Select Committee on International Development Minutes of Evidence


Supplementary memorandum submitted by UNICEF

CHILDREN, HIV AND AIDS: IMPACTS, ISSUES AND WHAT CAN BE DONE

INTRODUCTION

  1.  It is clear that the HIV/AIDS pandemic is causing a human tragedy of unprecedented proportions, particularly in Africa. In many parts of the developing world, HIV/AIDS is reversing the social and economic gains of past decades and is now being recognised as the single greatest threat to peace and development. Children and young people have been especially severely impacted by this epidemic and its consequences. While experience and knowledge exists of the interventions and actions which can make a difference, the response has been slow and limited. To respond adequately, commensurately, significantly more resources, and bolder leadership is required. Many governments, donors and affected countries alike, and development organisations will need to make some critical decisions in the very near term if we are to prevent AIDS from undoing totally all of our good work on behalf of mothers and children. To help mobilise this leadership, this paper seeks to describe the impact of HIV/AIDS on the lives of children; the role of UNICEF in the global response to HIV/AIDS; and to suggest some ways in which the Government (and people) of the United Kingdom could contribute to an intensified offensive against HIV/AIDS.

THE EXPLODING HIV/AIDS PANDEMIC

  2.  Today over 33.6 million people are living with HIV (1.2 million of them children) and most of these live in sub-Saharan Africa (70 per cent or 23.3 million). Today some 15,000 people will acquire HIV, of which some 60 per cent of these new infections will occur among children and young people under 24 years of age.[1] In 1999, an estimated 570,000 children under 15 were infected with HIV, of these 500,000 are in sub-Saharan Africa.

  3.  In the most severely affected countries (particularly of southern Africa) up to 25 per cent of the adult population is HIV+. All will die within 7-10 years. Over 16 million have died of AIDS since the epidemic began, and over 13 million of these in Africa (over 5,500 funerals per day), of which three million were children.

  4.  HIV/AIDS is having a devastating impact on families, societies and economies. Decades have been chopped from life expectancy and young child mortality rates are expected to more than double in the most severely affected countries of eastern and southern Africa. AIDS is reversing the child survival and development gains of the 1980s.

  5.  Over 11.2 million children have been orphaned (maternal orphans) by AIDS: 10.7 million of these (95 per cent) are in sub-Saharan Africa. While in most of the industrialised world, around 1 per cent of children are orphaned from all causes, including AIDS, in many countries of southern Africa the orphan rate is closer to 10 per cent: ie 11 per cent of children in Uganda are orphaned by AIDS alone; in Zambia 9 per cent; in Zimbabwe 7 per cent, and in Malawi 6 per cent. Moreover, in east and southern Africa, this proportion is expected to grow to nearly 20 per cent by 2010.

  6.  In many parts of Africa the capacities of families and communities to cope and care for orphaned children have been stretched to the limit. Within these societies, children are subject to:

    —  loss of family love, protection and care.

    —  discrimination and stigma associated with having lost their parents to AIDS.

    —  psychosocial distress. These children have witnessed the sickness and death of their parents, experienced economic hardship and the break-up of their families, and are worried about their futures.

    —  increased demand for labour. Demands increase for children's labour for domestic chores, caring for the sick and dying parents, and income generating work to contribute to the household economy.

    —  reduced opportunity for schooling. As household incomes are reduced, and costs increased by sickness, schooling is forgone.

    —  loss of health care and deterioration in diet, resulting in increased sickness and malnutrition.

    —  loss of inheritance. Orphans and widows are often disenfranchised within their extended family and lose legal entitlements (to property) upon the death of a husband and father.

    —  forced migration. Orphans are often separated from their siblings and forced to move to far-away places.

    —  abandonment. Increasingly, as family and community capacities are damaged, children are abandoned, become homeless and forced to live in "child headed" households. These children are extremely vulnerable and at heightened risk of abuse and exploitation.

    —  exposed to HIV infection. Children, especially girls, working or living on the streets, or in child-headed households are at particular risk of sexual exploitation, abuse and HIV infection.

UNICEF'S RESPONSE

  7.  Mobilising and supporting an effective response to HIV/AIDS is a priority amongst priorities for UNICEF. To orient the expansion of UNICEF's action on HIV/AIDS a five point strategy was developed in early 1999. These strategies are to:

    —  mobilise commitment and capacity to act. This includes breaking the "conspiracy of silence"—and its associated stigma and discrimination—that continues to hide the dimensions of the HIV/AIDS crisis from the very people most affected by it. It means encouraging leaders to declare HIV/AIDS the emergency that it is; supporting the development of policies and strategies that will help reduce the spread of the disease; building partnerships among all who can play a role in reducing the spread of the disease; and mobilising the resources required for an effective response.

    —  prevent HIV infection among young people. As half of all people who acquire HIV become infected before they turn 25 (and die before reaching 35), the active involvement of young people in the fight against AIDS is fundamental to an effective response. UNICEF stresses the importance of focusing on young people because (a) they are at the centre of the pandemic, (b) they are often more open than adults to change their behaviour and (c) they are a force for change among their peers and in society generally.

  Thus, as the future course of the HIV/AIDS pandemic lies in the hands of young people, it is vital that we do everything necessary to arm them with the knowledge, support and access to services they need to protect themselves and their communities.

