Wing sie cheng

Universal Access

Children as the Missing Faces of AIDS

Asia-Pacific

How many children are affected in Africa?

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How many children are affected in Asia?

Source: pg 199, 2004 Report on the Global AIDS, UNAIDS

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Source: 2004 Report on the Global AIDS, UNAIDS

Countries HIV Prevalence %

(end 2003)

Philippines < 0.1

DPR Korea No data

Mongolia <0.1

Timor-Leste <0.1

China 0.1

India 0.9

Indonesia 0.1

Lao PDR 0.1

Fiji 0.1

Nepal 0.5

Malaysia 0.4

Pakistan 0.1

Vietnam 0.4

Cambodia 1.9

Myanmar 1.2

Papua New Guinea 1.7

Thailand 1.5

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“99% of the popula-tion in Asia are still HIV negative. Let’s just keep it that way.”

Peter Piot to ADB President and staff in Manila, 22 Feb 2005

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lence %

(end 2003)

Tanzania 8.8

Central African Republic

13.5

Malawi 14.2

Zambia 16.5

Namibia 21.3

South Africa 21.5

Zimbabwe 24.6

Lesotho 28.9

Botswana 37.3

Swaziland 38.8H

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Countries HIV Prevalence % (end 2003)

Philippines < 0.1

DPR Korea No data

Mongolia <0.1

Timor-Leste <0.1

China 0.1

India 0.9

Indonesia 0.1

Lao PDR 0.1

Fiji 0.1

Nepal 0.5

Malaysia 0.4

Pakistan 0.1

Vietnam 0.4

Cambodia 1.9

Myanmar 1.2


Thailand 1.5

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lence %

(end 2003)

Tanzania 8.8

Central African Republic

13.5

Malawi 14.2

Zambia 16.5

Namibia 21.3

South Africa 21.5

Zimbabwe 24.6

Lesotho 28.9

Botswana 37.3

Swaziland 38.8H

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Countries HIV Prevalence % (end 2003)

Philippines < 0.1

DPR Korea No data

Mongolia <0.1

Timor-Leste <0.1

China 0.1

India 0.9

Indonesia 0.1

Lao PDR 0.1

Fiji 0.1

Nepal 0.5

Malaysia 0.4

Pakistan 0.1

Vietnam 0.4

Cambodia 1.9

Myanmar 1.2


Thailand 1.5

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India:

0.9 % ≈ 5.1 million

South Africa:

21.5% ≈ 4.8million

Estimated # between Sub-Saharan Africa & Asia

• HIV circulating within 3 major sub-populations: IDU, SW & MSM – with pockets of generalized epi (ANC >1%)

• Recent trend: ↑ clients of sex workers infected• Increased % of women - 23% (East Asia-Pacific), 26% (South Asia)

- 57% (Sub-Saharan Africa) Plus increased evidence of high risk of infection during pregnancy

International OVC framework

1. Strengthen the capacity of families Small scale projects, not at national policy stage except for Thailand & Cambodia through income-generation, drug, food and school assistance

2. Mobilize community-based responses to support affected familiesThailand & Cambodia (National models); India & Papua New Guinea (NGO & FBO)

3. Ensure equal access to essential servicesThailand, most recently “Health Thailand” 30-Baht Scheme that also covers ARV (including 2nd line regimen)

4. Policy, legislation, standards and enforcementChina “4 Frees 1 Care”, Thailand, Cambodia & Vietnam (legal review)

5. Raise awareness to create supportive environment (from angle of children affected)Cambodia, China, Laos, Vietnam & Thailand

Knowledge, capacity, commitment & leadership

1. Defining the target pop. – identifying beneficiariesPHIV prefers to remain anonymous, and children affected are invisible

2. Stigma & discrimination – AIDS as Social Evil

3. Approaches to programming• Spectrum of care – Info on families, foster care, adoption, and

alternative types of residential care – still not well examined (only Vietnam conducted a study)

• Integrating children affected by HIV/AIDS into broader community initiatives (selected countries: Thailand & Cambodia)

• Linking activities for children with other HIV/AIDS efforts (not much beyond PMTCT Prong III)

• Addressing fundamental needs – food security & nutrition, education, economic stability & protection (Thailand & Cambodia – not much elsewhere)

• Prevention among the most vulnerable children & youth

Source: Lynn Sussman, Providing Support to Children Affected by HIV/AIDS & their families in Low Prevalence Countries of India and Cambodia: Programmeing Issues, Policy Project, Washinton DC, Jan 2006

Coming to grip

– not only with children affected but also those Infected

Growing up alone 生存问题

Children affected by AIDS – an emerging issue

• Regional estimation conducted in 2005 – 1.5 million in Asia-Pacific (10% of global total)

• National data – not systemically collected – largely derived from initial assessments

• Estimation of orphans compounded by stigma – denial of deaths as related to AIDS

• Lack of clarity on definitions of vulnerable children & spectrum of vulnerabilitiesConservative estimates favoured in some instances due to budgetary implications – subsidies to affected families with children

Children affected by AIDS – an emerging issue

Country

At least one parent died of

AIDS

Double orphans

Children living with HIV

Thailand 300,800 30,000 --

Cambodia 60,000 -- 12,000

Papua New Guinea 9,400 -- 10,964

China -- 76,000 9,000 (in 2005 alone thru MTCT)

