Shockingly the 4th day of the International AIDS Conference marked the first ever plenary on children and HIV. That we could get to a point where there are 2 million people under 15 living with HIV and 30 million who have lost one or more parents and still not have had an address to conference on this topic shows a glaring lack of leadership in this area. Children and HIV was a topic picked up at a later satellite session ‘Beyond the Orphan Crisis: Findings of the Joint Learning Initiative on Children and AIDS’ at which Jerker Edstrom, STEPS Centre member, spoke.
The Joint Learning Initiative on Children and AIDS has been conducting research into family centred approaches to mitigating the impact of HIV on children. They argue that we fail to put children at the centre of the response to AIDS and the effect of this is immeasurable, particularly in its emotional impact. The solution, they believe is to place families at the centre of interventions by; abolishing school fees, creating cash transfer programmes, campaigning for comprehensive and integrated family services and responding to the psychosocial needs of children.
Their research has shown that families bear 90% of the cost of care and support for children affected by AIDS – which encompass not just children who have lost parents but all vulnerable children living in communities where AIDS is having an impact. Caring for these children is stretching already weakened coping mechanisms. Focusing on orphans alone is creating skewed systems that can leave other family members vulnerable and impoverished. Institutional care is no match for family structures in most cases. Yet in many cases opportunities for strengthening family systems are being missed.
The session heard of a successful family focused social protection programme that has been rolled out in Mexico. This intervention was rigorously evaluated and showed:
• A 34% increase in living standards
• A 6.4% increase in calories consumed by children
• A 56% increase in families taking fortified food
• 20% less anemia
• A 12% increase in earning potential for life amongst children who received the intervention
• A large drop in catastrophic expenditure on health care.
The programme achieved this by offering cash transfers linked to the nutrition of children under 5 and pregnant and breastfeeding women. Another transfer is linked to schooling and rises each year of attendance and is available until the age of 21. Girls receive a higher educational grant than boys in the light of the increased pressure upon them to work to support their families. Upon graduation young people receive a lump sum which is conditional upon opening a bank account. Later in the programme a transfer was added for families supporting an elderly relative. All transfers go to the woman of the household which has been seen to change gender norms and reduce levels of intimate partner violence. All cash transfers are conditional upon taking nutritional supplements, attending health services and schooling. Panelists at the session commented that, ‘AIDS has been the engine for health system strengthening – let’s make it the driver for social protection’.
Jerker Edstrom spoke on the intergenerational transmission of not just poverty but vulnerability to HIV infection. He argued that simplistic approaches to HIV prevention with children affected by AIDS – such as the ABC, abstain, be faithful, use condoms – are failing these children. What is needed is social protection that takes vulnerability to infection into account and efforts to build social capital outside the family. Papers from this research will be published in an upcoming edition of the IDS Bulletin.