Supplementary memorandum submitted by
CHILDREN, HIV AND AIDS: IMPACTS, ISSUES AND
WHAT CAN BE DONE
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
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.
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
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
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.
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
mobilise commitment and capacity
to act. This includes breaking the "conspiracy of silence"and
its associated stigma and discriminationthat 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
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
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.
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.
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 methodssuch
as female and male condoms, voluntary testing, counselling, and
follow upby 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
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
(e) expand cooperation with NGOs working
(f) expand support for UK-based research
and training institutions involved in HIV/AIDS research, programming,
monitoring and evaluation.
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