Vietnam 283,000 -- 19,200

Source: Various country assessments by MOPH, UNICEF or UNCT

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Countries HIV Preva-lence %

(end 2003)

National assessments - children affected by AIDS

Bangladesh Conducted – final report due Feb 2006

China 0.1 Planned - 2006 + Baseline initiated in Henan, Hubei & Yunnan

India 0.9 Exploring multiple forms of assess. at different levels

Indonesia 0.1 Planned – 2006

Lao PDR 0.1 Conducted in 2004

Fiji 0.1 --

Nepal 0.5 Conducted in 2002

Malaysia 0.4 Planned – 2006

Pakistan 0.1 --

Vietnam 0.4 Conducted 2003, along with legal review & assessment of alternative & inst. Care

Cambodia 1.9 Conducted, policy in place, national OVC working group set up

Myanmar 1.2 Small scale assessment – 2003

Papua New Guinea 1.7 Conducted 2005

Thailand 1.5 Policy & programmes in place – Good modes in Sanpatong, Chiang Mai

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Diverse cultures, local practices & governing systems

Tengatenga Care Centre for ChildrenTengatenga Care Centre for Children

Papua New Guina – 800 languages

Kartanim Care CentreKartanim Care Centre

Kenan Care CentreKenan Care Centre

Peace Care CentrePeace Care Centre

Diverse cultures, local practices & governing systems

Universal Access

Global campaign in the context of scaling up:

1. Asia-Pacific Universal Access Conference, Pattaya, Thailand, 14 – 16 Feb

2. Review of National HIV/AIDS Strategic Plan – are children given sufficient policy attention & programme support?

3. East Asia-Pacific Regional Consultation on Children and HIV/AIDS, Hanoi, Vietnam, 22 – 24 March

Universal Access

Estimated resource needs for HIV/AIDS – Asia-Pacific$4 billion - 2006

$5 billion – 2007

Eg. Thailand, 85% on treatment and care, including ARV

• Current annual spending, including both public and private out-of-pocket expenditures, about $700 million

• Region as a whole spends $100 billion a year on health care alone. Three-quarters (75%) of each dollar spent on health care right now are private payments to private providers

• Long-term financing of care & welfare support – a major issue

• Competing priorities: Recent threat of avian & pandemic human influenza

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Programmes & coverage

Programme area Global coverage survey (2004)

%

Prevention of mother-to-child-transmission

Southeast Asia regionWestern Pacific region

83

Pediatric AIDS treatment Asia & Pacific < 1.0

Voluntary Counseling & Testing Services


0.10.0

HIV/AIDS education among primary school students


1373

HIV/AIDS education among secondary school students


6433

Children living on the streets covered by prevention programs


2220

Orphans and vulnerable children receiving care and support services

Not available No data – global coverage survey of OVC due in 2006

Source: “Coverage of Selected Services for HIV/AIDS Prevention, Care and Support in Low and Middle-Income

Countries in 2003”, USAID, UNAIDS, WHO, UNICEf and the Policy Project, June 2004

Universal Access1. Key messages – children affected by AIDS – shared with UNAIDS

& Sec-Gen’s Special Representative on HIV/AIDS in Asia – Nafis Sadik

2. National consultations taking place:• Indonesia: Revised Presidential decree No. 30/1994 on HIV/AIDS

prevention and care to include children• Myanmar: National Strategic Plan should address children affected &

infected• Vietnam: Multi-sectoral response for children affected by AIDS (9 NAP

currently place children under Community Response)

3. Regional Consultation on Children and HIV/AIDS, Hanoi, Vietnam, 22 – 24 March• First of its kind (regional) in Asia• USAID/OGAC/FHI, WHO, UNESCO, Save the Children, UNICEF/UNAIDS• Defining needs, emphasizing rights of marginalized children,• International framework, coordination, integration & partnership• Hanoi Call to Action

Hanoi Call to Action, 22 – 24 Mar 2006

1. Develop country-specific targets and action plans for rapidly scaling up HIV prevention, including the prevention of maternal to child transmission, HIV testing and counseling, pediatric and adult antiretroviral treatment, family-oriented clinical care, psychosocial support and child and family protection services with accelerated effort targeted specifically for children by 2010.

2. Allocate a dedicated proportion of national HIV/AIDS budgets to the rapid scale up of responses targeted for children.

3. A quantitative and qualitative assessment of the situation of children and HIV/AIDS in each country to strengthen and scale up the response.

4. Establish systems for monitoring key indicators over time, including numbers of children infected and affected by HIV/AIDS and the core global indicators for monitoring the national response to children orphaned and made vulnerable by HIV/AIDS.

Hanoi Call to Action, 22 – 24 Mar 2006

5. National multi-sectoral working group that focuses on child welfare and coordinates the scaled up response for children vulnerable to, infected and affected by HIV/AIDS.

6. Eliminate HIV/AIDS-related stigma and discrimination, financial and other barriers to ensure that all children have access to essential services, including a continuous basic education.

7. Expanded efforts to ensure that all children are provided with the most family-like care environment and that institutional care is used for children without caregivers only as a temporary measure or option of last resort.

Over 200 government & NGO representatives from 17 countries in East Asia & Pacific

Thank you

Wing-Sie ChengRegional Adviser, HIV/AIDSUNICEF East Asia & Pacific Regional OfficeBangkok, ThailandEmail: [email protected]

Wing sie cheng

Health & Medicine

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