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1、Synthesis PresentationJimmy Kolker, UNICEF Global Partners Forum on Children and AIDS Dublin, 6 October 2008Thanks to Irish Government, UN Cosponsors, organizers, participantsThere are 15 million children around the world who have lost one or both parents to AIDSNearly 12 million of them are in Afri
2、ca.Not long ago, these children were the invisible face of the AIDS epidemic.Not only were their faces rarely seen where AIDS was discussed and plans were made, but data and evidence were missing about who they are, what they need and how the rest of us have helped them or failed to help.But we are
3、here today with the positive and promising message that not only do the authorities increasingly see and hear these children, but at last we have some solid evidence about them and their situation.Thanks to the focused work of the Interagency Task Team on Children and AIDS, to the Joint Learning Ini
4、tiative, to UNAIDS, to my own organization UNICEF and many others, we now know a lot about children affected by AIDS.The JLICA summary paper is in your folders. It and the IATT summary will be presented by the next speakers. Also in your folders is a paper entitled “Synthesis of Evidence” where we h
5、ave attempted to summarize new data from all sources as the basis for action. I urge you to review and share these important studies.While once missing in the international response, children who lost a parent, or are otherwise affected by AIDS have NOT been invisible to their own families and commu
6、nities. More than 90 percent of them are living in a family with a surviving parent or relative. In Zimbabwe, 98% of children who have lost one or both parents are living in a family setting.We also know that partners such as the United States, United Kingdom and Irish Governments have invested AIDS
7、 resources in helping children affected by AIDS and their families. Virtually everyone in the room represents an organization or government which is now responding to the needs of AIDS-affected and other vulnerable children.What else do we know? We know that the caregivers are predominantly female,
8、some of them are children themselves, and an estimated 1 million of them are elderly. And we know that children living in parent or grandparent headed households have less need for outside psychosocial support.But we also know that analysis of several high-prevalence countries show that only 15 perc
9、ent of these households caring for an AIDS-affected child are getting any kind of outside assistance at all to help them deal with this burden.Ladies and GentlemenIt is almost a clich to say that AIDS has had a huge impact on all aspects of society. And it has brought to light, exposed, and aggravat
10、ed many of the vulnerabilities of those nations and communities hardest hit.Scaling up toward the goal we all share of universal access to testing, prevention, care, and treatment of HIV has revealed chronic weaknesses in health systems. PMTCT and paediatric treatment, for example, cannot reach ever
11、yone in need unless they are an integral part of functioning primary health care for mothers and newborns. Likewise, scaling up help to children affected by AIDS is hampered by poorly developed and poorly functioning or even non-existent national child welfare systems.In communities with widespread
12、poverty and high HIV prevalence, there is a huge overlap, the studies show 70-80% overlap, between children vulnerable because of AIDS and children vulnerable for other causes.Thus, in these communities, singling out “AIDS orphans” is not only stigmatizing, it is virtually impossible. Where AIDS int
13、ersects with extreme poverty, with conflict and with high dependency ratios, helping all vulnerable children looks like a wise and cost-effective strategy for reaching those affected by AIDS.There is no question that a child who is HIV+ or whose parents are HIV+ has special needs. Nonetheless, the M
14、ACRO/Futures analysis of 37 potential indicators of vulnerability drawn from population based surveys showed that the markers which most consistently correlated with vulnerability were not AIDS or orphanhood, but asset ownership, household wealth status and education level of adults in the household
15、.This finding has several practical consequences. It means that our interventions, which are part of the global fight against AIDS need to be AIDS-driven, but not AIDS exclusive. It means that if an orphaned niece is taken in by her poverty-stricken aunt and uncle, it would be a mistake to provide h
16、elp only for the niece and ignore the other children and priority needs of the family as a whole. And if all of the neighbors are equally poor, helping only those families affected by AIDS likewise makes little sense.What sort of help does the most good?We now have evidence to support that usual hypothesis of social scientists, “It depends.”Lets look at school
