Technical Brief on Orphan and Vulnerable Children (OVC) and Proposed Project for OVC

Transcription

1 Technical Brief on Orphan and Vulnerable Children (OVC) and Proposed Project for OVC Background: Globally, the HIV/AIDS pandemic has orphaned millions of children. Over the past 30 years, an estimated 17 million children have lost one or both parents due to AIDS and 3.4 million children <15 years are living with HIV (CLHIV). In spite of tremendous progress made in the last decade, around 260,000 children under 15 years were newly infected with HIV in Only 34 per cent of CLHIV in low and middle-income countries received the treatment they needed in As a result, an estimated 210,000 children died from AIDS-related illnesses in In the absence of HIV testing and timely ART initiation, one third of infants living with HIV die before their first birthday, and more than half die before the age of two years. Approximately 2.1 million adolescents were living with HIV globally at the end of 2012, and approximately two thirds of new HIV infections in adolescents aged years were among girls. Current HIV Situation and CLHIV in India: India is estimated to have around 86 (56 129) thousand new HIV infections in There is 66% decline in new infections from 2000 and 32% decline from 2007, Children (<15 years) accounted for 12% (10.4 thousand) of total new infections while the remaining (75.9 thousand) new infections were among adults (15+years). The adult HIV prevalence at national level has continued its steady decline from an estimated peak of 0.38% in through 0.34% in 2007 and 0.28% in 2012 to 0.26% in National adult (15 49 years) HIV prevalence is estimated at 0.26% (0.22% 0.32%) in At 2015, adult HIV prevalence is estimated at 0.30% among males and at 0.22% among females. The total number of people living with HIV (PLHIV) in India is estimated at lakhs (17.11 lakhs lakhs) in 2015 compared with lakhs (18.00 lakhs lakhs) in Children (< 15 years) account for 6.54%, while two fifth (40.5%) of total HIV infections are among females. Among the States/UTs, in 2015, Manipur has shown the highest estimated adult HIV prevalence of 1.15%, followed by Mizoram (0.80%), Nagaland (0.78%), Andhra Pradesh & Telangana (0.66%), Karnataka (0.45%), Gujarat (0.42%) and Goa (0.40%) Undivided Andhra Pradesh and Telangana have the highest estimated number of PLHIV (3.95 lakhs) followed by Maharashtra (3.01 lakhs), Karnataka (1.99 lakhs), Gujarat (1.66 lakhs), Bihar (1.51 lakhs) and Uttar Pradesh (1.50 lakhs). These seven States together account for two thirds (64.4%) of total estimated PLHIV

2 Children Infected and Affected by HIV and AIDS: While estimates for children orphaned by AIDS are unavailable there is evidence that 3.8% (nearly ) of an estimated 2.5 million people living with HIV/AIDS in India are children. UNICEF estimates that there could be about 4 million affected children in India, located mostly in the high HIV-burden states of south and northeast India (affected children include those living with HIV or those who are orphaned by AIDS, and children whose parents are living with HIV). Children less than 15 years of age account for 7% (0.145 million) of all HIV infections and deaths among HIV infected children account for 7% of all AIDS-related deaths. By the end of 2015, around 75 thousand children <15 years of age needed ART. These estimates for children living with HIV exclude adolescents between the ages 15 to 18. Children (<15 years) accounted for 12% (10.4 thousand) of total new infections Estimated in 2015 Children Living with HIV/AIDS: Operational Definition of OVC in this project context: A child, 0-17 years old, which is either orphaned or made more vulnerable because of HIV/AIDS. Orphan: Has lost one or both parents to HIV/AIDS Vulnerable: Is more vulnerable because of any or all of the following factors that result from HIV/AIDS: Is HIV-positive; Lives without adequate adult support (e.g., in a household with chronically ill parents, a household that has experienced a recent death from chronic illness, a household headed by a grandparent, and/or a household headed by a child); Lives outside of family care (e.g., in residential care or on the streets); or Is marginalized, stigmatized or discriminated against. Needs of OVC (CABA): An absence of accurate data on children affected by AIDS shows how children are the most neglected groups in India's AIDS response. HIV and AIDS have a devastating impact on various aspects of a child's life and rob the child of her/his childhood. In India, OVC are living a precarious life in very large numbers in high HIV prevalence states and districts and suffer severe stigma and violations of rights in the public and private sphere. The most adverse impact of HIV/AIDS is stigma and discrimination, which may result in denial of basic services to affected children, especially in health and education. Illness and death of parents or abandonment makes them particularly vulnerable to exploitation and abuse. OVC 0 18 year old If a Parent dies of HIV/AIDS, their children face Children Living with HIV (CLHIV) Has a family member living with HIV Exposure to HIV, risk of trafficking & sexual exploitation Stigma & discrimination Born to parentseving with HIV HIV infected Children living with HIV Children Affected by HIV Lost one or both parents siblings or family members to AIDS Vulnerable to HIV due to circumstances Street Children Trafficked children Homelessness & lack of safety Lack of love & caring, Emotional distress Children of sex workers or child sex workrs Child labourer s Lack of access to education Malnutrition & lack of health care

