Resources — Regional Interagency Task Team on Children Affected by AIDS

Rob Worthington

Policy Brief: Child cash transfers halve HIV risk behaviours for adolescent girls

Why is this important?

A million youths in sub-Saharan Africa are infected with HIV annually. Girls are at up to three times the risk of boys. Transactional and age-disparate sex (‘sugar daddies’) are a key cause of HIV-infection. Systematic reviews show limited effectiveness of behavioural HIV-prevention programmes. Cash transfers to alleviate poverty may be helpful.

The research:

Longitudinal survey, 3,515 children aged 10–18 (<2.5% refusal, 96.8% retention rate), 2009–12.

Stratified random sampling of entire census enumeration areas in rural and urban sites in two South African provinces (Western Cape andMpumalanga).

Propensity score matching to replicate randomised controlled trial conditions, additional check in multivariate logistic regression

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Policy Brief: Household mobility and school drop-out in orphans and vulnerable children

Past studies have found that orphans and other children made vulnerable by HIV (OVC) in sub-Saharan Africa are at increased risk of moving household and of school drop-out. However, the relationship between child migration and school enrolment has not been established. We conducted secondary analysis of prospective data, collected from 2002–2006, to investigate whether children who recently migrated were at increased risk of dropping out of school. We also investigated associations between orphanhood, type of caregiver and school drop-out, and whether any such associations are explained by an increased risk of migration among affected children.

The questions:

•Are children who move household at increased risk of dropping out of school?

• Does moving household mediate the relationship between orphan hood and school drop-out?

The research:

• 2002–2006: Enrolled and followed up 645 children aged 6–18 as part of a cohort study.

• Included orphaned and non-orphaned children.

• Collected data on type of caregiver, school drop-out and migration.

• All analyses control for age, gender, socio-economic status, and community type.

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Policy Brief: Substance abuse and education in orphans and vulnerable children

Alcohol and drug use amongst adolescents and young adults in sub-Saharan Africa is a potential problem, particularly among orphans and vulnerable children (OVC), and may be ameliorated by school enrollment, but there are no published findings from Zimbabwe on this. We collected data from 5,297 adolescents and young adults from 2009–2011 to investigate whether orphans and/or children caring for a family member with HIV are at increased risk of alcohol, tobacco and drug use.

The questions:

• Are OVC at an increased risk for smoking and alcohol and drug* use?

• Do OVC who practice substance use have greater HIV risk behavior?

• Does school enrollment reduce substance use in OVC (thereby potentially reducing HIV risk behavior)?

* Believed to be mainly marijuana in this population

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Policy Brief: Adult treatment and care services an entry point for children’s well-being

HIV care and treatment services (HIVCTs) have greatly improved survival and reduced morbidity of HIV-infected persons. Also, HIVCTs have been associated with a significant decline in the incidence of orphanhood and children born with HIV infection (April, MD, et al., 2014; Mermin, J, et al., 2008; Makumbi FE, et al., 2012). However, the indirect effects of parental enrolment into HIVCTs on their children’s schooling are unknown. We investigated the association between parental enrolment into HIVCTs and children’s school non-enrolment or drop-out in Rakai district, South-Western Uganda.

The question:

• What is the effect of parental enrollment into HIV care and treatment services on children’s school enrollment and drop-out in a rural resource-limited setting with a universal primary education policy?

The research:

• Secondary data from four annual censuses/surveys in the Rakai Health Sciences Program population-based cohort in 50 communities.

• Inter-survey proportion of children (6-16 years) enrolled in school, drop-out (child in household previously enrolled in school but not currently in school) and adult enrollment into HIVTCs.

• Random effects logistic regression population average models for repeated measures analysis, with unstructured correlation structure used for the analysis.

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Policy Brief: Evidence for improving psychosocial outcomes for children affected by HIV/AIDS

Why is this issue important?

•HIV/AIDS places children at risk for poor social, emotional and mental health outcomes.

• There is a great deal of funding dedicated to addressing this issue, but very little evidence about what works to improve psychosocial outcomes for these children.

• In 2009, a systematic review could not identify any study that had adequately evaluated an intervention to improve psychosocial well-being for AIDS-affected children.

