Transcript Supporting community action on AIDS in developing countries Children Affected By AIDS in Low and Concentrated HIV Epidemics Supporting community action on AIDS in India Umesh Chawla International HIV/AIDS.

Supporting community action on AIDS in developing countries
Children
Affected By
AIDS in Low and
Concentrated
HIV Epidemics
Supporting community action on AIDS in India
Umesh Chawla
International
HIV/AIDS Alliance in
India
Presentation Overview
Supporting community action on AIDS in developing countries
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Scale of the Challenge
Barriers to Identification
Situation and Needs of CABA
Barriers to Services
Programming Challenges
Policy Implications
Role of Civil Society in Response
Successful and Innovative Approaches
Scale of the Challenge
Supporting community action on AIDS in developing countries
Total number of people living with HIV
33.2 Million
Young people aged 15–24 living with HIV
5.4 million
Children below 15 years living with HIV
2.5 Million
There are no clear estimates of children
affected by HIV/AIDS
Source: UNAIDS/WHO estmates, 2007.
Barriers to Identification
Supporting community action on AIDS in developing countries
• The HIV/AIDS epidemic is hidden, often children
of are from already marginalized groups such as
sex workers (SW), Injecting Drug Users (IDUs)
and spouses of Men who have Sex with Men
(MSM)
• Limited number of people are testing for HIV
• HIV/AIDS related stigma is very high
• In low prevalence settings case detection is very
expensive and challenging
• Legal age of consent for HIV testing
• Services and accessible technology needs to keep
up with the demand e.g. PCR for children less
than 18 months exposed to HIV
Situation and Needs of CABA
Supporting community action on AIDS in developing countries
• Highly vulnerable and especially in context
to marginalized population i.e. SW, IDU and
MSM
• Programmes that exist are based on clinical
services reaching out to a limited number of
those in need
• The programmes pay little attention to the
psycho-social needs of children
• Limited legal protection especially for
orphans
Supporting community action on AIDS in developing countries
Supporting community action on AIDS in developing countries
Situation and Needs of CABA
…..contd.
Supporting community action on AIDS in developing countries
• Often CABA are even more isolated and
vulnerable than other OVC
• Lack of children focused services e.g. VCT,
SRH and treatment services. These services
need to be adapted to address children
• Little attention to age and gender specific needs
of children
• The marginalized population already have
limited access, their children also suffer the
same
• Lack of children’s participation in situational
analysis and design of programmes
Barriers to Services
Supporting community action on AIDS in developing countries
• Limited availability and access to HIV and SRH
related services in general and especially for
young people and marginalized populations
• High level of stigma and discrimination
• Criminalization of the marginalized populations
• Lack of political commitment
Children came into focus late, maximum proportion of
the limited resources where invested on prevention
and treatment of adults
Programmes often a result of a reactive response
rather than forward planning
Often targets are set for HIV infected children only
Pediatric OI management and ART - Availability,
accessibility and knowledge
Programming Challenges
Supporting community action on AIDS in developing countries
• Which children do we target for services?
Infected, orphans or CABA
• Families with CABA already in dire
economic circumstances and socially
isolated
• Orphaned CABA are not taken care of by
relatives due to fear, stigma and economic
challenges of host families
• High levels of abuse, malnourishment,
dropping out of school
Programming Challenges...contd.
Supporting community action on AIDS in developing countries
• Women bear the maximum impact, e.g. In India,
50 % of households are single mothers and their
children are already socially isolated and
economically vulnerable
• Often the children are forced to take responsibility
for supporting families by working
• Few peer support programmes for CABA
• Basic as well as psycho-social needs of family
have to be addressed simultaneously– food,
shelter, education, counselling and supportive
environment
• Community versus institutional care – both present
huge challenges
Policy Implications
Supporting community action on AIDS in developing countries
• Political commitment to ensure children specific data is captured and
used – nationally and internationally
• Universal access targets do not prioritise the needs of CABA in low
and concentrated prevalence countries
• In ASIA, majority of programmes for children are implemented by
governments with low political commitment to meeting needs of
marginalised populations and by extension their children
• Particularly challenging with HSS approach – few governments
prepared to address to meet challenges of marginalised pops
and/or fund civil society organisations who are often best-placed to
respond
• Barriers to access of services must be addressed systematically:
Rights to participation, education and life-skills training – sex education,
SRH, child labour issues, consent to HIV testing
Role of Civil Society in Response
Supporting community action on AIDS in developing countries
• Bring forth the real needs of people to the national governments, donors
and international policy makers
• Facilitate accountability and transparency
• Civil society are bring unique and much needed resources and
experience
• Often best placed to work with marginalised populations due to peerbased approaches, emphasis on confidentiality and building trust
• Holistic approach in service delivery and establish linkagesmainstreaming
• Demand generation, mobilisation and provision for C&T, PMTCT,
treatment and adherence support done at community level
• Instrumental in scale up of services and quick response and help
countries reach universal access targets
• Stigma reduction programmes are done in communities by the
communities
• Demonstrate innovative, community focused and sustainable
approaches
Successful and innovative approaches
Supporting community action on AIDS in developing countries
 Taking a family centred approach – must see child within
home/care network
 Reaching out and meeting children where they live
 Strengthen links between health services and
community-based organisations for bi-directional
referrals
 Governments with PLHIV and marginalised population
networks working together: making them a part of the
solution not the problem
 Partnership between civil society organisations, local
and national governments in analysis, planning and
programme funding
Successful and innovative
approaches ….contd.
Supporting community action on AIDS in developing countries
 Increase access to child sensitive services e.g.
C&T, PMTCT, social support services, education,
treatment and child friendly SRH services
 Reducing stigma by working with health service
providers to provide sensitive services and maintain
confidentiality
 Participation of Children living with HIV/AIDS and
CABA is central to analysis, planning and solution
creation
 Strengthen legal services for succession planning
and education
Supporting community action on AIDS in developing countries
Conclusions
Low and Concentrated Epidemics
• Must respond to the challenges and needs of marginalised,
stigmatised and criminalised groups
• Increase political commitment and its implications for support for
and access to specialised children services
• Fund research to inform present and future needs?
• Ensure programmes are culturally and contextually specific e.g.
India has a very different epidemic to Eastern Europe
• Recognise the unique role of civil society and advocate,
prioritise and funding civil society actors
• Increase participation of children, families and communities in
the analysis, planning and programme design
Supporting community action on AIDS in developing countries
Supporting community action on AIDS in India
Thank You