A new agenda for children affected by HIV/AIDS

[Guest guest]

A new agenda for children affected by HIV/AIDS

The Lancet Editorial. The Lancet, Volume 373, Issue 9663, Page 517,

14 February 2009

[A copy of the report, " Home Truths: Facing the Facts on Children,

AIDS, and Poverty. The Joint Learning Initiative on Children and

HIV/AIDS (JLIC) 2009 " is available from the following url

http://www.jlica.org/protected/pdf-feb09/Final%20JLICA%20Report-

final.pdf]

As is so often the case in the provision of health care and deciding

research agendas, children have been sidelined in the fight against

HIV/AIDS. According to the latest UNAIDS figures, nearly 2 million

children live with HIV worldwide, two-thirds in sub-Saharan Africa.

In addition, 12 million children in sub-Saharan Africa have lost one

or two parents due to HIV/AIDS. Many more live with a parent or carer

with HIV. A very small proportion of infected children receive

antiretroviral treatment, and prevention of mother-to-child

transmission is only given to a third of women.

Diagnosis in infancy is difficult and therefore often delayed. Child-

friendly medication is lacking. 60% of children in southern Africa

live in poverty. Now that HIV/AIDS is evolving from an acute

emergency into a chronic epidemic, the way to deliver treatment and

achieve prevention needs to change radically from an individualistic

approach to a broader strategic one. Children and families need to

take centre stage.

In an excellent report, based on 2 years of research and analyses,

the Joint Learning Initiative on Children and HIV/AIDS—an independent

alliance of researchers, implementers, activists, policy makers, and

people living with HIV—has presented recommendations for such a

change in direction. Home Truths: Facing the Facts on Children, AIDS,

and Poverty, released on Feb 10, points out three broad policies that

will make an immediate and longlasting difference to children:

support children through immediate or extended families and deliver

integrated family-centred services; strengthen community action to

support families; and address family poverty through national social

protection. Such policies are AIDS-sensitive but not AIDS-directed.

The family is the most important support structure for children. The

report argues that the way orphans have been defined (as having lost

one or both parents) and have become the centre of attention for many

HIV/AIDS policies has been unhelpful, if not damaging. 88% of

children labelled as orphans have a surviving parent and overall 95%

continue to live with extended families. Additionally, children who

live with HIV-positive parents have needs long before their parents

die. Children need to stay within a family or kinship structure.

Infected children usually live with others who are infected with the

virus. The whole family, not the individual, needs to become the unit

for support and treatment. The report advocates home health visiting

and early childhood development interventions together with

strategies to encourage children's education. The use of schools as

intervention platforms misses the opportunity to reach children early

and to reach those who are not in education—the majority in some

countries. Economic strengthening of families has to be the basis to

allow many of these programmes to fully succeed.

The best immediate support for families is given by community groups.

International donors need to work with these groups in partnership to

avoid duplication, confusion, and waste of time and money. The

authors suggest that coordination could be strengthened with a

district committee that maintains an active register of community

activities and devises a system of accountability that is understood

by all and serves the community. All activities should be delivered

within a framework that is based on best practice. Communities also

have a crucial role to act as a backstop when families break down or

when children live in an abusive environment.

Family poverty and undernutrition can be addressed through income-

transfer programmes, such as Mexico's Oportunidades programme or

South Africa's child support grants. These projects are efficient and

simple, empower women, and can act as a springboard for other more

complex schemes, such as microfinance loans. Such economic support

increases school attendance, reduces illnesses, improves growth, and

encourages uptake of health services. The largest portion of money is

usually used to purchase food.

Extreme poverty, rather than HIV infection, should be used as a

criterion to avoid stigma and resentment. The report argues that " any

developing country, no matter how poor, can afford social protection

packages for children " . The positive effect of this policy is now

established beyond doubt and no further pilot studies are needed.

To integrate all these strategies, governments need to take the lead

with national plans and frameworks to scale-up programmes for

children and families. With this approach, society as a whole will be

strengthened with intergenerational effects that will go a long way

towards, but also go well beyond, tackling the effects of HIV/AIDS.

Putting children and families at the centre will show long-term

vision with guaranteed future benefits.

http://www.thelancet.com/journals/lancet/article/PIIS0140673609601744/

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