*EPF411 04/18/2002
Text: USAID Works to Help Youngest Victims of HIV/AIDS
(Agency funds 60 projects in 22 countries) (3330)

A study conducted by the U.S. Agency for International Development (USAID) finds that 34 million children around the world have lost one or both parents to AIDS. Millions more suffer when the disease strikes a family member and suffers a long period of decline, diminishing family resources and earning power. USAID Assistant Administrator for Global Health Dr. E. Anne Peterson told the House International Relations Committee April 17 that the trends are expected to get worse.

"This number is expected to increase to 44 million children by 2010," Peterson said in a hearing focused on ways that the United States may help nations cope with this aspect of the HIV/AIDS pandemic. USAID first brought attention to the youngest victims of the disease in 1997, and now supports 60 projects in 22 countries devoted to helping children.

"The fundamental principle underlying our programs for children affected by AIDS is that children are best helped by keeping them within a family environment," said Peterson. Rather than waiting until children are orphaned, some of USAID's projects work to prolong the lives of HIV/AIDS parents and minimize the disruption of family life caused by the disease, Peterson said. USAID programs work to insure that children do not suffer from hunger and lack of education as disease saps household resources.

Communities offer the next safety net for children whose families have been devastated and impoverished by disease, Peterson said, and USAID programs also work to strengthen that traditional system for coping with tragedy and loss. She said the agency's programs provide direct assistance to communities in some cases, and in others, to nongovernmental organizations (NGOs) that are mobilizing community efforts.

"Communities that have organized themselves to protect and care for vulnerable children are able to determine which children and households are most vulnerable and to channel outside resources to those most in need," Peterson said. "They are also able to identify and reintegrate those children who have slipped through the primary safety net back into families and communities."

Peterson said USAID advocates institutional care of HIV/AIDS children only as a temporary measure until they can be placed in supportive homes in their extended communities.

Following is the text of testimony Peterson presented to the committee:

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U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

Dr. E. Anne Peterson
Assistant Administrator for Global Health

before the House International Relations Committee

April 17, 2002

Chairman Hyde, members of the Committee, thank you for inviting me to testify today. The issue of children affected by AIDS is a priority for USAID. It is also an issue that I am very close to personally, as I spent six years in Africa, and part of my time there was dedicated to working with children affected by HIV/AIDS and other vulnerable children.

Scope of the Problem

The problem of children infected and affected by AIDS is enormous, increasing rapidly and unfortunately, one that will haunt us for decades to come. In 2000, USAID released a study that concluded that over 34 million children had lost one or both parents to AIDS or other causes. This number is expected to increase to 44 million children by 2010. Already in five countries in sub-Saharan Africa, more than 20 percent of children younger than age 15 are orphans. In another seven countries, more than 15 percent of children fall into this category.

As devastating as these numbers are, they do not tell the whole story. In addition to children who have become orphans, there are millions more children who are affected by AIDS. These are children who live with parents who are sick or dying of AIDS. The urgent needs of these children begins before the death of their parents, and it is important that we include these children when we try to understand the consequences for children affected by AIDS. In addition there are nearly 3 million children infected with the virus. Last year, over 800,000 children contracted HIV/AIDS, primarily through mother-to-child transmission of HIV, and the overwhelming majority of these cases are in sub-Saharan Africa. Most of the 580,000 children under the age of 15 who died of HIV/AIDS in 2001 were African.

The U.S. Agency for International Development has been at the forefront of drawing attention to the issue of children affected by AIDS. In 1997, we published Children on the .Brink, which first alerted people to the staggering impact of AIDS on children. In 2000, our new and updated version of this report provided the devastating statistics mentioned above. We will update those numbers this summer. The preliminary estimates are that the orphan crisis will become more grave as the pandemic spreads and infections increase.

In many African countries, even if new HIV infections leveled off today, infection rates would still remain high for at least 10 years. Deaths would not level off until at least 2020. Therefore the proportion of children orphaned will be unusually high through at least 2030.

Consequences

As you know, the AIDS pandemic is reversing several decades of development gains in Africa, in particular with regard to child morbidity and mortality. Increasingly hard hit are the health and education services. It also potentially has far-reaching consequences on social structure, economic development and human productivity.

AIDS is changing family and community structures. Children are forced to care for sick parents. When their parents die, children are sometimes forced to run the households themselves, and care for their younger siblings. Or, they may be sent to live with a member of their extended family. These relatives may already be caring for their own children, and may also be caring for the children of other family members who have died.

Individual children are impacted in many ways. They face the loss of their parents, and the psychological distress that goes along with such a loss. They may live in poverty, be forced to drop out of school and live with malnutrition. In addition, they face isolation, because in too many places, there is still a great stigma attached to HIV/AIDS. This stigma may also cause them to be neglected or abused. They also face a risk of contracting HIV themselves as their vulnerability increases, only adding to the cycle of HIV infection.

All of these concerns threaten key national interests related to African countries, including democracy, economic prosperity and humanitarian response.

