Ovc india fhi allianceppt

Working with Children Affected by AIDS : Experience and Lessons

Presentation at the

USAID/FHI Implementing Partners’ Workshop

on OVC and HIV/AIDS

Dr. Balwant Singh

India HIV/AIDS Alliance

17th February 2004

Working with Children Affected by HIV/AIDS

2

• Worked with NGO/CBO partners in over 40

developing countries of Africa, Latin America, Asia

and Eastern Europe since inception in 1993.

• Supported over 1000 NGOs and community groups to implement over 1500 prevention, care and impact-mitigation projects.

• An international development NGO focused specifically on HIV/AIDS, and serves as a Collaborating Centre of the Joint United Nations AIDS Programme (UNAIDS).

International HIV/AIDS Alliance

Working with Children Affected by HIV/AIDS

3

India HIV/AIDS AllianceStrategic Goals

• To improve coverage of effective community focused

AIDS efforts in India

• To strengthen leadership and capacity of civil society

to respond to AIDS in India

• To improve institutional, organisational and policy

environment for community AIDS responses in India

Working with Children Affected by HIV/AIDS

4

India HIV/AIDS Alliance

• Supporting HIV/AIDS programmes in India since 1997

• Established as Country Office of the International HIV/AIDS Alliance in 1999

• Implementing integrated and comprehensive HIV/AIDS programmes:– mobilising communities in the provision of focussed prevention with key

populations

– home and community based care and support for People living with HIV/AIDS, families and children affected by AIDS

Working with Children Affected by HIV/AIDS

5

Home & Community BasedCare and Support Programmes

• Supporting 40 NGOs in Tamil Nadu, Andhra Pradesh

& Delhi since 2001.

• Reaches 150 communities in 13 Districts in TN; 5

coastal districts in AP; and, urban and sub-urban

areas in Delhi.

• Reaches more than 5800 PLHA, approx. 8500

children affected by AIDS (CAA) and approx. 9000

family members affected by AIDS.

Working with Children Affected by HIV/AIDS

6

• Psycho-social support to PLHA, and Children & Psycho-social support to PLHA, and Children & Families affected by AIDSFamilies affected by AIDS

• Home visits & “hands-on care” programme for PLHA, Home visits & “hands-on care” programme for PLHA,

CAA & Families affected by AIDSCAA & Families affected by AIDS

• Livelihood supportLivelihood support

• Nutritional education & supportNutritional education & support

• Educational & other support for CAA & OVCEducational & other support for CAA & OVC

• Medical careMedical care

• Emergency supportEmergency support

Support Services Provided

Working with Children Affected by HIV/AIDS

7

Programme Strategies

• Addressing issues relevant to CAA & other vulnerable

children through ‘home & community based model’

• Ensuring involvement of children at all levels -

participatory community assessment, participatory

community review and programme design

• Child-centred programming – direct involvement

• Strong referrals and service linkages for improving

access to services & addressing stigma and

discrimination

Working with Children Affected by HIV/AIDS

8

Participatory Community Review with Children

Working with Children Affected by HIV/AIDS

9

Programme Innovations• Programming:

– Strategic planning and participatory community assessments and reviews with children

– Lead Partner model for technical support, capacity building, monitoring and scale up

– Integrated programmes reaching out to PLHA, CAA & affected families, and addressing prevention, care and impact mitigation on the HIV/AIDS continuum

• Integration:

– Engaging community development NGOs

– Involving youth groups/National Service Scheme volunteers in care and support in AP

– Involving Self-Help Groups of women for supporting children

Working with Children Affected by HIV/AIDS

10

A Family Tree Drawn bya PLHA parent and child

Source: VMM/World Bank Study on CAA in AP, 2003

Working with Children Affected by HIV/AIDS

11

Programme Innovations (cont’d)

• Community Models:

