Children and aids newsletter

Dr. Umesh Chawla, Programme Manager, Care, Support and Treatment, India HIV/AIDS Alliance outlined the characteristics of the situation of children affected by HIV and AIDS in low prevalence and concentrated settings including barriers to identification, services, programming challenges, policy implications, the role of civil society in the response as well as successful and innovative approaches. Key barriers to services and related programming challenges included:

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  limited availability and access to HIV and SRH related services in general and especially for young people and marginalized populations;
  
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  high level of stigma and discrimination, abuse, malnourishment, school drop-out;
  
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  criminalization of the marginalized populations;
  
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  lack of political commitment;
  
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  community versus institutional care;
  
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  basic as well as psycho-social needs of family have to be addressed simultaneously– food, shelter, education, counselling and supportive environment.
  

Chawla concluded that in low prevalence and concentrated epidemics, the response to the situation of children affected by HIV and AIDS must:

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  respond to the challenges and needs of marginalised, stigmatised and criminalised groups;
  
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  increase political commitment and its implications for support for and access to specialised children services;
  
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  fund research to inform present and future needs;
  
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  ensure that programmes are culturally and contextually specific;
  
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  recognise the unique role of civil society and advocate, prioritise and funding civil society actors;
  
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  increase participation of children, families and communities in the analysis, planning and programme design.
  

As the final presentation to inform the Global Partners Forum about the existing and emerging evidence base, Dr. Kiersten Johnson, Demographer, Demographic and Health Survey (MACRO) elaborated on a secondary analysis of DHS and MICS data to identify children at risk in the area of HIV and AIDS (“Who is a vulnerable child?”) commissioned by UNICEF. She highlighted the difficulties to date to find a cross-nationally applicable definition and indicators of vulnerability at global level that multinational organizations need to monitor and evaluate service coverage and progress towards international goals and targets. And that local definitions of vulnerability are critical for effective program implementation.

Johnson underscored the findings that standard OVC-related indicators of vulnerability (orphaning and living arrangements, chronic illness or HIV serostatus of adult household members) by themselves are not very satisfying for policy and programmatic purposes and that wealth and parents’ education are better correlates of child health and well-being outcomes. Models of early sexual debut were found not to be very useful and the analysis results presented support a multivalent approach to defining vulnerability which:

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  incorporates age-specific vulnerabilities;
  
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  tries to capture multiple aspects of vulnerability;
  
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  is limited to data that are commonly collected in surveys like MICS & DHS.
  

However, she also pointed out that even if we conclude that orphanhood is not the best or only marker of vulnerability, there is still value in continually assessing the status.