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A framework for the protection, care and support of orphans and vulnerable children living in a world with HIV and AIDS

May 2004

Posted with permission of the Pretoria office of Save the Children (UK)
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Executive summary

The HIV/AIDS epidemic is a massive and rapidly mounting disaster for children. Almost 3 million children are infected with the HIV virus or living with AIDS. More than 14 million children under the age of 15 have lost one or both parents to AIDS, the vast majority of them in sub-Saharan Africa.

By 2010, the number of children orphaned by AIDS globally is expected to exceed 25 million. But that is just a fraction of the number of children whose lives will have been radically altered by the impact of HIV/AIDS on their families, communities, schools, health care and welfare systems and local and national economies. With rates of HIV infection on the rise in many regions of the world, this crisis for children will persist for decades, even as prevention and treatment programmes are expanded.

The reaction of families and communities to the plight of these children has been compassionate and remarkably resilient. However, they are struggling under the strain. To date, few resources are reaching families and communities who are providing this front-line response, and little attention is given to orphans and vulnerable children in most national development agendas. Moreover, donors have yet to put forth comprehensive programmes on this issue. Responding to the crisis of children affected by HIV/AIDS is clearly not yet seen as a global priority.

This framework, which was drawn up in collaboration with development practitioners and representatives from a broad array of governmental agencies, faith-based and non-governmental organizations, academic institutions, the private sector and civil society, presents a unique opportunity for collective action. No single government or agency can effectively respond to the myriad of problems created by the epidemic. But by working together in a creative, coordinated way – with a common agenda – we can take an enormous step in the right direction.

The framework is based on lessons learned over many years. It considers families and communities as the foundation of an effective, scaled-up response. Children, too, can be powerful agents of change, a role that enhances their confidence and self-esteem as they become partners in the fight against HIV/AIDS. In addition, the framework recommends that interventions that result from it be directed to all vulnerable children and the communities in which they reside, and integrated into other programmes to promote child welfare and reduce poverty. Targeting children living with HIV or AIDS or orphaned as a result of it will only serve to exacerbate the stigma and discrimination against them. The framework’s key strategies are as follows:

  1. Strengthen 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;
  2. Mobilize and support community-based responses;
  3. Ensure access for orphans and vulnerable children to essential services, including education, health care, birth registration and others;
  4. Ensure that governments protect the most vulnerable children through improved policy and legislation and by channelling resources to families and communities;
  5. Raise awareness at all levels through advocacy and social mobilization to create a supportive environment for children and families affected by HIV/AIDS.
The specific mix of activities to be implemented within countries will depend on local needs, capacities and priorities. However, there is a growing consensus that education is pivotal in improving the lives and future prospects of orphans and those made vulnerable by HIV/AIDS. Access to essential services also includes equitable access for children, parents and carers' to life prolonging therapy with ARVs.

The framework concludes by defining key actions that must be taken urgently, including the prioritization of support for orphans, vulnerable children and their families in the national policies, actions and plans of affected countries. It asks all governments to assess their resource commitments to launch and sustain an adequate response over the decades that the crisis will be with us.

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