Children of people with HIV/AIDS are profoundly affected by the disease, experiencing grief, reduced living standards and discrimination, and facing an uncertain future. Already, HIV/AIDS is undoing years of progress in ensuring the health, survival and development of children, and undermining family and community life.

Children orphaned by HIV/AIDS often end up in orphanages or similar institutions. UNICEF programming aims to make sure children affected by HIV/AIDS are cared for in the extended family or community

At the national level, the problems of children affected by HIV/AIDS can be virtually "invisible". If they are visible at all, it is in a gradual but steady rise in children needing institutional care, out of school and working, missing vaccinations, living on the street.

In 1998, Thailand participated in an international study by the Global Orphan Project that sought to make accurate estimates of the number of children affected by HIV/AIDS (looking only at children under 15 years old of HIV-positive mothers).

The study found that in Thailand, some 512,152 children had HIV-positive mothers. Of those, less than 7% were orphans, and only another 11% had mothers who had developed AIDS. In the other 80% of cases, the majority of mothers did not yet even know they were HIV-positive.

Results of the 1998 Global Orphan Project survey of children affected by HIV/AIDS in Thailand, showing the delayed impact of an HIV/AIDS epidemic upon children Tertiary Risk: Children whose mothers had already died of AIDS-related causes Secondary Risk: Children whose mothers were living with AIDS Primary Risk: Children whose mothers were HIV-positive, but still largely asymptomatic

These findings have disturbing implications for countries like Papua New Guinea, Cambodia and Myanmar, where new infection rates among pregnant women are high. Even in Thailand, where new infections started to fall in 1996, the full impact of HIV/AIDS on children is still to be felt.

Guided by the new global UNICEF Principles to Guide Programming for Orphans and Other Children Affected by HIV/AIDS, UNICEF is helping countries in the East Asia and Pacific (EAP) region to recognize and respond to the needs and rights of children affected by HIV/AIDS.

Supporting Grassroots Responses

Children, families and communities around the region are having to cope with the reality of HIV/AIDS on a day-to-day basis. They are evolving workable, affordable responses out of urgent necessity. Supporting and building on grass-roots responses is a key strategy for protecting the rights of children affected by HIV/AIDS.

UNICEF Thailand's District-based Program for Children Affected by HIV/AIDS in northern Thailand works with district committees that coordinate and allocate resources for local activities to support the most vulnerable families and children (not just those affected by HIV/AIDS). These include scholarships, direct support to affected or foster families, income generation and the voluntary work of community groups.

From the With Hope and Help: Cambodia film

The District-based Program also supports the training of trainers in child rights orientation, skills for counselling affected families and children, and the special needs of the elderly in child care. (In Thailand, grandparents often become child carers when parents migrate or fall sick.)

The Program is closely coordinated with health and social services, temple-based initiatives, the Child Friendly Schools Initiative and related programs to create a "continuum of care" for affected families.

UNICEF also offers technical assistance to governments to ensure policies and legislation support local efforts and the rights of affected children and women.

Buddhist Leadership

The traditional roles of Buddhist temples in providing refuge and education for the poor and for abandoned or orphaned children have already involved many monks and nuns in care and support for children affected by HIV/AIDS.

Temple-based initiatives are providing much-needed care and support for children affected by HIV/AIDS and their families

The UNICEF Regional Buddhist Leadership Initiative is supporting their efforts and helping them to find new ways to provide support while keeping children within families. In Thailand, China and Cambodia, monks have been trained to deal with HIV/AIDS prevention and non-discrimination issues through temple schools and cultural education programs.

Monks and nuns in some temples also provide material support to families affected by HIV/AIDS from public donations, and have been trained to provide psychosocial/spiritual counselling for people affected by HIV/AIDS, which can help affected parents to cope.

Schools

Schools are often the only state institutions in every community, and are in daily contact with most households. Schools have a key role to play in ensuring the protection, care and support of orphans and other vulnerable children.

Lifeskills-based healthy living education programs, which are being expanded in schools across the Mekong subregion and elsewhere, provide children and adolescents with skills that help them cope with challenging circumstances and protect themselves from HIV/AIDS and from situations that put them at risk. Increasingly, UNICEF is encouraging and assisting countries to incorporate stronger elements on non-discrimination against people affected by HIV/AIDS.

School-based programs can go much further. In northern Thailand, a UNICEF-supported project linked to the national Child Friendly Schools program has seen schools in some vulnerable communities badly affected by HIV/AIDS providing a range of support services, including:

• Training teachers in psychosocial counselling for children
• "Rainbow Camps" to improve communication between orphans and their carers
• Psychometric testing to identify children suffering from depression and monitor their progress.

The psychometric testing has already shown marked improvements in depression and self-esteem among children in the pilot schools, particularly among girls.

Discrimination isolates affected children from their peers and devastates their self-esteem. It can also bar them from essential services, particularly schools and healthcare. With UNICEF help, countries are updating their Lifeskills curricula to incorporate issues of sympathy and non-discrimination. Training of trainers and orientation workshops combat discrimination among community leaders, local officials and direct service providers like schoolteachers and health workers.

Family Care the First Choice

When children grow up without family and community connections, they are cut off from the support networks they will need as adults, as well as the opportunities to learn the skills and culture that children learn in families and in their communities. Orphanages and similar institutions have often, unfortunately, not provided consistency of care, especially for younger children. – UNICEF, Principles to Guide Programming for Orphans and other Children Affected by HIV/AIDS.

Because fear and shame often drive a wedge between people with HIV/AIDS and their extended families, and misguided concerns about infection make some people unwilling to adopt a the child of a parent with HIV/AIDS, many children affected by HIV/AIDS are becoming household heads and swelling the numbers of children in institutional care or living on the street.

Particularly in Thailand, UNICEF supports initiatives by NGOs, community-based organizations and Buddhist monks and nuns that aim to strengthen and support families affected by HIV/AIDS and adoptive/foster families, so that children affected by HIV/AIDS can enjoy their rights within a family environment.

Information on UNICEF strategies and responses for children affected by HIV/AIDS in the Mekong Subregion can be found in the booklet "Securing a Future".

For more information on country-level activities, see the individual country reports.