First decade – PMTCT and paediatric AIDS

Second decade – Preventing HIV infection among adolescents

Across both decades – Protection and care for children affected by AIDS

Policy briefs


Across both decades – Protection and care for children affected by AIDS

© UNICEF/NYHQ2009-1923/Pirozzi
A boy orphaned by AIDS reads by candlelight in his grandmother's home in Swaziland.

Since the dramatic increase in provision of antiretroviral treatment in the mid-2000s, AIDS-related mortality has been declining rapidly. In 2011, 800,000 lives were claimed by AIDS in Eastern and Southern Africa, fewer than the 1.3 million lost in 2005. In several countries in ESA, including Botswana, Ethiopia, Kenya, Namibia, Rwanda, Zambia and Zimbabwe, AIDS-related mortality declined by more than 50 per cent between 2005 and 2011.

As a result, fewer children are being orphaned because of AIDS. Despite this, a disconcertingly large number of children in the region - estimated at 10.5 million in 2011 - had lost one or both parents to AIDS, and needed care and support. 

The strain AIDS causes on extended families, communities, and children themselves is enormous and well documented. Research from South Africa shows that children orphaned by AIDS and those living with a parent with AIDS, face greater risks of emotional and physical abuse and sexual exploitation than other children.[1] Many HIV affected children face huge challenges, including loss of parents, deepening poverty and economic vulnerability, reduced access to health services and education, and discrimination.

With millions of children made vulnerable by the epidemic, care and support to help them survive and be protected from abuse and exploitation are nowhere near adequate. Where data is available, the percentage of children receiving external support remains low: only in Swaziland (41 per cent) and Botswana (31 per cent) significant numbers of vulnerable and orphaned children are being reached. In most other countries in the region, around 20 per cent or less (7 per cent in Tanzania) of these children receive some sort of external support. 

UNICEF in action

In Eastern and Southern Africa, UNICEF’s programming in the protection of children affected by AIDS has two key programme priorities:

  • ensuring 50 per cent of the poorest households receive external economic support; and

  • ensuring priority countries have HIV-sensitive social protection and child protection systems and policies in place.

© UNICEF/NYHQ2006-0424/Pirozzi
A grandmother watches her grandchildren play in front of their house in Zimbabwe. The children are orphaned by AIDS and they are now under their grandmother's care.

Social protection, care and support works at all levels, from local and community to national, and from improving health, maintaining continuity in education, preventing marginalization, to reinforcing and supporting families in the face of poverty and illness. Over the past 10 years, social safety nets that are inclusive of vulnerable households affected by HIV have been expanded significantly in ESA, such as cash transfers. There has also been an increased focus on strengthening social services workforce at the lowest levels, to improve the capacity of care workers and social workers to identify and support children made vulnerable by HIV and AIDS.

UNICEF’s work in providing care and support to children affected by HIV and AIDS not only includes mitigating the impact of the epidemic on households, but also seeking to increase children’s and adults’ access to HIV prevention, treatment and care programmes. Central to achieving results is a thorough understanding of social determinants of HIV risk and vulnerability, such as poverty, inequality, social exclusion and gender norms. UNICEF also puts a strong focus on integrating HIV work in other areas, such as health, nutrition, water and sanitation, education, child protection, social protection, and emergencies. In addition, increased attention has been given to promote innovative technologies and approaches to empower children to be active participants in shaping HIV programming.

Results for children

Between 2000 and 2011, the number of cash transfer programmes, which have shown to have positive impact on families affected by HIV and AIDS, increased nearly tenfold throughout sub-Saharan Africa.

  • South Africa’s social protection programme is one of the most advanced and wide reaching for a middle-income country, helping to reduce income inequality among the poor, elderly and disabled. One of its best-targeted grants, the Child Support Grant has expanded more than tenfold since 2000, and in 2011, 10 million children benefitted from it. 

  • In Lesotho, the Child Cash Grant, initiated by UNICEF with funding provided by the European Union, was recently incorporated into the country’s larger social protection agenda. Since 2009, the number of children reached under the Grant has expanded from 5000 to almost 50,000, with many of them from child-headed households or living with elderly grandparents.

  • In Mozambique, nearly half a million people, 60 per cent of them children, benefitted from social protection programmes in 2011. Advocacy by UNICEF, the World Bank and the IMF led to the government allocating US$32 million to social protection programmes.

1]  Cluver, L. Orkin, M. et al (2011) Transactional sex amongst AIDS orphaned and AIDS affected adolescents predicted by abuse and extreme poverty, Journal of Acquired Immune Deficiency Syndromes.



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