3 A study in rural areas reports all-pervasive stigma and the resultant discrimination at all levels, within the family and community and also in schools and healthcare facilities.9 A study among child headed households reported that the girl child as head faces many more challenges than boys and they are taught to accept discrimination, neglect, violence and abuse. CABA are experiencing extreme isolation and neglect which impacts their survival, development and future. OVC lack access to nutrition, non-discriminatory education and comprehensive care which are critical needs. Major problem aspects identified are: Lack of comprehensive state and multi-sectoral response affecting equity and access: The current national response is limited to Anti-retroviral therapy (ART) and general treatment for opportunistic infections (OIs) for CLHIV. CABA lack access to nutrition, Child Identified Challenges non-discriminatory education and comprehensive care which are critical needs. In a series of six public hearings for CABA in India by NCPCR from , orphaned children from 10 states including Maharashtra and Tamil Nadu testified to neglect, mistreatment and abuse, being denied education and inheritance rights to parental property. Adolescent girl children living with HIV testified to working as child labour to support their younger siblings and elderly grandparents. Weak implementation of policies and programs for CABA: The Integrated Child Protection Scheme (ICPS) was launched by the Government of India (GOI) in the year 2009 and aims to build a protective environment for vulnerable children, including CABA. The centrally sponsored ICPS in partnership with civil society acknowledges gaps and spells out service delivery structure but implementation remains weak. The National 'Policy Framework for Children and AIDS' (NACO and W&CD, 2007) is yet to be scaled up to operational levels. Protective legislation in the form of HIV and AIDS Bill has not yet been cleared in Parliament. In the absence of protective legislation, rights violations of CABA System Level Challenges Social Welfare Social protection Health and Nutrition Orphan Child Education Child Labour Poor Health Poor self -esteem Fear & Insecurity School Drop out Broken Family Loss of Childhood Physical & Other abuse are common, and grievance redress mechanisms are absent or ineffective. Coupled with weak child protection mechanisms and lack of organised support groups, CABA are faced with frequent rights violations in extended families, communities and institutional settings like schools 0 Poverty, No food HIV, OL, ART sid effects Stigma & Disrimination Sibling separation, death of parents Insensitive Teachers Marital discord, Alcoholism Only grand parents to take care Orphan and hospitals.

