Transcript A National Policy Review of Existing Child Related

Review of Existing Child
Related Policies: Toward a
Child Centred Approach to
HIV/AIDS
Commissioned by
India HIV/AIDS Alliance
Conducted by
MAMTA Health Institute for Mother and Child
&
Tarun Roy
Objective of the current
review:
• The mapping and review of the existing
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national policies (explicit and implicit) related
to children and HIV/AIDS
The identification of policy gaps and
recommendations for addressing the concerns
and needs of children affected and infected by
HIV/AIDS with a rights-based perspective.
Developing an advocacy plan for the
promotion of child related policies
Policy Review Methodology
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Primarily qualitative in nature
Desk review of the epidemiological data about children
infected and affected by HIV and / or AIDS in India to
identify related issues
Identification and review of existing child related
national policies, guidelines, plan documents, reports
Assessment of current situation and responses in
conjunction with the current policies and programmes
Deriving policy recommendation
Scope and limitation
• A step ahead to strengthen already initiated dialogue
towards a policy for child-centred approach to HIV/AIDS
voiced by various stakeholders in Policy Forum meetings
• Could only identify the strengths and weaknesses of
existing national policies to fill in the current gap in
responses to children vulnerable, infected and affected
with HIV/AIDS
• To recommend specific policy requirements to scale up
national response towards child focussed HIV/AIDS
prevention, care and impact mitigation –
– a detailed review of state policies and programmes
needs to be carried out and
– inputs from policy makers and program personnel is
yet to be taken into consideration as a next step
Current status of children vulnerable, infected and
affected with HIV and / or AIDS in India:
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NACO estimated 55,145 children till the end of 2004 (only
captures possible perinatal transmission)
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No data available regarding children infected through
other modes of transmission.
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Inadequate data to cumulatively project the number of
vulnerable children
– Child workers [official estimate -Working children -
11.28 million 1991 census and 13.5 million by NSS
conducted during 1995-96; unofficial estimate 44
million and 110 million]
– Street-children
– Drug use and sexual behaviour among children
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Inadequate data to project the number of affected
children.
Contd.
• Although the number of AIDS orphans has not been
adequately measured, but some calculate as many as 1.2
million children under age fifteen in India have lost one or
both parents to AIDS.
• There is enough evidence suggesting violation of rights of
children who either themselves living with HIV or because
they are living with family member/s infected with HIV or
living with AIDS.
• STI/HIV vulnerabilities of working children (including street
children) due to sexual abuse / exploitation and early
initiation of risky sexual behaviour and drug use, needs to
be prevented. [official estimate -Working children - 11.28
million 1991 census and 13.5 million by NSS conducted
during 1995-96; unofficial estimate 44 million and 110
million]
• Out of school ‘girl children’, particularly of 6-18 years are
extremely vulnerable to HIV because prevailing early age
marriage and larger number being trafficked either to work
as child labour (prone to sexual abuse) or imbibed into
prostitution (this include vulnerability of girl children of
female sex workers residing in the sex work settings)
contd…..
• Children who are in need of frequent blood or blood product
are yet not completely protected from the risk of bloodborne infection including HIV.
• Majority of known paediatric HIV cases are due to failure in
prevention of perinatal transmission (3.45% of all known
AIDS cases till end Dec. 2004) in India.
• Children who are already made orphan (single or double)
because of HIV/AIDS are facing the adverse consequences
and their fundamental rights are being violated in every
walk of life.
• Initiation of early sexual activity among school children
establishes the vulnerability of elderly school children in
major metropolitan cities in India.
• There is insufficient documentation to influence the policy
makers to focus on reducing the impact of HIV/AIDS among
children.
Implication of lack of data in advocating for
a policy towards a child-centred approach
to HIV/AIDS:
• The politically viable approach to influence the policy
almost always calls for a number. If one considers the
‘number of HIV infected children’ for this purpose then
we must remind ourselves that politically convincing
number of HIV infected children gets reported – much
later in the process of progression of HIV epidemic.
