As of 2016, an estimated 16.5 million [range: 13.9 – 19.2 million] children worldwide had lost one or both parents to AIDS. More than 80 per cent of these children (13.8 million) live in sub-Saharan Africa. Many millions more were orphaned for other reasons.
Schools can be an important source of protection and stability for vulnerable children, and many countries in sub-Saharan Africa have made impressive strides towards parity in school attendance among orphans and non-orphans. A growing number of countries, in Africa and elsewhere, are also drawing up national action plans in support of orphans and other children at risk, embracing a wide definition of ‘vulnerability’.
RISKS FACED BY ORPHANS AND OTHER VULNERABLE CHILDREN
Orphans and children considered vulnerable for other reasons, including HIV and AIDS, are at higher risk of missing out on schooling, living in households with less food security, and suffering from anxiety and depression. They are also in greater danger of exposure to HIV. Their experiences differ across families, communities and countries, and are influenced by a complex mix of variables, including children’s relationships to their caregivers, the wealth of their household and community, HIV prevalence in the area and many other factors. To care properly for orphans and vulnerable children, a minimum package of support is needed and includes access to services such as education, health care, social welfare and protection. However, without laws, policies and services that assist families and communities in caring for children at risk, such support tends to remain low.
Developing routine monitoring indicators and tools for collecting data on orphans and vulnerable children is difficult since a standard definition of ‘vulnerability’ has not been established and a minimum package of services has yet to be determined. In addition, poor coordination of services means there is the strong possibility that children will receive multiple services and be counted more than once, skewing the data used to inform programmes. Greater attention needs to be given to defining optimum services and beneficiaries as well as strengthening coordination and reporting on the services provided to orphans and vulnerable children.
PROGRESS: ATTENDANCE IN SCHOOL
Schools continue to be a strong source of protection and support for all children, including vulnerable children and children affected by HIV and AIDS. Schools often serve as entry points for children in need of health services and meals, for instance. Moreover, the routine of schooling can help children affected by HIV and AIDS cope with their situation and regain a sense of normalcy and stability. The protective nature of schooling is, however, dependent on safeguarding rights within education and providing safe and inclusive learning environments at a reasonable distance from children’s homes and with access to clean water and sanitation.
Children who have lost both parents have generally been less likely to attend school than children whose parents are both still alive. Thus, a key indicator of the situation of AIDS-affected children is the school attendance ratio of orphans. This ratio compares school attendance of children aged 10 to 14 who have lost both parents with those children whose parents are both still alive and who live with one or both parents. Most countries in sub-Saharan Africa have made significant progress towards parity in school attendance for orphans and non-orphans aged 10 to 14. Across all least developed countries, between 2010 and 2014, children who have lost both parents were 89 per cent as likely to attend school as their non-orphaned peers. Within sub-Saharan Africa, they nearly have reached parity and children who have lost both parents are 96 per cent as likely to attend schools as their non-orphaned peers (91 per cent in Eastern and Southern Africa and 101 per cent in West and Central Africa).
PROGRESS: NATIONAL-LEVEL RESPONSES
The shift towards inclusive programming to help all vulnerable children, including those directly affected by AIDS, is making an impact. The growing call for a broader, more inclusive definition of vulnerability is reflected in many national action plans. In Zimbabwe, for instance, the National Plan of Action for Orphans and Other Vulnerable Children embraces a broad definition of vulnerability that extends beyond orphanhood and the impact of HIV and AIDS.
Many countries have developed or finalized national plans of action with benefits for orphans, vulnerable children and other children affected by HIV and AIDS. Countries in Eastern and Southern Africa have continued to make significant progress in this regard, followed by those in West and Central Africa. National-level responses to orphans and vulnerable children have increasingly become part of broader social welfare and assistance to vulnerable populations, including children, such as social protection programmes that are HIV-sensitive. In sub-Saharan Africa, social protection programmes have been scaled up significantly.
That said, the process of developing national action plans for orphans and other vulnerable children has been generally slow, and implementation at scale is lacking. The often-limited capacity of governments and implementing partners and lengthy periods for plan development – three to seven years or more – are major challenges. Insufficient resources for implementing national action plans are reflected in the levels of social assistance provided to vulnerable households. Efforts and investment should nonetheless be directed towards increasing access to basic services, ensuring appropriate alternative care, and providing social support and protection from abuse and neglect.
For more information on UNICEF’s programme and policy work on HIV and AIDS, click here.
Though progress has been made in preventing HIV infection in children, a UNICEF analysis of UNAIDS data suggests that without accelerated action, the 2020 super-fast-track targets for eliminating HIV transmission in children, reducing new infections in adolescent girls and young women, and for increasing HIV treatment in children and adolescents living with HIV will not be met.
Children are still dying of AIDS-related causes. Children living with HIV (aged 0–4) face the highest risk of AIDS-related death compared to all other age groups. The AIDS-response must focus on solutions for this extremely vulnerable population. Preventing new infections, but also testing and starting treatment early are the best ways to end AIDS among the youngest children. In an age when the tools and knowledge are at hand to prevent and treat HIV in children, new infections and deaths among this age group reflect a collective failure to prioritise children.
At the turn of the century, and the beginning of the Millennium Development Goals, an HIV diagnosis was equivalent to a death sentence for most children and their families in low-income countries. But now, an early diagnosis paired with treatment and care can ensure long healthy lives, regardless of location, and can help prevent transmission of HIV to others. Since 2000, 30 million new infections were prevented, nearly 8 million deaths averted, and 15 million people living with HIV are now receiving treatment.
Despite significant achievements in the global AIDS response throughout the past decade – declining new infections, decreased AIDS-related mortality, and the increased scale-up and availability of antiretroviral therapy – HIV and AIDS continue to have adverse impacts on the lives of children and families worldwide (UNAIDS 2012).
GLOBAL AIDS RESPONSE PROGRESS REPORTING/UNIVERSAL ACCESS
In an effort to harmonize data collection and minimize the reporting burden on countries, UNAIDS, WHO and UNICEF have developed a joint reporting tool. The tool, which has been translated into several UN languages, combines the Global AIDS Response Progress Reporting and Universal Access reporting on the health sector response to HIV/AIDS. Countries that have not yet begun using the tool are advised to download the latest version. Accompanying guidelines support countries in using the tool and provide detailed descriptions of the indicators used.
- For more information, click here.
- For Global AIDS Response Progress Reporting/Universal Access reporting guidelines, click here.
- To view the latest version of the reporting tool, click here.
- To view a list of indicators, click here.
SPECTRUM/EPP ESTIMATE MODELLING
UNAIDS, WHO and UNICEF are using Futures Institute’s modelling software, Spectrum/EPP, to generate estimates, which support policy decisions concerning public health. Spectrum includes modules for HIV estimates and projectors.
NATIONALLY REPRESENTATIVE SURVEYS
Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), AIDS Indicator Surveys (AIS), reproductive health surveys, sexual behaviour surveys and other nationally representative surveys are currently used to collect data on HIV and AIDS.