Memorandum submitted by Plan UK
SUMMARY
This submission, by Plan UK, aims to demonstrate
how children and young people are marginalised in terms of HIV
prevention, treatment, care and support. There are currently over
two million children living with HIV around the world, [47]yet
fewer than 5% of these have access to treatment.
In addition to the two million children infected
by HIV globally, the needs of young people affected by HIV—through
vulnerability, losing parents and family members and other factors—also
need to be addressed.
Plan welcomes the emphasis on young people in
"Taking Action: The UK's strategy for tackling HIV and AIDS
in the developing world", but more action is needed if children
are to be protected and cared for in a world with HIV.
As well as highlighting the main ways in which
children are marginalised in terms of HIV prevention, treatment,
care and support, this submission also makes recommendations as
to how the UK government could begin to respond better to the
needs of children.
INTRODUCTION
1. Plan is an international child centred
development organisation, committed to promoting the rights of
children world-wide. We currently operate in 46 developing countries.
Plan UK welcomes the opportunity to feed into the Committee's
inquiry on groups marginalised in the provision of HIV prevention,
treatment, care and support.
2. There are currently more than two million
children living with HIV around the world. [48]In
2005 alone, 640,000 children were newly infected and 510,000 children
died of HIV. A child dies of an AIDS-related illness every minute.
3. Despite this, the needs of children with
HIV have been largely left out of the research agenda and their
needs are still being over-looked when strategies on HIV prevention
and treatment are drafted and policies are developed.
4. Fewer than 5% of HIV-positive children
have access to treatment. Although there has been some improvement
in recent years in paediatric access to treatment, children progress
faster than adults to AIDS and therefore it is essential that
the needs of children are addressed urgently in the drive for
universal access to treatment.
5. It is important to recognise that as
well as addressing the needs of the many children infected by
HIV, there is also an urgent need to support children who are
affected by HIV in some way, for example those who have been orphaned
or are vulnerable to infection. Fewer than 10% of the estimated
14 million children who have lost parents to AIDS receive any
public support or care.
6. The vast majority (almost nine out of
10) of the children affected by HIV and AIDS live in Sub-Saharan
Africa and an estimated 15.7 million children there will have
lost at least one parent to AIDS by 2010. [49]
HOW ARE
CHILDREN MARGINALISED?
7. Although an increasing number of children
worldwide are infected with HIV, their care and treatment is still
not being treated as an urgent priority. Children form a silent
majority in the world and it is often difficult for them to make
their voices—and needs—heard. Governments are failing
to sufficiently prioritise children in national plans of action
on HIV and AIDS.
8. In many countries, there is a continued
violation of children's sexual and reproductive rights and an
increasing need to reduce children and young people's growing
vulnerability to HIV infection. Factors which increase children's
vulnerability to HIV infection—such as poverty and gender
inequality—need to be tackled effectively.
1. Prevention
9. Children are the primary constituency
for HIV infection, because their entire life will be influenced
by the way in which the epidemic is growing. The people who have
the greatest interest in preventing the spread of HIV are children,
because spreading HIV infection has an impact on the life of a
society in 20 to 30 years time, and not today.
10. Children are unable to protect themselves
from HIV infection. Although HIV infection at birth has been almost
eliminated in industrialised countries, many children in the developing
world continue to be infected. Around 35-40% of HIV positive mothers
transmit HIV to their babies, although proven interventions to
prevent HIV transmission from mothers to children can reduce this
risk to less than 5%. However, only 8% of HIV positive women in
developing countries currently receive anti-retroviral treatment
for Preventing Mother-To-Child-Transmission (PMTCT). [50]Not
enough is being done to prevent babies being infected with HIV
at birth.
11. A recent report by Plan International
highlighted how lack of awareness is rarely the main reason for
children's vulnerability to HIV infection. [51]Poverty,
tradition, disempowerment, gender inequality and other social
factors severely limit young people's margins of choice to adopt
behaviours that protect them from HIV infection. Young girls are
particularly vulnerable as they tend to be less likely to be in
control of when they have sex, with whom and how. Early marriages
to older men, sexual coercion and sexual violence all seriously
impact on the ability of girls and young women to protect themselves:
"My friend [a 13 year-old girl] lived on
her own with her 11 year-old brother after their parents had died.
Her uncle was a drunkard. He went with a drunken friend of his
to the children's house and the friend defiled the girl. She got
pregnant, and he also made her HIV-positive—at only 13 years
of age." Prossy, aged 16, Uganda. [52]
12. Victims of child trafficking, a serious
problem in West Africa and South Asia, are frequently exposed
to HIV infection, particularly as many end up being exploited
sexually or sold into prostitution. These children therefore have
no ability to protect themselves from HIV infection.
2. Access to diagnosis
13. Children are also marginalised in terms
of having access to diagnosis of HIV in many parts of the world.
Although HIV testing and counselling services are starting to
become widely available, they are often not youth-friendly, and
children and adolescents rarely have access to these services.
14. Although antibody testing is widespread,
it cannot be used for children under 18 months. Antigen testing,
which could be used for these children, is expensive and not widely
available. There is an urgent need to develop appropriate and
affordable tests for children, as many cases of HIV infection
in young children are currently going undetected.
3. Access to treatment
15. One of the most crucial ways in which
children are marginalised is through lack of access to treatment.
Although evidence suggests that children respond well to treatment
and that universal access to treatment is a basic right of every
child, less than 6% of those on antiretroviral treatment (ART)
are children, [53]whereas
at least 15% of those on treatment should be children. [54]
16. Without treatment, one in three HIV
positive babies will have died by the age of one. Even using simple
medication, such as cotrimoxazole, which are widely available
and cheap, can make a big improvement in a child's health. [55]However,
the majority of children in developing countries are still not
receiving any form of treatment. Routine use of cotrimoxazole
for all babies exposed to HIV (ie born to HIV mothers) is affordable,
easy to implement and would greatly reduce the mortality of children
living with HIV. Yet this is still not being done.
