they will try to humiliate me calling me

“…they will try to humiliate me calling me son of AIDS. ” - 14 year old boy who lost both parents to AIDS and has a younger brother living with HIV, Mynamar

“The neighbours burnt out all the things that my parents had touched in prevention of AIDS when my parents died, and some children scolded me that my parents died of AIDS: I cried tears all night. ” - 13 year old orphan to AIDS in Yunnan, China

“My dad was severely diseased and my mom borrowed a lot of money to save him. Being unable to pay my tuition, I left school. ” - 13 year old boy in Xinjiang, China “We don’t have rice for today meals. Food is more important than schooling. ”

“If my mother dies I do not know where to live; now she is sick. I would ask the pagoda or an organization where to live; I do not want to live with my relatives because they are violent. ” - Child quoted in Cambodia report

“I clean bottles and sell them to pay for my tuition, however hard I work I could not approach the sum demanded and my teacher let me stand in the classroom being laughed at by my classmates. ” - 10 year old girl from Xinjiang, China

“When I was fourteen, both of my parents passed away from AIDS. My mother was a prostitute. When they died, the pimp family with whom we lived, drove me out. There, I met with “Mommy”. She gave me some encouraging words and took me to her house. When I turned to fifteen, Mommy asked me if I wanted to work. Afterward, I got into this business. ” - 18 year old sex worker from Thaton

“… The monk gives me encouragement and hope. ” - Taken from the research report for Cambodia

Quotations drawn from: SMALL ALSO HAVE SOMETHING TO SAY: Report on Research into the Effects of HIV/AIDS on Children in Six Asian Countries Save the Children, February 2006

“…they will try to humiliate me calling me son of AIDS. ” - 14 year old boy who lost both parents to AIDS and has a younger brother living with HIV, Mynamar

“The neighbours burnt out all the things that my parents had touched in prevention of AIDS when my parents died, and some children scolded me that my parents died of AIDS: I cried tears all night. ” - 13 year old orphan to AIDS in Yunnan, China

“My dad was severely diseased and my mom borrowed a lot of money to save him. Being unable to pay my tuition, I left school. ” - 13 year old boy in Xinjiang, China “We don’t have rice for today meals. Food is more important than schooling. ”

“If my mother dies I do not know where to live; now she is sick. I would ask the pagoda or an organization where to live; I do not want to live with my relatives because they are violent. ” - Child quoted in Cambodia report

“I clean bottles and sell them to pay for my tuition, however hard I work I could not approach the sum demanded and my teacher let me stand in the classroom being laughed at by my classmates. ” - 10 year old girl from Xinjiang, China

“When I was fourteen, both of my parents passed away from AIDS. My mother was a prostitute. When they died, the pimp family with whom we lived, drove me out. There, I met with “Mommy”. She gave me some encouraging words and took me to her house. When I turned to fifteen, Mommy asked me if I wanted to work. Afterward, I got into this business. ” - 18 year old sex worker from Thaton

“… The monk gives me encouragement and hope. ” - Taken from the research report for Cambodia

Quotations drawn from: SMALL ALSO HAVE SOMETHING TO SAY: Report on Research into the Effects of HIV/AIDS on Children in Six Asian Countries Save the Children, February 2006

Stigma, Discrimination, Violence, Exploitation and Abuse of Children Affected by HIV and AIDS: A Children’s Rights and Protection Perspective

The Convention on the Rights of the Child in a World with HIV and AIDS: Infringements and Opportunities Presentation to Session on Children’s Rights and Protection Perspective International AIDS Conference Toronto, 17 th August 2006 mjkelly@jesuits. org. zm

What HIV and AIDS do • They highlight existing problem areas • They magnify the scale and complexity of ongoing problems • They create new problems

CRC Basic Principles • Non-discrimination (art. 2): Every child must be enabled to enjoy her/his rights with full equality of opportunity • Best interests of the child (art. 3) must always be a primary consideration • The right to life, survival and development (art. 6): Every child has a right to life, survival and physical, mental, emotional, cognitive, social and cultural development. • The views of the child (art. 12): Children have the right to be heard and to have their views taken seriously