• This lack of evidence means that we don’t know how programmes or interventions work to improve child outcomes, if they are reaching the most vulnerable, or even if they are having unintended negative effect

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Policy Brief: Pathways from parental AIDS to psychological, educational and HIV risks for children

The questions:

• Evidence shows that parental AIDS-illness and death have severe negative impacts on children. However, we need to understand why AIDS hasthese effects.

• This study aims to identify these pathways, and thus identify important targets for interventions.

• Three key outcomes are examined: psychological, HIV-infection risks and educational.

The research:

• Cross-sectional survey of 6,002 children aged 10–17.

• Rural and urban sites in the Western Cape, Mpumalanga and KwaZulu-Natal, South Africa.

• Validated scales and symptom checklists were used. Structural equation modelling in AMOS 19 identified pathways of risk. AIDS-orphanhood and parental AIDS-illness raise risks of poverty and parental disability. Through these linkages, AIDS-affected children are more likely to be stigmatised outside the home, and exposed to physical, emotional and sexual abuse or rape. It is these ‘interlinking factors’ that cause psychological distress such as depression, anxiety and suicidal behaviour. And it is psychological distress that leads to higher rates of HIV infection risks (such as transactional sex and low condom use) amongst AIDS-affected adolescents.

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The Role of Civil Society in Supporting and Strengthening National Child-Sensitive Social Protection Programmes

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The role of Civil Society in supporting and strengthening National Child-Sensitive Social Protection Programmes .pdf

This paper aims to provide an overview of the legal and developmental rationale for CSO participation, as well describe the role that CSOs have played – and could potentially play –in Africa in formulating and implementing child-sensitive social protection programmes to improve child wellbeing. Drawing on lessons identified from existing initiatives, the paper aims to highlight the challenges that need to be addressed and the opportunities that can be built upon to secure effective CSO participation in government-led national social protection policies and programmes benefiting children across Africa. Building on progress in social protection policies and programmes across Africa, there is the need to accelerate existing efforts by overcoming a number of constraints. This includes by putting in place more sustainable fiscal arrangements; strengthening accountability of multiple sectors and stakeholders through national platforms and institutional arrangements; and scaling up social protection to include a comprehensive package that reaches all children. This need requires collaborative efforts from all stakeholders, including CSOs.

Southern Africa community systems strengthening (CSS) framework

Southern Africa community systems strengthening (CSS) framework.pdf

In May 2010 the Global Fund (GF) finalized a Community Systems Strengthening (CSS) framework that provides a meaningful guide to strengthening community systems, including definitions, principles, service delivery areas, activities and key indicators.

However, the GF CSS framework falls short of regional contextualization and the elaboration of strategy to address the many competing interests and power imbalances at play in communities across the region.

The Southern Africa CSS Framework uses the Global Fund CSS framework as its foundation but argues for an appreciation of the challenges, nuances and peculiarities of the Southern African region since this is the region at the epicentre of the epidemic. Implicit within the regional CSS framework are four core elements: community systems; CSO capacity development and sustainability; integration agenda; philanthropy and social entrepreneurship.

This Framework is a resource to be used to address the unique and individual needs of communities in the Southern African region and is intended to compliment the resources developed by the Global Fund, WHO, UNAIDS and others at various levels

HIV and AIDS/STI and TB Multisectoral Strategic Plan and Implementation Framework 2015 - 2020

EAC HIV and AIDS Strategic Plan.pdf

This strategic plan lays out the strategic intents for East African Community (EAC) HIV and AIDS program for the period 2015-2020. The plan will set the boundaries within which the EAC will implement its HIV and AIDS, TB and STIs interventions within the spheres of its mandate. The costed plan will further be a tool for resource mobilization as well as being a reference point for addressing HIV and AIDS, TB and STIs issues that are trans-boundary in nature within the region.