  UNICEF is supporting actions which enable young people to lead and participate more fully in the fight against HIV/AIDS; promote young people's awareness of STDs, HIV and AIDS, life challenges and how to manage them; promote the use of youth friendly health services (information, education, voluntary HIV testing and counselling, STD treatment, family planning services, access to condoms, etc); support the conduct of sex education and life skills training in schools.

    —  prevent mother-to-child transmission of HIV. With an estimated 570,000 children infected in 1999, mainly through mother-to-child transmission, UNICEF is working with governments to provide voluntary HIV testing and counselling for pregnant women; and, for women who test HIV+, access to short anti-retroviral drug regimens and advice and support for infant feeding. Properly implemented, these interventions can reduce HIV transmission rates by half.

    —  care for orphans and children affected by HIV and AIDS. UNICEF supports actions to strengthen the capacities of families and communities to identify and respond to the needs of orphans and other vulnerable children; and to ensure their access to basic health, education and child welfare services.

    —  support UNICEF staff and their families affected by HIV and AIDS. Recognising that many UNICEF staff, and their families, are at risk of HIV infection and that many are already living with HIV/AIDS, an internal programme (entitled "Caring for Us" in east and southern Africa) is being implemented to promote a safe and supportive environment for UNICEF staff; provide information and education on how to prevent HIV; advice and support on how to live with HIV/AIDS; provide access to high quality health and counselling services; and provide solidarity and support in times of need, stress and bereavement.

  8.  In acting on the HIV/AIDS priority, UNICEF is using every programming opportunity (ie the preparation of new programmes, annual and mid term reviews, etc) to assess whether more can be done to intensify the fight against HIV/AIDS; additional staff are being recruited to strengthen programming capacities in each of the priority areas; partnerships are being formed with other UN agencies and NGOs to rapidly expand the coverage and quality of HIV/AIDS programme interventions; and, in east and southern Africa, an accelerated programming exercise is currently being undertaken to mobilise some $250 million in support of HIV/AIDS actions in these countries over the coming three years.

THE CHALLENGE

  9.  An effective response to HIV and AIDS is possible. Experiences in Uganda, Senegal and Thailand have proven that effective action can reduce HIV infection, improve the quality of care for HIV infected people, and establish care for orphans and children affected by HIV and AIDS. The success of these countries has reflected strong and sustained leadership, the active participation of those infected and affected (especially youth), and the dedication of considerable resources to the fight against HIV/AIDS. The challenge is to learn from and apply these successful experiences in a rapid and expanded fashion to halt the unfolding tragedy.

THE UK—WHAT CAN BE DONE

  10.  The commitment and contribution of the Government and people of the United Kingdom to the fight against HIV/AIDS is clear. This hearing is one excellent example of your leadership and priority on the issue. However, more can be done particularly by other governments and your leadership within the UK and around the world can be used to increase the commitment of others to attach an appropriate level of priority to HIV/AIDS. We encourage the UK Government to demonstrate its strong global leadership on HIV/AIDS at the upcoming G8 meeting which provides a good opportunity to urge the heads of the eight most powerful economies in the world to declare their own commitment to address the pandemic as a critical priority and to support the effective actions by our community to prevent the spread of the disease. Such a declaration could include the commitment of the G8 to:

    (a)  heighten senior level advocacy with state leaders, especially in Africa, to do more to respond to HIV/AIDS. Advocate for a stronger and sustained personal leadership involvement in the fight against HIV/AIDS and for specific actions in providing policy and planning guidance for the national response, monitoring the implementation of the national HIV/AIDS programme, building partnerships and alliances with civil society, mobilising resources and international partnership, etc. In so doing, UK leaderships should act as international advocates on behalf of children living in families, societies affected by HIV/AIDS.

    (b)  advocate for the adoption of specific goals to mobilise attention, efforts and resources around interventions affecting children and young people living in environments affected by HIV/AIDS. Some such goals could include:

      Goal 1. Reduce HIV infection rates among young people aged 15-24 years by 25 per cent in most affected countries by 2005 and by 25 per cent globally by 2010 (ICPD+5)

      Goal 2. Reduce vulnerability to HIV/AIDS infection by ensuring that at least 90 per cent of young men and women (aged 15-25) have access to preventive methods—such as female and male condoms, voluntary testing, counselling, and follow up—by 2005, and at least 95 per cent by 2010. (ICPD+5)

      Goal 3. Prevent mother-to-child transmission of HIV by ensuring that all pregnant women are enabled to undertake an HIV test, and if found positive, are provided with full services to minimise the risk of transmission of HIV infection to their baby

      Goal 4. Protect the rights of orphans and children affected by HIV/AIDS by ensuring that by end 2002, at least half of all local authorities will have found a way to make sure that families caring for orphans are able to supply them with adequate food and shelter, access to education and health care, and ensure that they live under the protection and care of a responsible adult.

    (c)  expand the development budget dedicated to achieving the above goals.

    (d)  ensure that all DFID programmes, particularly in sub-Saharan Africa, address HIV/AIDS as a development and political priority.

    (e)  expand cooperation with NGOs working on HIV/AIDS.

    (f)  expand support for UK-based research and training institutions involved in HIV/AIDS research, programming, monitoring and evaluation.

UNICEF

June 2000


1   HIV infections in the former Soviet Union have doubled in just two years. Injecting drug use gave Eastern Europe and Central Asia the world's steepest HIV curve in 1999 with 360,000 people infected. Back


 
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