Articles 6 & 24: Right to Life and Health • Every child’s right to life and to the highest attainable standard of health • 570, 000 children under 15 died of AIDS in 2005 • PMTCT reaches < 10% of the mothers in need • HIV testing for infants & paediatric ARVs often unobtainable, unsuitable, very expensive • Children under 18 months not tested and not receiving life-saving cotrimoxazole • Children under-represented in numbers accessing ART

Article 12: Right to be Heard • Child’s right to express views and have due weight given to these • Children denied necessary grieving expressions and funeral participation • Orphans not involved in deciding their placement (or repatriation to village) • No mechanisms for listening to the voices of OVC and children from families where there is AIDS

Article 13: Right to Information • Right to freedom of expression, including the right to seek, receive and impart information and ideas of all kinds • What knowledge about cause of parental death? About personal HIV status? • Limited access to information on how to prevent HIV infection – reaching only 33% of young males and 20% of young females • Right to information often denied because of false concerns about protection of morals

Articles 18 & 26: Right to Social Security • States shall assist parents and guardians in the performance of their child-rearing responsibilities (18) • Child’s right to benefit from social security (26) • State failure to provide assistance to families and communities caring for vulnerable children • Absence of budgetary provision for orphan responses or social security

Article 28: Right to Education • Child’s right to education which, at the primary level, should be free and compulsory • The most marginalized children are the ones most likely not to access education: poor, girls, rural, from families where there is AIDS, orphans • Education costs still almost universal and a major barrier to exercise of this right

Article 31: Right to Happiness • Child’s right to rest, leisure, play – happiness • AIDS deprives many children of their childhood • It transforms them into adults before their time - juvenile adults who must care for the sick, generate income (including by selling sex), head households, assume responsibilities beyond their years

OVC Protection, Care and Support in a World with HIV/AIDS 1. Strengthen the capacity of families 2. Mobilize and support community-based responses 3. Ensure access for orphans and vulnerable children to essential services 4. Ensure that governments protect the most vulnerable children 5. Raise awareness at all levels through advocacy and social mobilization

Strengthen family capacity and mobilise & support community-based responses • The surest route for v. Protecting the best interests of child v. Ensuring the child’s life, survival and development v. Protecting the child’s right to parental or family environment v. Ensuring that children grow up in an atmosphere of happiness, love and understanding

Ensure Access to Essential Services • Thereby protect the child’s right to v. Birth registration and identity v. Health v. Education v. Social security

Ensure Government Protection of the Most Vulnerable Children • Administrative procedures, courts, legal instruments, all institutions respect the best interests of the child • Protection and assistance in absence of family environment • Protection from violence, abuse and trafficking • Protection from exploitation and harmful work

Raise Awareness through Advocacy and Social Mobilization • Foster understanding and improved knowledge of size, depth and universality of the challenge • Promote action by parliaments, civic institutions, faith-based groups, civil society, media • Promote child’s right to be heard, to information, to non-discrimination • Promote child’s right to happiness and a true, formative childhood

Priority Actions 1. Improve child protection services and systems 2. Develop a continuum of alternative care options 3. Provide social welfare assistance and services 4. Foster open discussion on issues of child protection 5. Strengthen the state’s social protection system

Thank you

Community Level Child Protection-Fulfilling the rights of a child in a world with HIV/AIDS: Practice and Interventions Presentation to Session on Children’s Rights and Protection Perspective International AIDS Conference Toronto, 17 th August 2006 Ms Boipelo L. Seitlhamo seitlhamob@yahoo. com bseitlhamo@info. bw

BACKGROUND • HIV & AIDS response in Botswana – Currently 330, 000 people are HIV positive out the 1. 7 million people. – 20% of children orphaned due to HIV/AIDS – 53, 000 orphans registered. – Government set up a multi sectoral strategy to combat the epidemic. – Creation of national, district and community level structures to coordinate the response and plan programs.

National OVC Program • Objectives: – Respond to the immediate needs of orphans i. e. food, clothing, education, shelter, counseling, protection of their basic rights. – Identify mechanisms for supporting community based responses to the orphan problem. – Develop a framework for guiding the long term program development for orphans. – Facilitate the review of important policies and laws that affect the welfare of orphans.

