Despite increased access to treatment and testing facilities, the number of orphans due to HIV/AIDS will continue to increase, particularly in regions such as Sub-Saharan Africa. Children living without one or both parents are at greater risk of dropping out of school and have higher rates of emotional /physical abuse and sexual exploitation (1). In many countries, the infrastructure to care for orphaned children is not sufficient and puts additional stress on extended families if they are able to care for the child at all. This additional stress affects children’s health, nutrition, mental health, and education. In some cases, children have to do difficult or exploitative work to help meet basic needs. Children may also experience HIV-related stigma and discrimination, keeping them out of school and away from groups of friends and health services (2). Though all income levels can experience the loss of a parent due to AIDS, the poorest households are typically the least resilient to HIV’s economic consequences and least able to manage the lost household income. Special attention needs to be given to children who do not live with one or both parents as they are more likely to be out of school and experience early marriage, which has its own negative outcomes (3).
Recently, UNICEF has led a review into how programs can better impact children living with HIV/AIDS or are suffering the consequences from the disease (ex. The loss of a parent due to AIDS). Health programs were often too “goal-focused” and did not address factors that were so influential and crucial to their program. Programs for children affected by AIDS have typically targeted individual children, bypassing their families and similarly many HIV programs for adults have bypassed children (1). Finally, a family centered program addresses the needs of a whole family and not just an individual has been proposed. Family-centered approaches can be facilitated through community-based care workers who are well-positioned to support HIV-affected families by linking adults and children to antiretroviral treatment, legal support, food and nutrition assistance, and social protection entitlements (2). It is theorized that this link will also improve child and family outcomes by reducing barriers to HIV-related services (2).
Though less feasible due to
unstable governments and a lack of funding, social protection would be able to
greatly impact HIV transmission and consequences. Social protection is defined
as a set of public and private initiatives that provide income or consumption transfers
to the poor, protect the vulnerable against livelihood risks, and enhance the
social status and rights of the marginalized (4). In small scale studies, it
has been shown to promote access to healthcare, education, and nutrition. These social protection programs would need to
be short term in order to not create dependency and allow people to use the
skills and education learned through the program.
Overall, children are at the
greatest risk of suffering the consequences of HIV/AIDS. It is important that
health campaign programs are somewhat flexible in order to address the needs of
the community instead of forcing the predetermined plan. It seems that UNICEF
realizes this and plans to implement programs with more leeway, but not many “flexible
programs” are running now. The greatest issue with this is the inability to
prove impact. Protection, care and
support programs often fail to attract funding due to this inability.
Monitoring systems should include baseline measures, comparison groups, and
quantifiable targets to ensure progress can be measured and impact attributed
to the campaign (1). Context-appropriate indicators should be developed to establish
a universal standard of measurement. Flexibility does not mean impact cannot be
measured, only that health workers and program designers must be especially conscious
of added variables and confounders.
(1)
Cluver, L. Orkin, M. et al. (2011) Transactional
sex amongst AIDS orphaned and AIDS affected adolescents predicted by abuse and extreme
poverty, Journal of Acquired Immune Defincieny Syndromes.
(2)
Range of 14.4 – 18.8 million. UNICEF (2010),
Children and AIDS: Fifth stocktaking report, New York
(3)
EveryChild, Maestral and UNICEF (2012), Children
living with and affected by HIV and AIDS in residential care
(4)
Devereux, S. & R. Sabates-Wheeler, Transformative
Social Protection‟, Institute ofDevelopment Studies Working Paper 232, Brighton,
2004
I think of the staggering impact that AIDS can have on the health of a nation. Thinking about the number of orphans created from AIDS, the number of health-care workers killed, and the loss of productivity toward building a better nation all contribute to a self-perpetuating cycle of poverty and poor health. I wonder what kind of qualitative research by UNICEF has been done to elucidate the dynamic family factors that affect single parent households the most and how programs can best meet the needs of these small families. The orphan problem is certainly a tragedy. To think of the advent of antiretroviral therapy and the benefits it can bring to those affected by HIV, the devastation that is observed despite its discovery is...bewildering.This discussion serves as a prime example of how the health outcome of one individual extends well-beyond the purview of the individual to affect a much larger population. Whether it is an extended family, or the city who lost a nurse or physician, the loss of one individual makes a big difference. Multiplied several million times, it is devastating.
ReplyDeleteSince the number of orphans varies across countries, health workers or programs should be approachable between different regions within countries. For example, certain areas may have more number of orphans suffered from HIV/AIDS or living with HIV infected parents. Also, the percentage of orphans is highly related with total rates of HIV prevalence and probably there will be difference between rural and urban regions. (However, I read a article mentioned that the age of orphans suffered from HIV/AIDS is consistent across countries.). Children living with HIV infected parents are very emotionally and physically venerable, long before they are orphaned. More seriously, it results emotional traumas that will never disappear. I also think family-centered approaches with effective measure should be the first step to take care of them.
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