What have HIV and AIDS and child protection got to do with each other?

In this article we look at vulnerability and protection issues for children in the context of HIV and AIDS. It is the first installment of a series of articles on this site which will look at child protection, HIV and AIDS, suggested responses and the role of communities.

Recent reviews of evidence around children and HIV show us that children who are HIV-affected – namely children who have been impacted by HIV and AIDS directly or indirectly through their family or household – are more vulnerable to abuse, neglect, exploitation and discrimination.

With this understanding, it is clear that we need to be working to link HIV and AIDS and child protection responses as closely as possible.

How protecting of children and supporting children affected by HIV grew into separate sectors – a short history

A few decades ago the impact of HIV and AIDS became a prominent consideration in development approaches. Responses to the “AIDS orphans crisis” came to the fore with programming which singled out these children for special support. There was much concern and focus on “child-headed households” and their material needs.

This was closely followed by programming which targeted “Orphans and Vulnerable Children” or “OVC” – in order to include children who we now recognised were made vulnerable by HIV and AIDS in many different ways, but who were not necessarily orphaned. This was also later coupled with a better understanding of the role of family in a child’s wellbeing, as well as the drawbacks of singling out individual children for support. Accordingly, support shifted away from the individual child and towards supporting the family as a whole.

Our understanding of support had also moved from providing material or “basic” needs such as food, shelter and access to schooling to providing “soft” but essential services such as psychosocial support.

This somewhat organic process, fuelled by large injections of donor funding in to OVC programming, resulted in a separation of support for these children from mainstream child protection programming. “OVC” had become its own sector and parallel OVC policies and programmes were often developed which did not always link clearly to national child protection and other relevant frameworks. There was, and arguably still is, a general lack of understanding on both sides of this divide in terms of what support is being offered by the other side to children and their families, and why.

How the child protection and supporting children affected by HIV are finding their way back to each other

In very recent years there has been a concerted move away from addressing single child protection issues as HIV and AIDS or violence, through the promotion of strengthening child protection systems, at the national and sub-national levels. Child protection systems strengthening means that a national strategy is developed within a framework which straddles and links to a number of different sectors, such as health, education and social services, in order to provide an integrated, coordinated and more effective response to protect children.

The systems strengthening approach also presents an excellent opportunity to bring children affected by HIV back into mainstream child protection frameworks by encouraging child protection systems to be “HIV-sensitive”. Likewise, it is also an opportunity for the children affected by HIV sector to work towards integrating stronger child protection measures into its programming.

Some recent studies have responded to these opportunities by seeking to identify exactly how HIV can make a child vulnerable and where the potential synergies between the HIV and child protection sectors lie.

What do we mean when we say a child is vulnerable because of HIV and AIDS?

For many years children affected by HIV have been considered especially vulnerable and in need of targeted support and services. A myriad of vulnerabilities have been identified ranging from being discriminated against at school because a family member is known to be HIV-positive, spending long hours contributing to household chores and increased poverty due to the illness or loss of a carer or breadwinner, to girls having sex with older men for financial, emotional and other kinds of support.

However, whilst many aspects of vulnerability such as these are already well documented – and no doubt will be very familiar stories for many child protection fieldworkers – we are only now beginning to better understand exactly why and how being affected by HIV in the family is the driver of a chain of vulnerabilities or risks for children as they grow up.

In fact, recent studies such as “Pathways from parental AIDS to psychological, educational and HIV risks for children” by Cluver et al. have been able to show us exactly how children who come from a family where a parent is sick or has died from HIV and AIDS are exceptionally vulnerable to a chain of risks which lead to community violence, stigma, and psychological distress and even a higher risk of HIV infection. Surprisingly,in this South African study, it is the children living with an AIDS-sick relative, rather than those who are orphaned as a result of AIDS, who seem be the most negatively affected.

These beginnings of a more profound and nuanced understanding of the vulnerabilities of children in HIV affected households also shines a light on the areas where interventions and support, which includes vital child protection measures, can make the biggest impact.

What are the main child protection issues for children affected by HIV?

Taking into account the findings of Cluver et al’s South African research, the recent study by the Interagency Task Team on Children and AIDS:Building Protection and Resilience: Synergies for child protection systems and children affected by HIV and AIDS” looks globally at evidence around children who come from HIV and AIDS-affected families.

For example, children orphaned by or living with HIV-positive caregivers face an increased risk of physical and emotional abuse compared with other children in sub-Saharan Africa, including other orphans, and that they also have higher rates of transactional sex or increased, unsafe sexual activity and sexual abuse.

We also now know that children affected by HIV experience greater stigma, bullying and emotional abuse than their peers and that children who have HIV-positive mothers are at significantly higher risk of being abandoned or placed into residential care in areas where there are concentrated HIV epidemics.

In addition, households affected by HIV or other stigmatized households are more likely to be excluded from social networks and protective environments than many other households that are otherwise similar, in high HIV prevalence settings.

The study also highlights children who are at extremely high risk – such as the HIV experiences of children living in residential care and other alternative care settings, and children living with disabilities.  It warns that there is little or no evidence to assist in designing effective responses to what are still intuitive and anecdotal understandings of and concerns for these groups of extremely vulnerable children. Importantly, it also points out that these gaps in understanding include children who are not part of the formal “system” or do not live within settled households.

What is clear, however, is that children who come from HIV and AIDS affected households are more vulnerable to a set of cumulative risks than many of their peers who live in similarly difficult circumstances, but do not have the contributing factor of HIV in their family. It is imperative, therefore, that child protection systems strengthening efforts incorporate our evolving understanding of HIV-affected children’s vulnerabilities by developing HIV-sensitive responses.

In our next installment we look at what an HIV-sensitive child protection system could look like and how community action and participation plays a pivotal role.

References:

Cluver, L, Orkin, M, Boyes, M, Sherr, L, Makhasi, D, Nikelo, J., 2013,  Pathways from parental AIDS to child psychological, educational and sexual risk: developing an empirically-based theoretical model

Inter-Agency Task Team (IATT) on Children and HIV and AIDS, 2013, Building Protection and Resilience: Synergies for child protection systems and children affected by HIV and AIDS