Specific Objectives of the strategic plan includes: 
• To reduce new cases of HIV by 60%, TB by 50% and STIs by 50% by 2020 in the EAC region
• To reduce HIV and TB related mortality by 75% by 2020 in the EAC region
• To increase access and utilization of integrated HIV, TB and STI services by 50% in 2020 

Even though all Partner States have generalized HIV epidemics, with some of the highest rates of TB infection and disease burden in the world, there are still higher levels of infection and transmission within certain geographic areas, as well as among some key populations and venerable groups. Although this strategic plan promotes a broad framework for addressing HIV, STIs and TB at a general population level, it also identifies priority populations that should be targeted for specific prevention, care, treatment and support interventions based on the analysis of the EAC epidemic. The risk of HIV, STIs or TB is not equal for all populations. In the context of this strategic plan and for the purpose of regional programming, the priority populations include, but it not limited to:

  • Adolescent girls and young women
  • Migrant populations and mobile workers.
  • Orphans and other vulnerable children and adolescents
  • People with disabilities
  • Young people in and out of school
  • Adolescents living with HIV and AIDS
  • Infant and young children

This strategic plan makes provision that these populations will be targeted with different, but specific, interventions during implementation to achieve maximum impact. The EAC in collaboration with partner states will ensure geographical mapping and geographical prioritization of interventions for Key and Vulnerable populations for HIV and TB especially for regional aspects of the response.

Reflections on Africa’s Indigenous knowledge on parenting

Reflections on Africa’s Indigenous knowledge on parenting

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Indigenous knowledge of parenting.pdf

The publication  by PAN presents snapshots of indigenous parenting practices of different communities in Africa. 

Africa is blessed with diverse cultures and tribes, these rich traditions play a critical part in shaping the lives of communities and the family unit.

Indigenous positive parenting practices in Africa are under threat because of modernisation. People are moving to the cities, and the close community, and family ties of the past, is under pressure. In this Brochure, you see highlight, how the pastoralist community of the Gabra and the Maasai people in Kenya, East and the horn of Africa region; Bozo community in Mali, West Africa; Ndebele of South Africa, and the Swahili of the coastal strip of Africa parented. 

Promising practices in community engagement for elimination of new HIV infections among children by 2015 and keeping their mothers alive

Promising practices in community engagement for elimination of new HIV infections among children by 2015 and keeping their mothe

The methods used in this study included literature review and key informant interviews. “Community engagement” was defined broadly to include participation, mobilization and empowerment, while excluding activities that involve communities solely as the recipients of information or services. A “promising practice” was defined as a practice for which there is documented evidence of effectiveness in achieving intended results and some indication of replicability, scaleup or sustainability.

The promising practices identified through this research are organized below in terms of their primary intended outcome. The study describes each practice, provides documented examples, and summarizes the lessons learnt.

Protecting Africa's future: Livelihood-based social protection for orphaned and vulnerable children in East and Southern Africa

FAO REOSA policy brief 01

Despite greater access to antiretroviral (ARV) drugs in southern Africa, the current HIV epidemic continues to result in increasing numbers of orphaned and vulnerable children. In many countries in the region, as many as 50 per cent of all orphans under the age of 17 years had parents who died of AIDS-related illnesses. According to bodies like UNAIDS, this level of AIDSrelated orphanhood is expected to remain high until 2030.

Although noteworthy policy and investment in programmes aimed at responding to these children’s needs exist, too many programmes remain ill-equipped to cater for their needs in a sustainable and cost-effective way. This is partly as a result of gaps in OVC social protection policy and legislation.

This policy brief presents a series of Regional Inter-Agency Task Team for Children (RIATT) and FAO recommendations. 

Among them are:

  • Drafting stand-alone social protection policies to fill gaps in protection of orphaned and vulnerable children (OVC); and
  • Strengthening existing policy frameworks.

It also advocates for:

  • Livelihood-based social protection initiatives aimed at reducing vulnerability and providing social transfers to the poor; and
  • Protecting the vulnerable against livelihood risks and enhancing the social status of themarginalized.

Psychosocial Support Source Book for Vulnerable Children in Malawi

This practical guide for service providers working with children in Malawi is designed to improve psychosocial support services (PSS) to orphans and other vulnerable children by bringing together available knowledge and experiences in a user-friendly manner. The publication presents strategies and tools in the PSS service area in Malawi. According to the publishers, it is hoped that this Source Book will stimulate dialogue on the issue and help to develop a culture among service providers of documenting and sharing best practices. The Source Book is intended for PSS practitioners working with children in Malawi: families, volunteers and other community members, government staff, development partners, and civil society organisations including community-based organisations...

