Global overview of the situation of children affected by HIVAIDS

1
Global overview of the situation of children
affected by HIV/AIDS
Day 1 November 3, 2003

• Orphans and vulnerable children technical
  consultation
• Washington, November 3-5, 2003
• Roeland Monasch

2
Outline

• I - Characteristics of orphans
• II - Changing caring practices -gt extended
  family
• III - Impact of orphaning on children
• IV - Needs response

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Age of orphans Proportion of orphans in different
age groups
Source UNICEF-MICS, Measure DHS, 1997-2002
4
Where are the orphans Distribution of orphans by
urban/rural areas
CAR
Ethiopia
Liberia
Guinea Bissau
Zambia
Uganda
Malawi
more orphans in rural areas
more orphans in urban areas
Kenya
Ghana
Equatorial Guinea
Zimbabwe
Namibia
60
40
20
0
20
40
60
5
Over 90 per cent of orphaned children with
extended family Relationship of double orphans
single orphans not living with surviving parent
to the head of household
Source Measure DHS, UNICEF-MICS, 1997-2000
6
II - Changing caring practices Families
increasingly under pressure

• Poverty
• Stigma discrimination - isolation
• (Potential) care takers of orphans are dying of
  HIV/AIDS
• Changing caring patterns
• Grand parent headed households
• Female-headed households
• Youth and child-headed households
• Seperation of siblings

7
Increasing role of grandparents Relationship of
double orphans single orphans not living with
surviving parent with head of household they live
in, Namibia 1992 2000
1992
2000
8
The burden falls on female-headed households of
children who lost their mother living in a
female-headed household, 1993-2000
Percent ()
Source UNICEF MICS Measure DHS, 1992-2000
9
Female-headed households take in more orphans
than male-headed households Average number of
double orphans cared for by female- and
male-headed households
Gambia
Cote dIvoire
C.A.R.
C.A.R.
Uganda
Guinea Bissau
Uganda
Zimbabwe
Malawi
Chad
South Africa
Source UNICEF-MICS, Measure DHS, 1997-2002
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Orphans are likely to be separated from their
siblings Four districts in Zambia, 2001
Frequency separated siblings see each other
of orphan households where not all siblings are
living together
Source OVC Head of Household Survey, USAID,
SCOPE-OVC, FHI, 2002
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III - Impact of orphaning on children

• Nutrition
• Education
• Psycho-social impact
• Exploitation and abuse
• Street children

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Orphans are less likely to be in school
Source MICS/UNICEF DHS, 1997 - 2001
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Psychosocial impact Orphans are less optimistic
about their future Psychological effect of
orphanhood, Rakai - Uganda
Source The psychological effect of orphanhood a
study of orphans in Rakai district. James
Sengendo and Janet Nambi. Health Transition
Review, Supplement to Volume 7, 1997, 105-124
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Orphans more likely to be exploited. Child
domestic workers in Addis Ababa, Ethiopia - 2002
Source Ethiopia, Child Domestic Workers in Addis
Ababa a Rapid Assessment. Abiy Kifle .July 2002,
Geneva
15
Majority of street children are orphans Most
children living on the street in Lusaka, Zambia,
are orphans, 2001
Source Rapid Assessment of Street Children in
Lusaka, Concern/UNICEF, March 2002.
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IV - Needs Response

• International commitments are made
• but Government response inadequate
• Many households do not get any support
• Families and communities at forefront
• We have examples of response that work

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United Nations GA Special Session on AIDS
Declaration of Commitment The Goal

• 65. By 2003, develop and by 2005 implement
  national policies and strategies to build and
  strengthen governmental, family and community
  capacities to provide a supportive environment
  for orphans and girls and boys infected and
  affected by HIV/AIDS including by providing
• appropriate counselling and psycho-social
  support
• ensuring their enrolment in school and
• access to shelter,
• good nutrition, health and social services on an
  equal basis with other children
• to protect orphans and vulnerable children from
  all forms of abuse, violence, exploitation,
  discrimination, trafficking and loss of
  inheritance

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Most immediate need households with orphans
cannot meet
Bobo-Dioulasso, Burkina Faso
Mwanza Region, Tanzania
Source Whitehouse, A. A situation analysis of
orphans and other vulnerable children in Mwanza
Region, Tanzania, Dar-es-Salaam, Catholic Relief
Services Tanzania and Kivulini Womens Rights
Organisation, Mwanza, 2002 Needs Assessment of
Orphans and Vulnerable Children in AIDS affected
areas, in Bobo-Dioulasso, Burkina Faso. Axios,
2001.
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Inadequate response by national governments 46
sub-Saharan countries
Percent ()
20/46
17/46
4/21
6/46
Source UNICEF Regional offices and 2003 National
reports on the follow-up to the Declaration of
Commitment made at UN General Assembly Special
Session on AIDS, 2001
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Majority of households with orphans get no
support Proportion of OVC households that
received support in last 6 months, 4 Districts,
Zambia, 2001
Received support
Type of support received
Fin. assistance for education
Fin. assistance for medical care
support 33
No support 66
Clothing
Fin. assistance for food
Direct food assistance
Counseling
0
5
10
15
20
25
Source OVC Head of Household Survey, USAID,
SCOPE-OVC, FHI, 2002
21
Community at forefront of caring for vulnerable
households Providers of support to OVC households
who received assistance, 4 Districts, Zambia,
2001
Financial assistance for food
Emotional support/counselling
Friends
19
Church
Friends
7
26
Church
43
Relatives
15
Relatives
Neighbours
Health
74
Care Unit
12
5
Source OVC Head of Household Survey, USAID,
SCOPE-OVC, FHI, 2002
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We know what works

• EXAMPLES
• Free education
• School feeding programmes
• Succession planning

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Disadvantage disappears under a universal primary
education policy Percentage of children
attending school (orphans / non-orphans), Uganda,
1995-2000
attending school
Source Measure DHS 1995 2000
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School feeding programmes keep vulnerable
children in school Proportion of children from
households with serious food deficits dropping
out of school, related to receipt of school
feeding during preceding school year, Zimbabwe,
2003
of households with at least one child dropping
out of primary school
Source Zimbabwe Emergency Food Security and
Vulnerability Assessment - April 2003, ZIMBABWE
Vulnerability Assessment Committee, SADC
FANR Vulnerability
25
Succession planning works Results from a
succession planning programme reaching
HIV-positive parents, Luwero and Tororo districts
of Uganda, 2001
Percentage ()
Source Succession Planning in Uganda Early
Outreach for AIDS-Affected Children and Their
Families, Horizons, 2003.
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Conclusion

• Extended family will continue to be the central
  social welfare mechanism
• Different countries -gt Different contexts -gt
  Different responses
• Disproportional burden on female-headed,elderly
  and poor households
• Orphans are disadvantaged (health, education,
  discrimination, etc.)
• Response is inadequate - but interventions work

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Thank you
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Orphans at risk of property dispossession who
experienced property grabbing, Uganda, 1999
Source Making a Difference for Children Affected
by AIDSBaseline Findings from Operations
Research in Uganda. Laelia Zoe Gilborn, Rebecca
Nyonyintono, Robert Kabumbuli, Gabriel
Jagwe-Wadda. June 2001
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Majority of children in prostitution are
orphans Lusaka, Chirundu and Kapiri Mposhi,
Zambia, 1999
Source Child Labour Survey, Country Report,
Zambia, 1999, CSO/Zambia, ILO