– Community fostering - coastal Andhra Pradesh & Tamil

Nadu

– Community resource mobilisation – Tamil Nadu & Andhra

Pradesh

– Children’s support groups - AP

– Child-centred counselling - Delhi

• Policy and advocacy work with the Education Department and

media on CAA issues - AP

Working with Children Affected by HIV/AIDS

12

Issues and Challenges

• Child-centred approaches and programming: NGO capacity

• Institutional Care vs Community Care• Predominance of emphasis on prevention• Psychosocial support needs of children• VCT for Children: Informed Consent, especially for

children orphaned by AIDS & street children• Confidentiality: Status of children• ART & Children- Access, affordability, community

preparedness & technical capacity• Education: Sex, sexuality & sexual health

Working with Children Affected by HIV/AIDS

13

Voices of Children*

• "My father, mother and my brother require medicines. The school is far from the house. Moreover when there is work, my parents send me to the work. I like studying, but now I am used to the work and I am not preferring to continue studies.”

• "We clear the debts of the family by working on daily wage basis. Though we are interested in studying it is not possible, as we have to work and earn.“

* PCA done in Coastal AP by NGOs in Coastal AP

Working with Children Affected by HIV/AIDS

14

Voices of Children* (cont’d)

• “ We do not have food to eat or money to get medicines for my sick mother”

• “I do not want to join in the hostel. I want to live only with my parents”

• “My mother wants me to go to school regularly. You are providing us school fees. Why do you not (sensitise) my friends and teachers?”

* PCA done in Coastal AP by NGOs in Coastal AP

Working with Children Affected by HIV/AIDS

15

CAA/OVC study in AP*:Key Findings

• 37% of the 1,977 CAA interviewed had lost

both parents; 18% had lost their mother; and,

18% their father

• CAA who are not orphans - 59% both parents +ve

• 15% dropped out of school & 11% started

working to support their family

* Study conducted by Vasavya Mahila Mandali on the Care and support projects in Coastal AP, on behalf of World Bank in 2003.

Working with Children Affected by HIV/AIDS

16

Lessons

• An integrated approach helps to respond to diverse care and support needs of PLHA, children & affected families in locally appropriate & cost effective ways

• Capacity building of NGO staff & volunteers is important to have ethically appropriate & value-based interventions for care and support especially of children affected by AIDS

• Mainstreaming care and support needs of PLHA, CAA & families helps to overcome prevailing stigma & discrimination

Working with Children Affected by HIV/AIDS

17

Lessons (cont’d)

• Important to differentiate and address the specific needs of CAA

from those of adults with HIV/AIDS or affected by AIDS

• Children require psychological, social & emotional support in

addition to having their basic needs met - such support is most

effective when provided in environments they are familiar with

and where their relatives and friends live

• Children too can and should participate, and take decisions on

matters affecting their lives!

• Involvement of PLHA & Children affected by AIDS is essential

for successful interventions and programmes

Working with Children Affected by HIV/AIDS

18

Working with OVC/Children:Key Principles & Values

• Respect and protect confidentiality• Children have their ‘likes’ & ‘dislikes’ and so need to be

understood• Equal treatment and non-discrimination• Children have their own curiosities and aspirations, and need

inspiration & guidance• Children’s self-esteem is very important and fragile – they need

care & nurturing• Children have emotional needs which need to be understood

and met• Children have rights and these need to be upheld

Working with Children Affected by HIV/AIDS

19

India HIV/AIDS AllianceOVC Priorities for 2004 & beyond

• Develop & strengthen child-centred programme framework incorporating rights-based approaches and participatory methodologies

• Skills building for our Lead Partners and implementing NGOs – Child rights & rights-based approaches– Child-centred programming– Participatory methodologies for involving children– Psychosocial support for CAA and other vulnerable children

• Child-centred policy review with our Lead Partner in Delhi• Fostering integration and community ownership• Promote sustainability by further enhancing linkages with

Government and other service providers

Working with Children Affected by HIV/AIDS

20

Next Steps

• Establish an OVC/Children & HIV/AIDS Forum as an outcome of this workshop– Promote children’s involvement as central element– Agree agenda and priorities with children– Monitor progress with children

• Identify & document good practice in OVC work and disseminate widely through networks of NGOs, CBOs & community groups

• Foster collaboration amongst NGOs/CBOs working on HIV/AIDS and those working with children and on children’s issues

• Promote children’s involvement in all OVC programmes e.g. assessment, planning, review, peer education, volunteering, etc.