4 Programs for CABA so far: The National AIDS Control Organization (NACO) launched the Children Affected by AIDS (CABA) pilot scheme in May, 2010, with progress demonstrated in some of 10 pilot districts. The review of the pilot scheme conducted in January 2011 by NACO highlighted several examples of effective interventions, such as linking children affected by HIV/AIDS with government cash transfer schemes in the states of Tamil Nadu and Karnataka; formation of districtlevel coordination committees that conducted monthly reviews of services for children affected by HIV/AIDS by the District Commissioner; and training of school teachers on the needs of, and services for, children affected by HIV/AIDS. The National AIDS Control Organization (NACO) launched the Children Affected by AIDS (CABA) pilot scheme in May, 2010, with progress demonstrated in some of 10 pilot districts. The review of the pilot scheme conducted in January 2011 by NACO highlighted several examples of effective interventions, such as linking children affected by HIV/AIDS with government cash transfer schemes in the states of Tamil Nadu and Karnataka; formation of district level coordination committees that conducted monthly reviews of services for children affected by HIV/AIDS by the District Commissioner; and training of school teachers on the needs of, and services for, children affected by HIV/AIDS. The key lesson learned from this pilot scheme was that there is a need for effective coordination of the Departments of Health, Women and Child Development, Social Justice and Empowerment, and Education to ensure that children affected by HIV/AIDS were effectively mainstreamed into health, education, social protection and welfare services. Similarly, the Integrated Child Protection Scheme (ICPS) was launched by the GOI in This nationally sponsored scheme aims to build a protective environment for vulnerable children, including children affected by HIV/AIDS. The specific objectives of the scheme are to institutionalize essential health and social services for vulnerable children and to strengthen these services at the state, district, and community levels. DAC has clearly articulated the critical need for CABA to benefit from governmental health, educational, social protection and welfare services in the National AIDS Control Program-Phase IV. Highlights of the current Program: Project Title: HIV/AIDS Orphans and Vulnerable Children Social Protection 1. Executive Summary: This USAID/India funded project works with the purpose of increasing access to priority health, educational, social protection and welfare schemes for children affected by HIV/AIDS (CABA). Many factors currently deter or prevent CABA benefiting from essential health care and other social welfare services provided under the Government of India schemes. Program Goal: Increased access to priority health, educational, social protection and welfare services by children affected by HIV/AIDS (CABA). Program Objectives: 1) To identify and profile girls and boys living with and affected with HIV and provide quality and timely treatment, care and support 2) To increase access and utilization of priority health, educational, social protection and welfare services, by children affected by HIV/AIDS and their families 3) To strengthen inter-sectoral collaboration between various government departments to ensure that CABA are provided all essential services Geographic focus: This project is being implemented in the states of Maharashtra, Andhra Pradesh and Karnataka

5 covering 17 districts in these three states. The districts in Maharashtra include: Mumbai, Pune, Thane, Ahmednagar, Dhule, Kolhapur, Sangli, Solapur, Yavatmal, Karnataka include: Bagalkote, Belgaum, Bellary, Bijapur, Dharwad. Andhra Pradesh: Krishna, Guntur and East Godavari. Partners and expected roles: The Karnataka Health Promotion Trust (KHPT) is the prime implementing agency with following sub-grantees: Family Health India (FH India), Catholic Health Association of India (CHAI), Sneha Charitable Trust (SCT), International Ser vices Association (INSA-India), Committed Communities Development Trust (CCDT) and NMP+ FH India's role is for Capacity enhancement and Knowledge management, CHAI's role will be for Innovative approaches for interventions and services, SCT's role is for Knowledge management and translation, INSA-India's role is for increasing access to Child Protection services for children affected by HIV/AIDS, CCDT is the implementation partner for Mumbai and NMP+ is the implementation partner for Pune. The project is implemented in close collaboration with Vihaan CSCs and state management team and builds on the platform of institutional networks supported by MAC AIDS Fund and Government schemes and services. Additionally, KHPT works closely with Government, Networks of Positive People, non-government and community based organisations working on targeted interventions, the prevention of parent to child transmission in India, the link workers scheme and providing care to children infected and affected by HIV. Program Strategies: Figure below, shows the framework on which the strategies are proposed for reaching the objectives of the project: Develop national level advocacy for mainstreaming OVC issues into existing government structure and in uencing better service delivery to OVC Organise and strengthen government and nongovernment organisations, service providers and others to develop a networked and coordinated response to protect children orphaned by HIV in three states. Enable families to care for children by increasing their access to health, education, social protection and welfare schemes and services, and to become economically stable Enlist, educate, enable and empower children to protect themselves and be resilient to HIV and other risks in 16 selected districts. Anticipated results: Result 1: Data on the profile and needs of, and the uptake of services among, children affected by HIV/AIDS There is paucity of data on children affected by HIV/AIDS, for example, including better estimates of the total numbers, the family structures in which they live and whether or not they access to; health, educational, social protection, or welfare services. There is a need to generate such data and a system for regular updates and their dissemination. Availability does not always ensure that data or information is used and systems to ensure that such data informs program planning, budgeting, and implementation are also lacking. Coordinated Multi-level Response Multisectoral- Fragmented respones Insensitive, Not coordinated lack skills & resources Lack capacity Vulnerable Government Civil society & service Providers Families Children Adapted PEPFAR Framework Result 2: Increased uptake of health and education services for children affected by HIV/AIDS. Skills and resources for Child Welfare & Protection Organised & resourced to identify children/families and provide safety nets Protected & Resilient to JIV and other risks Many factors are likely to deter or prevent children affected by HIV/AIDs from benefiting from essential health care. For example, anecdotal reports of discriminatory attitudes and practices by health providers, limited financial support for preventive and primary care, and poorly developed referral systems may deter children affected by HIV/AIDS from using proven, high impact health interventions. Ways to identify and address deterrents of health care will be essential if children affected by HIV/AIDS are to benefit from