17. Another key issue which is often neglected
in HIV treatment programmes is nutrition. In order for HIV programmes
to be effective, it is important that they address the issue of
malnutrition which is widespread in many communities with a high
HIV prevalence.
18. The health systems in many countries
are simply not able to cope with the number of adults and children
affected by HIV. In particular, many countries face serious human
resources constraints in the health sector which is impacting
on the provision of medical care and treatment to children with
HIV. There is a limited capacity for health systems in terms of
child health interventions and specialised services.
19. A key problem preventing all children
from receiving treatment is the lack of "child-friendly"
formulations that have been developed by pharmaceutical companies.
Although there has been some progress made on this recently with
the development of new drugs, the medication required by children
is more expensive than adult formulations. Other problems concerning
the drugs include the lack of simple dosing guidelines and problems
with the shipment and storage of medicines.
4. Legal issues
20. HIV positive children often face discrimination
and can be victimised by their community. In some cases, children
infected with HIV are thrown out of their houses and denied their
legal rights.
21. This is also a problem faced by a number
of children orphaned by AIDS, as in some cases they have their
property seized and are left homeless.
22. The failure of states to register the
births of all children mean that often vulnerable children are
denied access to inheritance, education and health care as they
do not have an official birth certificate.
HOW DOES
PLAN'S
COMMUNITY-BASED
RESPONSE WORK
WITH MARGINALISED
GROUPS?
23. Plan works to reduce children's vulnerability
to infection. Preventing HIV infection at birth is part of Plan's
work to improve the safety of pregnancy, delivery and infant care.
In Uganda and in Benin, Plan supports the Ministry of Health in
delivering services to prevent HIV infection among infants during
pregnancy and delivery. [56]
24. The core focus of Plan's work is child-centred
community development. A crucial part of this work involves supporting
and strengthening community-based mechanisms of support for children
affected by HIV to help reduce children's vulnerability.
25. Child protection work, such as combating
child trafficking and advocacy to end early marriages, are vital
in order to prevent children and young people from becoming infected
with HIV.
26. Plan works to promote the legal rights
of children affected by HIV and AIDS, for example by promoting
universal birth registration. This is vital in order that every
child is recognised as a citizen of their country. Without a birth
certificate, children may be denied their basic rights, such as
access to health care and education. It also enables children
to claim their rightful inheritance, which is vital for children
whose parents are suffering from AIDS.
27. Plan provides family therapy to support
children and parents affected by HIV. This emotional support is
vital and is an area that is often neglected in resource poor
settings. A key part of Plan's HIV work involves planning for
succession, which allows parents to help plan for their child's
future. The use of memory books, pioneered in Uganda, is a way
to help both children and parents to prepare for life after the
death of one or both parents. [57]
28. Plan is working with Ministries of Health
in a number of countries to make health services more "child
and youth-friendly". This is vital both for the prevention
of HIV in young people and in terms of the provision of treatment.
29. Plan focuses on improving nutrition
and food security, livelihood and emotional support to children
affected by HIV. An important part of Plan's work involves community
mobilisation to eliminate stigma and discrimination, which is
often directed at HIV positive children.
WHAT SHOULD
DFID BE DOING
TO ADDRESS
THE NEEDS
OF CHILDREN
AFFECTED BY
HIV?
30. DFID should ensure and encourage children's
participation in HIV and AIDS programmes. The UK response to the
global HIV epidemic should be developed in consultation with children
and young people. In particular, DFID should recognise the key
role of adolescents in HIV prevention.
31. DFID should work with national governments
and partners to develop comprehensive social protection packages
of support for all children and their families, encouraging national
governments to commit a specific proportion of their national
budget for such support and should recognise and respect minimum
standards and targets. DFID should ensure that any measures directed
towards vulnerable families are financially sustainable and are
consistent with government thinking on "best practice"
in social protection.
32. DFID should provide support to communities
with a high HIV prevalence to help protect vulnerable children
from being infected. A particular emphasis should be placed on
areas where children are not being protected due to severe poverty
and a lack of family support.
33. DFID should provide long-term, predictable,
and increasing as a proportion as capacities build, financing
for supporting the development of health services in developing
countries. In the case of fragile states, DFID should better coordinate
with non-governmental agencies providing health services.
34. DFID should continue to provide political
leadership to ensure that the world comes as close as possible
to the goal of universal access to anti-retroviral treatment by
2010, and to support developing countries in providing access
to appropriate and affordable medicines, especially formulations
and diagnostics adapted to the specific needs of children. The
setting of specific targets for children needs to be included.
35. DFID should support the scaling up of
innovative, local initiatives which help to prepare children affected
by AIDS for the future.
October 2006
47 UNAIDS, Report on the Global AIDS Epidemic,
2006. Back
48
Ibid. Back
49
UNICEF, Children Affected by AIDS: Africa's Orphaned and Vulnerable
Generations, 2006. Back
50
UNICEF, Children-The missing face of AIDS, 2005. Back
51
Plan International, Circle of Hope: Children's Rights in a
World with AIDS, July 2006. Back
52
Plan International, Circle of Hope: Children's rights in a
world with AIDS, July 2006. Back
53
World Health Organization, Scaling up in resource poor settings-what
about the children?, a presentation given at ODI, 24 July
2006. Back
54
UNICEF, Children-The missing face of AIDS, 2005. Back
55
Ibid. Back
56
Plan International, Circle of Hope: Children's rights in a
world with AIDS, July 2006. Back
57
Plan International, Circle of Hope: Children's rights in a
world with AIDS, July 2006. Back
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