National Program Interventions • • National Orphan registration system. Access to education and health. Provision of social welfare services. Village, district and national child welfare structures. Home based care services. Free ARV program and PMTCT. Funding to orphan care program e. g. year 2005/06 $43 million and $1. 4 million to NGO’s for partnership building. • Additional funding from Development partners, UN agencies, PEPFAR, ACHAP, SIDA.

OVC CHALLENGES AT COMMUNITY LEVEL • Growing number of children who are abused, neglected, HIV positive and enrolled for ARV demanding skilled help. • Inadequate coordination of OVC referral activities leading to fragmented services delivery negatively affecting child rights. • Lack of knowledge regarding policies and procedures for child care intervention compromising quality of service for OVCs. • Insufficient community based institutional infrastructures for scaling up OVC response. • Inadequate competence to develop sustainability plan creating dependency syndrome on external financial assistance. Disrupting continuity of care.

MARANG CHILD CARE NETWORK TRUST “THE PRACTICE” Objectives – To provide guidance, coordination and support to all members. – To promote advocacy in support of OVC policies to strengthen delivery of services. – To provide technical input to ensure effective integration of child rights base interventions. – To form linkages with Government, regional and international bodies working with OVC.

Marang’s Core Interventions The strategy is to mobilise and build the capacity of community based organisations for child rights based response. Interventions: • Advocacy • Networking • Community mobilisation • Governance • Child Day care • Partnership with Government

Interventions Cont…. . • Advocacy – Child Policy education and awareness workshops. – Child participation; skills, knowledge and techniques. – Funding and sustainability in the best interest of the child. • Networking – – How to communicate with stakeholders? Available services and programs (directory). Information sharing on programs. Mentoring to avoid duplication, competition and conflict.

Interventions cont… • Community Mobilisation – – Identify relevant stakeholders and their roles. Raising awareness of child rights and needs. Establish a referral system for quality care. Enhances continuity of care services. • Governance – Program management and coordination of child services. – Ensure that alternative care services are well understood. – Role of the board and committees. – Reporting program and financial. – Monitoring and Evaluation for quality assurance.

Interventions cont… • Child Day Care – – – Pre- schooling. Child counseling. Parenting skills. After school support to older children. Support groups for caregivers. Feeding and nutrition. – Pediatric ARV management.

Interventions cont…. • Partnership with Government – Involvement of Government in governance structures. – Trust, openness and dialogue. – Facilitate policy and law reform. – Increase visibility of NGO/CBO/FBO contribution at all levels. – Enhances complimentarity of services. – Consensus on standardization and quality control.

PRIORITY ACTIONS 1. 2. 3. 4. 5. Educate and empower organisations to work effectively with government. Ensure organised technical and financial support for implementing alternatives forms of care. Strengthen existing mechanisms for identifying and reporting child abuses and ensuring quality control. Develop systems for participation and involvement of the child at policy, programming and service delivery. Ensure availability of Institutional care only where family care is detrimental to the right and welfare of the child.

THANK YOU PULA

The Protection and care of Children Affected by HIV and AIDS in Conflict settings: The Case of Northern Uganda By Timothy Ahimbisibwe National Advisor- HIV/AIDS, Save the Children in Uganda

Background • An estimated 20, 000 children have been abducted by the LRA since 1996 • Exposed to extreme violence, sexual abuse and very harsh living conditions • 1, 6 million people into camps, with abject living conditions • Districts in the north have prevalence rates are at approximately 9%

Background Cont … • The HIV/AIDS pandemic is a major root cause of childhood poverty. • 6. 4% of adults in Uganda are living with HIV/AIDS • fourth leading cause of death among children. • 1. 8 Million are orphans (14. 6% of children) • About 50% 0 f the orphans are a result of HIV related death.