6 essential child health care interventions. Because there is reported discrimination of children affected by HIV/AIDS by teachers and classmates, reducing educational disparities and barriers to accessing educational opportunities among school age children affected by HIV/AIDS will be critical if this generation is to grow into productive members of society. There are needs to work closely with Education Departments to track enrolment, retention and absenteeism among children affected by HIV/AIDS. More importantly will be the identification of effective solutions to ensure their enrolment, retention and reduced absenteeism. Result 3: Increased uptake of social protection and welfare services by children affected by HIV/AIDS and their families or caretakers. India has a range of social protection policies and programs that have not been fully accessed by children affected by HIV/AIDS and their families. These schemes are aimed at reducing poverty, vulnerabilities, and social inequalities. Examples of such schemes include, but are not limited to, the National Rural Employment Program for family members; the Public Distribution System for rice, wheat, and edible oils to families below the poverty line; and the Widow Pension schemes for mothers who have lost their husbands could benefit children affected by HIV/AIDS and their families. Monitoring and Evaluation: Individual tracking system will be developed to track, age and gender disaggregated outputs and outcomes. Mid line and end line evaluation will also be conducted. Gender Analysis: All consortium partners will integrate gender into CABA activities at the state and district level. District level data will be used to critically analyse genderrelated cultural norms, behaviours and practices in the three states that impede women and girls in particular from accessing health, education, nutrition, social protection, economic and legal services. Results from the situational assessment will help to strategize specific strategies to address the gender gaps. In addition, efforts will be made to address the five President's Emergency Fund for AIDS Relief (PEPFAR) elements on gender through all stages of project planning, implementation, monitoring, evaluation and reporting. 1. Joint United Nations Programme on HIV/AIDS, Global Report: UNAIDS report on the global AIDS epidemic 2013, UNAIDS 2. Joint United Nations Programme on HIV/AIDS, Global Report: UNAIDS report on the global AIDS epidemic 2013, UNAIDS 3. Annual Report , Department of AIDS Control, Ministry of Health & Family Welfare 4. 5,6,7 & 8 India HIV Estimations 2015: A Technical Report- NACO 9. Barriers to Sustainable Access of Children and Families to ART Centres in Rural India, India HIV/AIDS Alliance, December Situational Analysis of Child-headed Households and Community Foster Care in Tamil Nadu and Andhra Pradesh, India, India HIV/AIDS Alliance and TISS, 2006