USAID's Response

USAID has made support to children affected by AIDS a key component of our HIV/AIDS program. We are working with host country governments, citizen groups, and other donors, to meet the goal of ensuring that countries with a high prevalence of HIV-infection can provide community support services to at least 25 percent of children affected by AIDS (including children in households with sick or dying parents and orphaned children) by 2007.

As part of our effort to improve our use of scarce resources in this critical area, we are developing and testing new indicators to measure coverage of assistance programs for children affected by AIDS. This is more difficult than it may seem for several reasons. In many of the countries we work in, the concept of being an "orphan" is not part of the culture, as extended families take in children who have lost their parents. Because of the stigma attached to HIV/AIDS, it is important that children not be identified as "AIDS orphans." In addition, the issues impacting children affected by AIDS begin before a child is orphaned. All of these factors make it difficult to quantify exact coverage of these programs.

Currently, we have more than 60 projects in 22 countries working with children affected by AIDS, the vast majority of these in sub-Saharan Africa. Last year, approximately $20 million was used for children affected by AIDS to expand existing activities and initiate new ones. We expect to increase this to $40 million this fiscal year, and will continue to expand the coverage of existing activities, and support the initiation of new efforts to reach increasing numbers of children affected by AIDS.

I'd like to submit for the record USAID's publication, "Project Profiles: Children Affected by AIDS," which provides details on each of these projects. This summary was first published in October 2001. We will update it in July, and regularly thereafter, as a way to monitor our progress toward reaching our goal.

Experience to date in USAID has shown that five complementary strategies are required to best protect and care for children affected by HIV/AIDS:

-- Strengthen the capacity of families to cope

-- Mobilize and strengthen community-based responses

-- Strengthen the capacity of children and young people to meet their own needs

-- Ensure that government to protect the most vulnerable children and provide essential services

-- Create an enabling environment for affected children and families

Let me explain and give some examples of each of these program areas.

Families

The fundamental principle underlying our programs for children affected by AIDS is that children are best helped by keeping them within a family environment. Twenty years into the pandemic, families and communities have provided, and continue to provide, the first line of response, and traditional African value systems support this approach.

However, the scale of the pandemic is causing enormous strain on the traditional coping mechanisms of the extended family and their communities. As these structures are weakened under the increasing pressure caused by illness, death, and subsequent emotional and economic deterioration, children lack food, shelter, medical care, school expenses, protection from neglect and abuse, economic support, and emotional care. Increasingly, children slip through weakened safety nets to live on the streets or in child-headed households.

Therefore, USAID's programs provide families with support to cope with the strains caused by AIDS. These programs give attention to both immediate survival needs and the longer-term issues of how to improve the ability of households and families to sustain themselves.

Our programs include a combination of material and psychosocial support. We help treat parents for AIDS-related infections, like tuberculosis, so they can live longer and with dignity. And we provide them with assistance to improve their economic situation, and to increase food security.

In Uganda, USAID has made a commitment to provide $30 million in food aid in the next five years. By providing food to people living with HIV/AIDS and their families, it will improve nutritional status and will help remove one of the burdens a family faces as health deteriorates -- providing an adequate food supply. In addition food is being used to provide assistance to faith groups and other civil society groups providing home based care and support, including support for orphans and other vulnerable children. In Rwanda, several programs work together toward the goal of providing food to 22,000 AIDS-affected children.

Reducing daily labor demands within vulnerable households provides support to family members whose time is consumed by caregiving activities. Such efforts have included cooperative community childcare, extending piped water to villages, planting crops that are less labor intensive, and production of fuel-efficient stoves by local artisans to reduce the time required to collect firewood.

In Kenya, the K-Rep project receives support to provide vulnerable households with business training, access to low-interest credit, and group savings activities.

Communities

For children whose families cannot adequately provide for their basic needs, the community is the next safety net. Community groups can help vulnerable children directly or assist AIDS-affected families to provide for children's needs.

Supporting community-led initiatives to care for children and adolescents affected by HIV/AIDS is a priority for USAID. We support communities in two ways: giving them direct assistance, and by supporting non-governmental organizations that in turn support a greater number of community efforts.

Community mobilization often starts with non-governmental organizations, often with the active support of government ministries. Many work with local churches. Some have organized district-level structures that, in turn, stimulate and support village efforts. Communities that have organized themselves to protect and care for vulnerable children are able to determine which children and households are most vulnerable and to channel outside resources to those most in need. They are also able to identify and reintegrate those children who have slipped through the primary safety net back into families and communities.

In Malawi, district AIDS committees have learned mobilization skills and have set up AIDS committees, which in turn, have organized and supported 208 village committees to raise funds and channel resources to affected children and adults. These committees have aided almost 13,000 orphans and vulnerable children.

If communities are key to helping children affected by AIDS, faith-based institutions are often the catalyst for action within communities. That's why we have provided support for the first conference of religious leaders to discuss children affected by AIDS, to be held this June, in Nairobi.

Through USAID's Core Initiative, which provides grants to faith and community-based organizations, we have given the Rob Smetherham Bereavement Service for Children a small grant to educate and train community members to meet the emotional needs of children affected by AIDS deaths and the grieving they experience as a result of the death of a parent.