Traditional Child Protection • High levels of personal and sexual security and protection prior to marriage • Women were active players in the transition from adolescence to womanhood • Premenstrual sex taboos/cultural sanctions if compromised • Family and personal consent to sexual debut/marriage

Understanding the devastation • This system collapsed with displacement families mixed in with other families • no infrastructures to facilitate learning • no land for cultivation • severe congestion • Minimal adult supervision of children who spend more time without parents. • Vulnerable to sexual exploitation at night

Our Experience Strengthening families • Promoted Livelihoods to take care of the increasing family needs. Parents use children as a coping mechanism “I cant share his house with you, go and look for your own” forcing the girl into child marriage • Home based care and counseling for children with HIV

Mobilizing the community • We work to strengthen active community based child protection systems. • Support community lead initiatives in hard to reach areas/ camps • We support reintegration of formerly abducted children. • Professional out reach systems for Children living with HIV. • Life skills education and promotion

Essential Services for OVCs • Working with health units to provide friendly and affordable treatment, and care services • Sufficient access to nutritious food • Support for Prevention from Mother to Child (PMTC) • Adolescent friendly sexual and reproductive health services • “Safe shelters” for night commuters • Recreational and intellectually empowering activities outside formal schooling e. g. recreational facilities, child lead clubs

Policy and Legislation • Enforce laws against defilement and child abuse to reduce HIV spread. • The Health sector budgets prioritize HIV/AIDS treatment for children. • Dissemination of the National OVC policy • Advocacy to increase funding allocated to strengthen the capacity of community service providers

Supportive Environment • We address HIV in the context of other protection issues e. g. Sexual abuse, GBV, education etc. • We work with the community to protect children living with HIV from prejudice and discrimination. • Peace building and reconciliation as a long term solution for many of the problems in the region.

Lessons Learnt • Understand that HIV is both a social and health problem. • Professional community outreach is ensures strong linkages between Health Unit and families. • Children are able to meaningfully promote their own health and well being. • The family is the basic provider of health and strengthening family structures is a sustainable option to ensuring care and support.

Recommendations • Children must be prioritised for treatment for HIV/AIDS • community follow up should be a precondition for all ART programmes • Funding for the treatment and care of children should be significantly increased. • Uganda must make a significant investment into health infrastructure for conflict regions • Re-build the confidence of the families to take care of children affected by HIV/AIDS in the conflict settings.

Recommendations Cont. . • Honour Children’s rights to influence their own lives through participation “If I am consulted, this makes me happy and I feel loved and trusted; also I know what to expect from the decision that has been taken. ”

THANK YOU!

Social Security: a Core Response to the Impact of AIDS on Children Clare Shakya Social Development and Livelihoods Advisor Global AIDS Policy team Policy Division

AIDS exceptionalism – a driver not a response We must • Match scale of impacts of AIDS with scale of response • Strengthen not undermine capacity of families and communities to care and protect those affected • Respond to social & political realities – tackle stigma, violence, exclusion and inequality Social security systems • Are at scale • Are affordable • Can crowd in care for most vulnerable • Can strengthen state’s capacity to tackle social exclusion and inequality…

So what sort of scale do we need? The statistics • Over half of children in Africa live in absolute poverty; • 11 million children globally die before 5 years old • 110 million children out of primary school Every minute: • a child under 15 dies of an AIDS-related illness • another child becomes HIV positive; • four young people between the ages of 15 and 24 contract HIV. In Africa: • 12. 4 million children lost a parent to AIDS – expected to rise to over 18 million by 2010

Are we committed? • 2001 UNGASS: develop and implement by 2005 National Plans of Action for orphans and children affected by AIDS • 2004 UN Framework for Protection, Care and Support of OVCs Living in a World with AIDS • 2005 Commission for Africa: social protection for OVCs by supporting their families and communities • 2005 G 8, World Summit: commitment to scale up towards universal access for AIDS prevention, treatment and care • 2006 UN HLM Political declaration: Commit ourselves (to)… increased protection for children orphaned and affected by HIV/AIDS… and building, where needed, and supporting the social security systems that protect them • 2006 DFID White Paper: increase spending on public services, make longer term commitments through 10 year plans and significantly increase spending on social protection in at least 10 countries by 2009…

So what’s the problem? • We can’t get to scale with gold plated projects • Money not reaching communities let alone individuals • And institutions can’t compete with families and communities in nurturing or socialising children • States have a role and a duty (CRC, UN framework) – but if reliant on donors have not been able to act

