HIV/AIDS: Need for a Child Centered Response
Address by Dr. Isiye Ndombi, UNICEF Representative, at the launching of the HIV/AIDS and Children Campaign in Auckland, New Zealand on 25 October 2005.
Please come along with me on a brief mental journey to Papua New Guinea to explore why, as elsewhere in the Pacific and in the world, a major step-up in a child-centered response to HIV/AIDS is required right now. Such a response is urgent and should be rapid, comprehensive and massive. Papua New Guinea has a population of 6 million people of whom about half are children: these children are the future of the country; the pride of communities and families; the embodiment of the Millennium Declaration and the Millennium Development Goals. By the end of 2004, it was estimated that 80,000 Papua New Guineans were infected by HIV of whom – UNICEF and partners estimate – 11,000 are children. We also estimate that beyond those 11,000 children who are infected, 800,000 children are affected by HIV – that’s 10 children for everyone living with the virus. At the same time, we estimate that there are at least 50 new infections happening every day: most of these in young people 15-24 years of age including 3 young babies and children, each day, who get it from their HIV-infected mothers.
HIV/AIDS is threatening the human rights of Papua New Guinean children in three principal ways:
- Young people (especially adolescents) without proper knowledge and means to protect themselves form the majority of all new HIV infections. Older people and leaders often misunderstand the rights, needs risks and pressures facing young people and misdirect information, resouces and platforms for attacking the epidemic.
- As parents ail and eventually die to leave their children behind, these same children pass from the traumatic phase of dealing with the psychological, social and material costs of terminal illness of one or both parents - and stigmatization of the family - to a phase where their inheritance rights are threatened and some are burdened with the task of fending for themselves and their siblings.
- With an estimated 4,000 HIV-infected pregnant mothers each year - at the 2004 prevalence rates which we know are changing by the minute - about 1,200 babies will get infected every year.
And yet, the thrust of the response has not fully reached children to address their human rights within the communities in which they live. From the perspective of the UN and UNICEF, development programming entails the fulfillment, protection and respect of the human rights of each individual, each child. And yet HIV/AIDS leads to ‘a vicious cycle of unfulfilled rights’. Firstly, lack of appropriate care of children whose parents are ill with or die of AIDS threatens the children’s right to health, education, participation, inheritance and parental care. These children will often fall by the wayside, succumbing to circumstances that place them at great risk of contracting HIV themselves.
Secondly, denial of the right to access appropriate information, especially for adolescents and young people, leads them to partake in experimentation and/or behaviour that heightens their risk of contracting STDS/AIDS. Early marriage and dropping out of school endangers the girls since a significant number of the marriages soon break-up pushing the girls into commercial sex work, exploitation and other risky behaviour.
Finally, lack of adequate parental care (such as in the case of orphans) leads to exploitation which soon pushes them into the vicious cycle that enhances their risk of contracting HIV infection.
This campaign on HIV/AIDS and children is a call for a massive step-up in activities and programmes to radically expand the international, national, sub national and community responses to HIV/AIDS while putting children, the future of their countries, in the centre. UNICEF and partners in Papua New Guinea will focus on the following priorities:
- Primary prevention will be driven through intensified public advocacy as well as rapid expansion of the community mapping and theatre against AIDS (COMATAA) initiative, which emphasizes facilitation of communities' own assessment, analysis and response to the epidemic. It will entail massive expansion of access to counseling and HIV testing facilities and youth-led/youth-sensitive communication modalities to stem the epidemic. Schools will become major channels of HIV/AIDS education within themselves and for communities around them. The Government, UNICEF and partners will provide support for every sector (public or private) to formulate an HIV/AIDS response strategy consistent with the National Strategic Plan and capacity building for adequate monitoring and surveillance systems to track the reach of interventions for risk reduction, vulnerability and impact mitigation. Strong linkage between good data and advocacy will be built at all levels. The Government, UNICEF and partners will also support strategies to make social services more youth-friendly, while integrating all aspects of HIV/AIDS prevention, care and support.
- Prevention of mother-to-child transmission of HIV focuses on the promotion of improved pregnancy outcomes and community care and support services. Information, counseling and voluntary testing will be available to all women of reproductive ages through maternal and child health services. This calls for partners to significantly improve the quality of health service provision and has significant implications on the workload of health workers, which must be urgently addressed. In addtion to the important focus on mothers and newborns, PMTCT will be an entry point for primary prevention throught the full integration of the relevant communication strategies. PMTCT will also link with initiative to expand access of both parents and children to anti-retroviral treatment.
- Protection entails ensuring that orphans and vulnerable children have adequate access to social services (such as health, education, water supply, etc.) on the one hand. On the other hand it obligesthe duty-bearers to ensure that orphans and vulnerable children have access to justice recourse (to them from violations and protect their inheritance rights) as well as welfare (to provide for the essential needs. UNICEF and partners will mobilize to step-up prevention from abuse, violence, neglect and exploitation.
- Access to treatment for HIV as well as opportunistic infections will be facilitated through the National Department of Health and other providers of health, especially at the sub-national levels. This will entail appropriate modifications in themodules on the prevention and management of childhood illness. UNICEF and WHO will work closely with AusAID and othr key development partnrs to build capacities for expasion of acess to treatment for children. A strong monitoring framework will be put in place to ensure that diagnostic capacities, whether symptomatic or laboratory-proven, can be quality assured and trackable to secure good and comparable databases.
- UNICEF will engage partners at all levels to highlight the human rights of children and these partners' obligations to fulfill them. There will be increasingly ope dialogue, closer collaboration and effective sharing of expertise. UNICEF has strong links with churches, which provide a significant proportion of health and education services in the country. Collaboration in promoting the Global Campaign will emphasize the cross-cutting issues surrounding children and AIDS and push for a cohesive response.
Ladies and Gentlemen,
Let me finish with eight messages that Papua New Guinea’s children repeatedly convey, in the many meetings I have held with them during my community interaction visits:
- Education is the key to and the basis of life. It is the gateway to poverty reduction and should be made accessible to all children. It is the responsibility of parents, communities and the Government. My own addition to this is that universal basic education is part of the ammunition against HIV/AIDS and partners should accelerage to ensure this important MDG is realized in all countries including Papua New Guinea.
- The capacities - defined as the combination authority, responsibility, motivation and resourcing - of families to meet the needs and fulfill the rights of children are small and need to be built or enhanced.
- Government and partners' policies do not always relate to the current situation of children and the future
- Some children do not fully enjoy and develop through their childhood stages, hence they lose their potential as adults.
- Children say they are witnessing too much violence in their homes and communities.
- Children want to be listened to and to give their opinions on issues relating to them.
- Children find that they are caught up in communities in denial, communities in dilemma.
- The power relations dynamics between adults and children, leaders and communities, men and women impedes effective communication against HIV/AIDS. It is clear, that adults do not always fully undrstand the needs and rights of children.
Finally, I want to call on all partners to rally behind this campaign which will provide the critical shot in the arm for the global response and help all countries to gain a major step-up in the war against HIV/AIDS. We must break with business as usual. Every minute we delay is a minute during which more young people become infected and more children will die of AIDS-related illness.
Unite for children, unite against AIDS.
Many thanks for your attention.