AIDS response in Swaziland is a new initiative based on traditional ways which people understand and respect,” said UNAIDS Country Coordinator in Swaziland, Mulunesh Tennagashaw. “They empower local communities to look after their orphaned children within their own traditional structure.”

The KaGogo centres respond to the need to support the overwhelming numbers of orphans in Swaziland. There are currently an estimated 63,000 children orphaned by AIDS and extended families are finding it increasingly difficult to cope.

One of the new 'KaGogo' social centres in Swaziland, traditional meeting places now being used to provide essential services for orphaned children. Credit: UNAIDS/R. Evans

Construction of the centres began in 2003 and the KaGogo programme has made huge progress in a very short time. So far 50% of the centres have been completed nation-wide, and a further 30% have been constructed up to roof level. All the KaGogo social centres in Swaziland have been built by the communities themselves who provided labour and local materials.

Mambane’s KaGogo Centre

The KaGogo centre in the Mambane Community, Lubombo region—one of the most remote, poorest and driest parts of Swaziland—is built solidly out of local stone and has a large, airy veranda where meetings are held. It also doubles up as the Neighbourhood Care Point where food and education are provided—the only one in the community.

Under the thatched veranda about 40 children sit on plastic chairs doing sums in shared, well-thumbed maths sheets. The children range in age from seven to 17 years of age. For these and over 40 others registered with the centre, these represent their only school lessons. In addition to educational support, the children are provided with two meals of maize porridge and bean soup a day.

Lungile Matse is one of the volunteer teachers and a caregiver at the KaGogo centre. Recently widowed, and with five children of her own to care for, she still finds time to come to the centre every morning, five days a week.

Lungile and the other volunteers teach maths, siSwati and English using work sheets and books provided by UNICEF. The education they provide here is designed for children of primary school age who haven’t had the chance to go to school, but several of the children attending are older.

A chart on the wall shows that 18 of the children have no parents or are ’double orphans’. Twenty-three have only one parent and 42 are classified as ’vulnerable’. Carers say that many more children would like to come to the centre but live too far away or are too young.

The Mambane community has been badly hit by recurrent drought in recent years, leading to a growing food crisis. The KaGogo social centres have become a central point for distribution of emergency food. UNAIDS Cosponsor organization, the World Food Programme has been providing food at the Mambane centre since July 2005.

World Food Programme has been providing food to the KaGogo in Mambane since July 2005

“Other hungry children come here looking for food,” said Busisiwe Mazibuko, another of the caregivers. “But we only have enough to give the children here. It’s very hard to turn the other children away but we can’t feed more. We have been trying to grow vegetables for the Care Point, but water is scarce and we don’t have enough seeds.”

In Mambane and across Swaziland, it is envisaged that the community KaGogo social centres will eventually be able to provide other essential services for orphaned and vulnerable children, whilst enabling them to continue living in the community they belong to. Whilst the centres can be used for pre-schooling and non-formal schooling, both for children and adults, the Government is keen that KaGogo centres should be used prepare children for school and channel them into mainstream education.

“I believe the orphans of my areas should be looked after by the people of that community, and not somebody else. We can sustain these kids of ours in the community, using community resources and land. I strongly believe that as a community, we can solve most of the problems, provided we are given financial support,” said Chief Sipho Shongwe, Minister of Health and Social Welfare.

The National Emergency Response Council for HIV and AIDS in Swaziland (NERCHA) and the Global Fund to Fight AIDS TB and malaria provided financial and technical contributions to the KaGogo Social Centre initiative. The estimated cost of each centre is US$ 10 000.

Related links
Helping Ourselves: Community Responses to AIDS in Swaziland
More on Swaziland
World Food Programme
The Global Fund to fight AIDS, Tuberculosis and Malaria

Third Global Partners Forum Focuses on Protection, HIV Prevention, Treatment, Care

The global response to children affected by HIV and AIDS does not come close to matching the enormity of their rapidly expanding plight. By 2010 an estimated 18 million children in sub-Saharan Africa alone will be orphaned by the disease. Children living with sick and dying parents remain extremely vulnerable, and an estimated 4 million infected children do not have access to appropriate treatments.

This year’s Global Partners Forum, hosted by UNICEF and the UK Department for International Development (DFID), has brought together high level representatives from 90 international organisations, NGOs and governments in an effort to ramp up practical responses to the suffering of millions of children caught in the AIDS pandemic.

“Children are missing from the world’s response to the global AIDS pandemic,” said UNICEF Executive Director Ann M. Veneman. “Less than 10 per cent of the children who have been orphaned or made vulnerable by AIDS receive public support or services.”

This year’s forum will focus on ways to:

• Strengthen the capacity of families to protect and care for orphans and other children made vulnerable by HIV.
• Mobilize community-based responses to support affected families.
• Ensure equal and full access to education.
• Guarantee universal access to HIV prevention, treatment and care.

The forum will underline that communities and families should be the primary beneficiaries of an increased global AIDS response. A mix of economic assistance should be provided including direct cash grants for affected families, small loans and funds to pay community outreach workers.

“This is a crucial time in our global efforts to tackle HIV and AIDS- and a time to turn commitments into action,” said UK International Development Minister Gareth Thomas. “We must ensure that the needs of children are central to this and ensure that communities can fulfill their potential.”

Care and support for vulnerable children should not be limited to their material needs. More effort is required to provide orphans and other children traumatized by AIDS with counseling and psychosocial support.

To date, non-governmental and faith-based organizations as well as community groups have pioneered assistance to children and communities. Funds are needed to expand proven responses from pilot interventions to nationally scaled programmes.

Improving Access to Education

Education is one of the most important weapons against the spread of AIDS. The evidence for this is growing: in countries with severe epidemics, young people with higher levels of education are more likely to use condoms and less likely to engage in casual sex than less-educated peers. Educated children are also more likely to escape the poverty trap that ensnares orphans and children forced to take care of sick or dying parents.

However school fees remain a powerful barrier to educational access for the very children most at risk in many countries affected by AIDS. Ending school fees at the primary level is an essential step to achieving universal education. It can only be sustained if the international community increases funding to governments making the bold move to abolish school fees. With the abolition of primary school fees in Kenya, for instance, 1.3 million new pupils have poured into class rooms.

Ensuring that girls get equal access to education is also vital, especially as girls are disproportionately affected by HIV and AIDS. The UK government is a key partner in the United Nations Girls Education Initiative (UNGEI), a UNICEF-led effort to narrow the gender gap in education.

In addition, this year’s forum will focus on steps to ensure that children come as close as possible to gaining universal access to appropriate treatment and care by 2010; to prevent the spread of the disease among adolescents and young people; and to stop the transmission of the virus from mothers to their babies.
“Twenty five years into the epidemic, considerable progress has been made in mobilizing the world against AIDS,” said Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “But when it comes to accessing HIV prevention and treatment services, children and young people continue to be left behind. If we are to break the cycle of HIV infection, children and young people must know how to protect themselves from HIV.”

Legislative Protection

The forum will also examine ways to:

• Advocate for changes in law and policies governing the protection of vulnerable children.
• Raise awareness and reduce stigma for children affected by AIDS.

Improving systems of birth and death registration would have a positive impact. Currently it is difficult for children to obtain official records proving that they are orphans, which would make them eligible for such benefits as food aid or free medical care.

More about the Global Partners Forum at UNICEF