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Caring for children and families affected by HIV in concentrated and low level epidemics

© UNICEF/Shirley Mark Prabhu
Anupama Rao Singh listens to discussions at ICAAP session.

BALI, 14 August, 2009 — At the Ninth International Congress on HIV and AIDS in Asia and the Pacific (ICAAP) Bali, Indonesia, a symposium on the topic of ‘Caring for Children and Families Affected by HIV in Concentrated and Low Level Epidemics’ was held. Ms Anupama Rao Singh, the Regional Director of UNICEF East Asia Pacific Regional Office talks about its impact in the region.

How are children in Asia and the Pacific being affected by HIV and AIDS? How serious is the situation?

There are at least 151,000 children under the age of fourteen living with the HIV virus in the region. In terms of absolute numbers or as a proportion of the population, this is by no means as bad as the situation in the most severely affected regions of the world, such as sub-Saharan Africa.

However, it is extremely disturbing that this number is making up an increasingly large proportion of the total number of infections. This is because patterns of HIV infection are changing, and an increasingly large number of women not traditionally considered to be members of high risk groups are becoming infected. Many women are infected because their partners engage in high risk practices. These partners may be the clients of sex workers, they may be having sex with men, or they may be injecting drug users. With the increasing number of infections among women, very young children are also making up an increasingly large proportion of new infections.

The issue of HIV and AIDS must be seen in the larger context of promoting the welfare of children and young people. Rather than developing HIV and AIDS specific strategies, governments, development agencies and civil society must work together to develop and implement HIV and AIDS sensitive strategies.

Amongst other strategies, this will involve strengthening the capacity of families to protect and care for orphans and vulnerable children by prolonging the lives of parents and providing economic, psychosocial and other support. It will involve ensuring access for orphans and vulnerable children to essential services, including education, health care, birth registration and others services. It will involve ensuring that governments protect the most vulnerable children through improved policy and legislation and by channeling resources to families and communities. Finally, it will involve raising awareness at all levels through advocacy and social mobilization to create a supportive environment for children and families affected by HIV/AIDS.

How well are governments in the region doing?

There has been much positive progress. Across the region, governments and communities are taking positive steps to address the needs of children affected by HIV. Many countries have developed legislation to protect and care for children living with HIV and AIDS.

As a delegate at the Ninth International Congress on HIV/AIDS in Asia and the Pacific (ICAAP) held here in Bali, Indonesia, I am pleased to note the political commitment of the Indonesian government on the issue. I was impressed with the support for the Congress provided by President Susilo Bambang Yudhyono, who opened the Congress. I am also happy to note the efforts of the Indonesian National AIDS Commission to strengthen social protection and support of orphans and young children and young people. One particularly impressive initiative is the extension of the implementation of life skills education through the education system in the province of Papua. This is a promising example of a program that empowers communities in the management of HIV.


© UNICEF/2008/Estey
Children in Indonesia's Papua learn about HIV and AIDS at school.

What is the main means of transmission of the HIV virus to young children?

A very small proportion of young children are infected because of blood transfusions and through surgical procedures. The vast majority of HIV infections in children are vertically transmitted from mothers to their children. This could be averted by the implementation of the appropriate medical protocols. In particular, these infections could be implemented by universal HIV testing of pregnant women, followed up by the provision of ART prophylaxis to infected mothers. At present, it is estimated that only 28 per cent of all infants in the region born to infected mothers are receiving ART prophylaxis.

What are the main impacts of HIV on children living with and infected by HIV?

It is important to realize that the two groups are not identical. In addition to the growing number of young children actually living with HIV, a hugely greater number are affected by it. This includes a very large number of children orphaned by AIDS. It is estimated that there are more than 1.3 million children in South Asia who have lost one or more parents to AIDS and 450,000 in East Asia and the Pacific.

Even when they are not infected with HIV themselves, those who have lost one or more parents to AIDS are highly vulnerable to ill health, malnutrition, psycosocial suffering, delayed cognitive development, anxiety and depression, abandonment and abuse. One of the most serious impacts is that orphaned children are much less likely to attend school than other children. Thus, the long term impact on human development can be devastating.

Are the issues affecting those orphaned by AIDS different from those facing orphans generally?

There are some specific issues facing those orphaned by AIDS. For example, children may be bearing the double burden of having lost one or both parents to AIDS and of living with HIV themselves. There are particular and specific issues related to the provision of ART and other medical treatments to orphaned children. In addition, many of these children are subject to multiple vulnerablities compounded by the fact that their parents may be sex workers, injecting drug users or members of other high risk groups. In and of itself, this may make them more subject to stigmatization and discrimination.

At the same time, it is true that those orphaned because of AIDS make up a very small proportion of all orphans in the region. It is estimated that in total, there are 67.5 million orphans due to all causes in Asia Pacific. A large proportion of these children are also in need of special care and protection. Given the low-level and concentrated nature of the HIV pandemic in the Asia Pacific region, the best response to address social protection measures for children affected by HIV is to engage in integrated programmes to promote overall child welfare and reduce poverty. Rather than treating children with HIV or affected by HIV as a distinctly different category of children at risk, measures to address the specific issues affecting them should be mainstreamed into larger child welfare and poverty reduction programs.



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