What have we been doing? • Small states (the Washington consensus) • Reliance on macro-economic policy • Poor families regarded as responsible for pulling themselves out of poverty: “dependency” frowned upon • Communities and families expected to care for those affected by AIDS • But AIDS money not reaching communities let alone individuals • Social security restricted to formal sector employees

And response for children incoherent and fragmented • Interventions spread across a range of ministries and civil society • eg. food aid, school feeding, social funds, home based care projects and psycho-social support projects • minimal co-ordination, ad hoc and unpredictable… and small scale • Child poverty and social security not well- integrated into Poverty Reduction Strategies • And AIDS-specific interventions are added on • not part of broader social protection frameworks or strategies for addressing child poverty • Reflected in National Plans of Action for OVCs minimal consideration of social security or at achieving scale.

What can be learnt from our response in the North? • Social security has been a key tool to address inequality and social exclusion • Free access to health services for the poor • Free basic education • Package of social transfers to ensure a minimum standard of living • Spending on social transfers has been significant – often over 10% of GDP • Social security spending increasing in middle-income countries • Functioning, powerful social ministries more able to protect children’s rights e. g. child protection agencies

Impact of social transfers on poverty in OECD countries

What are social transfers? • Regular and predictable grants – usually in the form of cash – that are provided to vulnerable households or individuals • Social pensions (eg. Brazil, South Africa, • • Lesotho, Namibia, Bangladesh, Nepal) Child benefits (eg. Child Support Grant in South Africa) Conditional cash transfers (eg. Bolsa Familia in Brazil, Oportunidades in Mexico, Cash for Education in Bangladesh) Disability allowances Unemployment benefits

Why is social security essential: pretty simple • In a market economy, families need cash to live • If they cannot get enough cash from work, what are the options? • Take on more risk: sex work, scavenging from • • rubbish tips Beg Sell necessary assets Criminal activity Sell children • Frequent response is humanitarian aid • Social transfers are another option • In Malawi and Kenya, cash transfers have been used to access health services, for transport and for ART related costs

Social security: investing in people • Social security is a transformational agenda – not just “redistribution” • Social security is an investment by the state in its citizens, especially the poor and vulnerable • And including those vulnerable to AIDS • Social protection gives poor people a future; changes attitudes; people use cash rationally • Contributes to women’s empowerment • “Crowds in” care for children as well as investment in their future

Potential impact in Africa: Tanzania, social pension and child benefit

Tackling poverty: impact on income and hunger • Social pensions doubled income of the poorest 5% in Brazil; increased by 50% in South Africa • Mexico’s Oportunidades significantly reduced depth of poverty among beneficiaries (by 40%) • 70% of households in Oportunidades have improved nutritional status • South Africa – presence of recipient of social pension correlated with a 3 -4 cm increase in height among children

Tackling poverty: impact on education and health Education: • Bangladesh: 20 -30% increase in enrolment among recipients • Nicaragua – 23% increase in school attendance among recipients • Social pensions result in increased school attendance of children in households Health • 12% reduction in ill-health among under 5 s in Oportunidades; 19% among adults • Nicaragua – immunization levels among children aged 12 -23 months increased 18%

Social security: why economists like it too… • Social security can promote growth: Ø Reduce distress selling and build productive assets; people can plan better Ø Allow people to take up higher return but also more risky economic activities Ø An investment in people: a healthier workforce; children grow up to be more productive workers Ø Increases the number of people contributing to the economy Ø Little evidence of “dependency”. Those receiving transfers more likely to be in work than nonbeneficiaries Ø Can stimulate local markets Ø Essential pillar of a market economy

Social transfers are affordable: example from Africa Equivalent to less than 5% of donor funding

Social security: essential for children affected by AIDS • Break cycle of poverty, inequality • Investments in social security complemented by investment in health, education, HBC etc • Social transfers do not have to be child focused • Entry point for dialogue and targeting criteria not the same • Universal transfers may reduce vulnerability to AIDS and mitigate impact of AIDS • Stigma of targeting by being AIDS affected • Can’t conflate problem with intervention: • Good nutrition not only delivered by food provision • Psycho-social support best delivered through crowding in care of family and community – quality and scale • Stronger social ministries can advance protection of child rights – e. g. inheritance, birth registration, abuse