Online at: http://www.stopaidsnow.org/sites/stopaidsnow.org/files/CABA_Psychosocial-Support-Source-Book.pdf

Cadre Régional Conceptuel Pour Le Soutien Psychosocial Des Orphelins Et Autres Enfants Et Jeunes Vulnérables

Book_2_SADC_framework_f_web.pdf

Related resource: 

Regional Conceptual Framework for Psychosocial Support for Orphans and other Vulnerable Children and Youth

La région de la SADC est confrontée à une augmentation sans précédent du nombre d’enfants et de jeunes sans accès aux/qui n’ont aucun accès aux services de base nécessaires à leur survie et leur croissance harmonieuse, en particulier, la nourriture, l’éducation et les compétences de vie, les soins médicaux, l’eau potable et la santé publique, la protection contre les abus, la dénégation de leurs libertés fondamentales, et l’extrême pauvreté. Les privations et la vulnérabilité des enfants et des jeunes dans la région sont largement dues au VIH et SIDA dont on enregistre une forte prévalence dans la SADC par rapport à d’autre région globalement, des niveaux élevés de pauvreté (exacerbés par la crise globale financière et économique), et dans certains cas les conflits et catastrophes naturelles. La majorité des jeunes sont au chômage. Éprouvés par toutes ces difficultés et en l’absence de filet de sécurité, d’emploi et autres opportunités pour subvenir à leurs besoins, la majorité des enfants et des jeunes affectés ont épuisé leur capacité à répondre à leurs besoins psychologiques, sociaux, émotionnels et spirituels. Par conséquent, ils sont engagés ou probablement à risque de s’engager dans des comportements socialement déviants et risqués tels que: activités criminelles, relations sexuelles transactionnelles, conflits et violence, mariage précoce, abus d’alcool et de substance, ainsi que dépression et suicide.

Si ces problèmes perdurent et ne sont pas abordés de façon globale, ils posent une sérieuse menace au développement socio-économique, à la paix et la sécurité de la région. Par conséquent, la SADC a développé un cadre conceptuel pour le soutien psychosocial. Le cadre propose une compréhension commune des problèmes psychosociaux affectant les enfants et les jeunes gens, et les interventions requises pour garantir leur bien-être psychosocial [Avant-propos].

Regional Conceptual Framework for Psychosocial Support for Orphans and other Vulnerable Children and Youth

Book_1_SADC_framework_e_web.pdf

The SADC region is facing an unprecedented increase in the number of children and youth who are deprived of basic services which they need to survive and grow up well, in particular, food, education and life skills, health care, clean water and sanitation, protection from situations of abuse, denial of their basic liberties, and from extreme poverty. Deprivation and vulnerability of children and youth in the region is largely caused by HIV and AIDS which have been recorded to be more prevalent in SADC than in any other region globally, high levels of poverty (which has been exacerbated by the global financial and economic crisis), and in some cases conflict and natural disasters. The majority of the youth are unemployed. Compounded by all these challenges and in the absence of safety nets, employment and other livelihood earning opportunities, the majority of the affected children and youth have strained their capacity to respond to the psychological, social, emotional and spiritual needs. As a result, they are engaging or more likely to engage in socially deviant and risky behaviours such as criminal activities, transactional sex, conflict and violence, early marriage, alcohol and substance abuse, as well as depression and suicide.

If these challenges continue and are not addressed comprehensively, they pose a serious threat to socio-economic development, peace and security of the region. As a result, SADC has developed a conceptual framework for psychosocial support. The framework provides common understanding of psychosocial challenges facing children and young people, and the interventions that are required to ensure psychosocial wellbeing

Protect my future In the: The links between child protection and good governance: In the post-2015 development agenda

Protect my future In the: The links between child protection and good governance: In the post-2015 development agenda

Overall, the poor governance of the child protection sector is an indication of a lack of leadership commitment to this sector, which has been impacted by the absence of any goals, targets, or indicators on child protection in the current MDG framework. It is therefore proposed that any future framework also includes the following overall goal on child protection: Ensure all children live a life free from all forms of violence, exploitation, abuse and neglect, and thrive in a safe family environment.

Promoting Equity for Children Living in a World with HIV and AIDS

The purpose of this brief is to provide a summary of the evidence at a global level of ‘who is missing out’ on programming to achieve an AIDS-free generation, and ‘which evidence-based interventions may be implemented with partners to improve both HIV and equity outcomes’. However, this is a global snapshot, and no one specific context will match the situation presented in this brief. An equitable children and AIDS response must be based on local data and experience to determine the most appropriate interventions.

