Children and AIDS campaign update: June – August 2007
The Unite for Children Unite against AIDS campaign was launched in Mozambique in November 2005. Following the launch event, significant progress has been made in the four programmatic areas (Four Ps) of the campaign as a result of partners working together.
Prevention among adolescents and young people
The School Awareness Programme was expanded at the beginning of the year to cover 10 provinces plus Maputo City. The programme target for 2007 is to ensure that approximately 260,000 children in over 600 schools in all provinces have improved knowledge on HIV prevention and demonstrate positive life and non-discriminatory attitudes towards HIV positive people. This target had been surpassed by the end of June, with 305,438 children participating in the life skills programme in 717 schools, of which 49 per cent are girls, up from 45 per cent in 2006. The programme is supported by the Ministry of Education and Culture (MEC); RENSIDA, the National Network of Associations of People Living with HIV and AIDS, and UNICEF.
Support to RENSIDA’s advocacy initiatives for inclusion of the School Awareness Programme in prevention strategies for the children aged 10-14 who constitute the Window of Hope, resulted in discussions with the National AIDS Council (CNCS) and a subsequent presentation of the programme to CNCS and other partners in August. The outcomes of the meeting include recommendations to document and disseminate lessons learnt from the programme and increase collaboration between RENSIDA and CNCS in prevention strategies for children aged 10-14.
The Window of Hope Initiative which aims to call attention to the need to protect children, adolescents and young people from HIV infection has been approved by CNCS. The initiative involves the collaboration of various partners working in communication for HIV prevention. It will use mass media interventions, community-based communication and Information, Education and Communication (IEC) material to support adolescents and young people make informed decisions as a result of increased access to life skills and sexual reproductive health information.
Prevention of mother-to-child transmission (PMTCT)
By the end of June, 350 PMTCT sites were established in the country, up from 220 at the end of 2006. A total of 8,947 pregnant women had received Nevirapine and 1,541 pregnant women had initiated antiretroviral treatment. In addition, a total of 14,109 babies born to HIV positive mothers received antiretroviral prophylaxis as part of the PMTCT programme. The target for 2007 is to reach 22,500 pregnant women (15 per cent of HIV positive pregnant women).
The number of HIV positive pregnant women receiving combination therapy for prophylaxis (AZT from 28 weeks and up to seven days postpartum and NVP during delivery) in Mozambique is steadily increasing in comparison to women who are receiving monotherapy (NVP alone). This is encouraging because the combination of antiretrovirals (ARVs) is more efficacious and reduces the chances of resistance against NVP. The Ministry of Health’s monitoring & evaluation system is being revised to allow for appropriate documentation of the numbers of women receiving combination therapy.
From 16-18 July, UNICEF facilitated an exploratory visit of the South Africa-based NGO Mothers2Mothers, which is implementing a successful model of mother-to-mother support in the context of PMTCT programmes. Mothers2Mothers has expressed interest in working in Mozambique. With the positive response from the Ministry of Health and other partners to the visit, Mothers2Mothers is presently developing a concept note with details of their proposed interventions in Mozambique.
At the end of June, 65,296 people including 4,826 children under the age of 15 were receiving ART (antiretroviral treatment). The numbers of children receiving ART has improved considerably since June 2005, when approximately 1,100 children were receiving ART, and June 2006, when 2,330 children under 15 were receiving ART. UNICEF and partners are now supporting 55 sites providing paediatric ART plus an integrated package of care and nutrition support. There are 167 health facilitates with ART services and 95 of these facilities (57 per cent) are treating children who are HIV positive.
Despite the progress made, the proportion of children enrolled in treatment remains lower than the growing number of adults who are receiving ART. The challenges in increasing enrollment and adherence of children to ART were discussed by various partners at the HIV Implementers Meeting in Rwanda. The reasons why enrollment of children is low include the following factors: paediatric treatment sites have increased at a faster rate than training of health staff in paediatric treatment, many facilities face an acute shortage of health workers, ART can only be prescribed by a doctor, trained medical staff are often hesitant to put children on treatment and the low demand from mothers themselves often leads to missed opportunities in identifying children who need treatment.
The government and partners are responding to these challenges by training medical staff, supporting non-governmental organisations that provide training and supervision, advocating for approval to allow medical technicians to prescribe medication, developing a communication initiative on paediatric treatment and supporting the production of reference material for health staff. Technical and financial support is being provided for the revision and re-printing of modules in The Child Treatment Manual, first issued in 2005, as well as a training module specifically designed for medical technicians. An updated version of the Integrated Management of Childhood Illness (IMCI) case management chart booklet is also being finalised and integrates identification and care of HIV positive children.
To date 1,189 HIV positive malnourished children have been reached with PlumpyNut. Data analysis conducted on the use of PlumpyNut in seven ART sites and one PMTCT site show positive outcomes in terms of weight gain, cure rates and prevention of malnutrition in HIV exposed children weaned at six months, as well as improved adherence for follow up consultations (46 percent versus the usual rate of <10 per cent) for exposed children. A comprehensive study is needed to provide the scientific evidence for the effectiveness and appropriateness of PlumpyNut as a support for exposed children weaned at six months. UNICEF is also working with international and national partners on the introduction on local production of PlumpyNut in Mozambique.
Protection and support for children affected by HIV/AIDS
The development of descentralised plans for the care and protection of orphaned and vulnerable children have been carried out by all seven focus provinces. Umbrella partnerships linking civil society initiatives for orphaned and vulnerable children and governmental partners at provincial level have also been put in place.
At the end of 2006 approximately 60,000 children were being reached with at least three basic services, and 100,000 children were being supported with psycho-social support and home visits. By the end of June this year, an additional 45,000 children had been reached with at least three basic services and 10,000 particularly vulnerable children were identified to receive a basic package of materials. The package includes basic household items, hygiene products, water purification kits, school uniforms, school kits and mosquito nets.
As part of the Child Friendly Schools Initiative, 9,933 orphaned and vulnerable children were identified in the district of Maganja da Costa (Zambezia province) in the first half of the year, of which 9,128, or 92 per cent, were supported to access school and provided with school material and clothing; 7,456 orphaned and vulnerable children (75 per cent) were supported with access to psychosocial support.