Where are we? • Global Partners Forum called for governments • • to develop plans for social welfare and for donors to support these plans African governments in Livingstone, Zambia, called for costed national social transfer plans and for support from international community New EU development policy has social security as a priority area DFID has set out social protection as an essential part of government’s basic services in new White Paper There is a big window of opportunity in many very poor countries

From challenges to action • Effective targeting • children most vulnerable year before and year of death of parent • Develop capacity to implement: • Delivery of cash: corruption, accountability • 5 -10 yr donor commitments to financing • Political will • Constituencies for change: AIDS, food security • And EVIDENCE for constituencies • Impacts on AIDS vulnerabilities • And more on impacts on gender, on stigma and on child protection

Protection for Children Affected by HIV and AIDS A Companion Paper XVI International AIDS Conference August 2006

82 82 Origins • Early 2005 – dialogue between CIDA’s Children’s Rights and Protection Unit and UNICEF’s Child Protection Team. • Decision to develop a Companion Paper to the Framework on Protection for Children from … • Reference group formed following Inter Agency Task Team on Children & HIV Meeting June 2005 Globally, 15 million children under the age of 15 have been orphaned by AIDS, and more than 2 million children are infected themselves. By 2010, AIDS is expected to orphan 25 million children.

83 83 Background Companion piece on Protection for Children Affected by HIV/AIDS aims to build on: • UNGASS HIV Declaration of commitment to “protect orphaned and vulnerable children from all forms of abuse, violence, exploitation, discrimination, trafficking and loss of inheritance” (UNGASS on HIV/AIDS, 2001) • Strategies laid out in the “Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS” • Unite for Children, Unite against Aids Campaign 2006 • On key recommendations of the 2006 Global Partners Forum around civil and birth registration and social welfare systems

84 84 Added Value • Provides additional information and outlines 3 priority actions for protecting affected children from increased vulnerability, and for reducing the higher risks they face of abuse, exploitation and neglect. By looking at Factors which contribute to vulnerability among children affected by HIV/AIDS, including poverty, lack of access to basic services, stigma and loss of parental care How these vulnerabilities put children at increased risk of protection and rights violations, such as exploitation, trafficking, child marriage, violence and sexual abuse

85 85 Approach Application of a human rights based approach: • Recognizing government obligations and the responsibilities and potential contributions of civil society, communities, families, children and young people • Increasing focus on capacities, systems and structures needed for protection • Recognizing children’s resilience as well as the importance of their participation • Making distinctions on how HIV/AIDS impacts girls and boys in differing situations

86 86 Action Area 1 - Social Protection • Implement social transfer programmes • Invest in family support services • Involve communities in the provision of social transfers and family support services

87 87 Action Area 2 -Legal Protection and Justice • Combat disinheritance • Improve civil registration systems • Strengthen and/or develop specialized child protective services in police, justice and social welfare systems • Strengthen, develop and implement legislation and enforcement policies on child labour, trafficking, sexual abuse and exploitation • Support community-based monitoring mechanisms

88 88 Action Area 3 -Alternative Care • Find appropriate ways of supporting and monitoring informal care mechanisms • Improve the formal care system • Develop government and communitybased protection and monitoring mechanisms

89 89 Cross-cutting Recommendations Address stigma related to HIV, AIDS, abuse and exploitation: • Facilitate open discussion • Sensitize the media to issues of HIV and AIDS and protection risks • Train national and community leaders to stimulate discussion on child protection issues and HIV and AIDS

90 90 Cross-cutting Recommendations Strengthen the state’s social welfare sector • Increase budgetary allocations to government agencies responsible for social welfare, alternative care and protective services within national frameworks • Invest in human resources within the social welfare system • Develop regulations, guidelines and coordination mechanisms

91 91 Next Steps • To be successful, these actions will need to be integrated into existing development frameworks, including poverty reduction strategies, national plans of action for all children and specifically for orphans and vulnerable children, sector wide approaches and emergency response plans such as the Consolidated Appeal Processes. • Final draft and endorsements following on from the XVI International AIDS Conference • Final document • Dissemination strategy and distribution

Stigma, Discrimination, Violence, Exploitation and Abuse of Children Affected by HIV and AIDS: A Children’s Rights and Protection Perspective