• Projection of the number of adults in the reproductive
age group, who are infected with HIV and their number
of children must guide us to advocate for child centred
policy making to address the effect of HIV and / or AIDS
on children including other specific HIV vulnerability
factors and impact on children.
Current responses to reduce STI/HIV
vulnerability, provision of care and support
to infected and affected children:
National AIDS Control Programme II
• PPTCT – for prevention of perinatal transmission of HIV extremely low scale
• TI with streetchildren – 26 (among 933 TIs supported till
March 2004)
• SAEP – targets students of class IX to XII – primarily
awareness and life skills - implemented in most of the
states (quality of reach and impact not known)
• ‘Youth to youth’ and ‘campus to community’ – primarily
awareness, not known whether includes adolescents (upto
18 years) and what is the number reached?
• Reaching rural youth through Nehru Yuva Kendra
• Family Health Awareness Campaign targets 15-49 years
Responses other than NACP II, to Children
vulnerable, infected and affected with HIV and / or
AIDS:
• Ministry of Women and Child Development
– included HIV/AIDS in their ICDS program – NIPCCD has
trained all staffs – reach to adolescents not known
– Supports NGOs in running orphanages – scope of
accommodating HIV infected and affected children
– UNICEF is collaborating with WCD including various
other ministries for developing a strategy child-centred
HIV/AIDS intervention
• Ministry of Social Justice and Empowerment – NISD - Child
Protection Division of NISD is responsible for building
capacities of service providers, promoting research and
documentation in the areas of child protection & juvenile
justice. It implements National Initiative for Child
Protection (NICP) which is a major national initiative in the
areas of child protection and juvenile justice in
collaboration with Childline India Foundation.
• Ministry of Health and Family Welfare – RCH Program
contd…..
International donors and UN agencies
(major players):
• UNICEF – assisting NACPII in countrywide implementation
of PPTCT, coordinating with WCD and other ministries
• WHO – technical assistance in 3 by 5 (ART), scaling up of
VCTCs, second generation surveillance of HIV
INGOs:
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FHI, India
India HIV/AIDS Alliance
Save the Children (UK) –
Richard Gere Foundation
Railway Children Federation
Catholic Relief Service
Relevance of Existing Public policies and legal
framework to build up child centred approach to
HIV/AIDS:
• All policy documents of Government of India, related to child,
including the recent one the National Charter for Children (Feb.
2004) has endorsed the importance of taking all measures for
protecting the child from different vulnerabilities, provision of child
friendly services and ensuring the rights of the child in every sphere,
through legal, welfare and social service.
• Department of Women and Child Development under Ministry of
Human Resource Development is the lead ministry in this direction
and are coordinating and collaborating with all concerned ministries
like Health and Family Welfare, Labour Ministry, Ministry of Social
Justice and empowerment etc to ensure the child development,
implemented through the state government. So review of state
programs and guidelines related to children needs to be reviewed to
identify the gaps.
• Child welfare and development is not the mandate of NACO.
National AIDS Control Policy has no strategic focus towards children
vulnerable, infected and affected with HIV/AIDS
Broad Recommendations:
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Develop a data base for planning and to influence the childcentered policy making
Based on generated data, inform the policy makers on the
estimated number of vulnerable, infected and affected children
with HIV/AIDS and about the impact of HIV and /or AIDS on
children.
Document the small scale intervention experiences and
recommend a comprehensive intervention model. Which may
help in revisiting the available child-related policies.
Analyse the barriers in translating the child related policies into
action at the state level and come up with recommendation,
based on programmatic review.
Reduction of legal barriers for children in accessing the services
e.g. VCT, ART
Sensitisation of concerned ministries and departments for an
internal review of the policies, in the light of establishment of
rights of children vulnerable, infected and affected with HIV and
/ or AIDS
A collaborative effort – NACO and WCD – for child centred
interventions
THANK YOU