Promoting community engagement in national plans

IATT CEWG Community Engagement in National Plans Sept 2012.ppt

The Community Engagement Working Group (CEWG) recently held a meeting to discuss and concretise community action to end vertical transmission.

The Community Engagement Working Group (CEWG) is a working group developed to provide Global Plan countries with practical tools and technical assistance for developing, implementing, managing, and monitoring community engagement programs addressing the Global Plan goals and objectives.

The meeting developed a checklist of checklist of Minimum Community Engagement Activities that aim to support community engagement in prevention of mother to child transmission programmes.

See the powerpoint presentation from the CEWG meeting here. 

Reflecting on child and youth participation: A publication for programmers and policy makers in east and southern Africa

Reflecting on child and youth participation

RIATT-ESA commissioned a review of methodologies that involved child and youth participation in the eastern and southern Africa region in the context of HIV and AIDS. The review focused particularly on children’s involvement in relevant decision-making processes at policy and programming levels; in research, including monitoring and evaluation; and in conferences. 

A number of descriptive reviews of child participation have already been undertaken in recent years. In order to build on these reviews, the RIATT-ESA review decided to take an analytical approach. Therefore, the review is not a 'how to do' nor a description of what is being done in the region, but rather an attempt to highlight important issues that need to be thought about when considering how to encourage greater child and youth participation in policy making initiatives and in our programming.

The intention of the review was to delve beneath the surface of the rhetoric around child and youth participation, and ask some tough questions about what we as development professionals - in our various roles - understand about this topic, and how we perceive our own involvement. Whilst the full review is available from the RIATT-ESA secretariat, this publication is a summary of the key issues. RIATT-ESA’s ongoing collaboration, through its child rights and participation working group, with the SADC secretariat was the initial motivation for the review, and it is hoped that it will also be used to get organisations talking about how children participate in their programmes. It can also be used for advocacy purposes to raise key issues with donors, programmers and policy makers.

Supporting aid effective responses to children affected by AIDS: Lessons learnt on channelling resources to community based organisations

Supporting aid effective responses to children affected by AIDS

In response to growing numbers of orphans and vulnerable children affected by HIV and AIDS in the last two decades, many communities have formed organisations to provide material and other support to these children. Likewise, international donors and intermediary agencies have increased their funding levels and capacity building efforts to Community Based Organisations (CBOs). Considerable effort has been spent on looking at how to get financial and technical resources to CBOs quickly and efficiently.

This study seeks to improve our understanding of successful initiatives that can create a more predictable and long-term funding environment for CBOs, managing to both address the trade-off between reducing fiduciary risk of monies being misspent yet also avoid disproportionate and onerous levels of accounting and reporting for relatively small sums of money. The study is the result of field research in Uganda, Burkina Faso and Malawi undertaken between April and July 2010, in collaboration with CARE Uganda, SAT Malawi, and IPC in Burkina Faso whose support is gratefully acknowledged.

This study was commissioned and funded by UNICEF-HQ and World Vision UK (WV), as members of the Communities and Resources Working Group (C&RWG) of the Inter-Agency Task Team on Children and HIV and AIDS (IATT), in collaboration with the Regional Inter-Agency Task Teams on Children & AIDS (RIATT) for Eastern and Southern Africa and for West and Central Africa.1 It sought to identify examples of financial mechanisms that provide financial and technical resources to CBOs who themselves provide care and protection to children affected by HIV and AIDS.

Burkina Faso, Malawi and Uganda have successfully established financial mechanisms that attract funding from multiple donors, which improves alignment and harmonisation of donor funding to Civil Society Organisations (CSOs).2 These mechanisms also provide an opportunity for funding to be more strategically allocated against nationally developed strategic plans of action on OVC. However, the degree of input from community level into the setting up or resource allocation was limited. Of the over 50 CBOs interviewed during this study, none had any knowledge or understanding of the macro-environment that had such a significant impact on their access to money. In all three countries, the message was clear – money talks, and with the donor and government at the table, the voice of CBOs was usually not considered, or CBOs were considered too ‘weak’ and poorly informed to have a valid point of view.

Using the five key principles of the Paris Declaration (ownership, alignment, harmonisation, managing for results and mutual accountability) as a guide, examples of good practice and areas for further improvements were identified.