Young People - Meeting their Own Needs

HIV/AIDS catches children in a double bind. Faced with a premature need to support themselves, other economic pressures, and the need to replace lost labor of their parents, many are forced out of school at the very time they most need to prepare for their own futures with an education. Girls are often forced to drop out first, which not only undermines their own health and well being, but also that of the next generation. Enabling children to stay in school and providing them with opportunities to learn vocational skills improves their ability to provide for their own needs -- now and as they grow into adulthood. Measures can be taken to protect those children who must work, often as the result of the illness and death of a parent. These include: promoting safe ways for children to earn income; working with employers to improve children's working conditions, shelter, education, and training, and sensitizing police to the plight of children who work on the street and enforcing laws that protect them.

Upon the death of the parents, helping siblings to remain together is another way of strengthening orphans' ability to cope. Many poor extended families disperse orphaned siblings among different households to share the cost of their care. Interventions that enable families to keep siblings together help these children recover from their loss, support each other, and remain in their own community.

In some rural areas, remaining in their parents' house is a way for children to retain possession of the land, to support themselves, and to have a sense of continuity. To do so, they need help and support from their extended family and community, who can monitor their situation and help with cultivation, home repairs, and basic needs. Legislation and informal community interventions can help protect the property rights of orphans and widows. Child-headed households often receive ongoing support from extended family, neighbors, teachers, welfare officials, faith-based groups, non-governmental organizations, and other community initiatives. At USAID, we increasingly include support to child-headed households, as they are often the most vulnerable.

Governments

UNAIDS has identified "strong political commitment at the highest level in dealing with an epidemic" as key to combating HIV/AIDS. High level political leaders in Uganda and Senegal publicly acknowledged the disease at the onset of the epidemic and mobilized resources for disease control and prevention. These two countries are considered as having two of the best successes in fighting AIDS.

Concerted efforts are needed by governments to strengthen action to protect vulnerable children and provide essential services. National governments have generally recognized their responsibility to ensure that children are protected and cared for if they are on their own or live with adults unable or unwilling to adequately care for them. Laws and policies are fundamental to developing the necessary legal framework to protect increasing numbers of vulnerable children.

Just last week, USAID, along with UNICEF, UNAIDS, Save the Children/UK, and Family Health International, sponsored the first-ever West African meeting on children affected by AIDS. Representatives from 21 countries attended, including a delegation of four first ladies from West and Central Africa. This resulted in the development of individual country draft national action plans for children affected by AIDS. Participants committed to take the draft action plans back to their individual countries and to start a process of consulting with other stakeholders.

Environment

A fundamental area for action is increasing awareness among policy makers, community leaders, organizations, and the public about the impacts of HIV/AIDS on children and families. This involves generating a broadly shared sense of responsibility to support and protect those affected and a vision of how to do it.

Religious bodies, civic associations and other non-governmental organizations can assist in raising awareness. In many countries, faith-based networks are extensive and can be influential in urging a compassionate response to people with AIDS and their families. Religious groups can also play a critical role by identifying the most vulnerable among those affected and helping to mobilize community responses.

The role of institutions

Many have suggested that building more orphanages or other group residential facilities is an effective way to care for the increasing numbers of orphans in AIDS-affected countries.

However, the experience of international child welfare organizations has shown that children benefit greatly from the care, personal attention and social connections that families and communities can provide. Particularly in the developing world, where the extended family and community are the primary social safety nets, the absence of such connections greatly increases long-term vulnerability. Children raised in institutions often have difficulty re-entering society once they reach adulthood; many are ill equipped to fend for themselves in the outside world.

The costs for providing care to children in institutions is also exceptionally high compared to community care. Cost comparisons conducted in Uganda show the ratio of operating costs for an orphanage to be 14 times higher than those for community care. A 1992 study by the World Bank found that institutional care at one facility in Tanzania cost $1000 per year per child, a figure six times more expensive than the average cost of foster care in that country.

In developing nations, the extended family and community are the traditional and the best mechanisms for caring for orphaned children. Where circumstances prevent immediate care within a family, care in an orphanage is best used as a temporary measure until more appropriate placement or fostering within a family can be arranged.

Therefore, orphanages do provide critical services. Earlier this month, HHS Secretary Thompson and I visited two orphanages in Mozambique and South Africa, which were serving in this critical role. And we are pleased to support the community-based care of children infected by AIDS and their families through the Lea Toto program, which is a sister organization to Nyumbani Orphanage in Kenya, which you will be hearing more about on the next panel from Father D'Agostino.

Working Together Matters

Reducing the vast numbers of, and providing care and support to, children made vulnerable due to AIDS will require action from communities at all levels: global, regional, national and local.

We are proud of all the work we are doing for children affected by AIDS. But we do not do it alone. We work closely with other bilateral donors, United Nations agencies -- in particular UNICEF, national governments, non-governmental organizations, faith-based organizations and others. Together, we are working to identify and scale up model programs and to share these successes.

We thank Congress for your support on our work on children affected by AIDS, and thank you for holding this important hearing today.

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(Distributed by the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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