1. Dr Rachel Yates Senior Adviser, UNICEF HIV/AIDS section New York OWN, SCALE-UP & SUSTAIN The 16 th International Conference on AIDS & STIs in Africa 4 to 8 December 2011, Addis Ababa www.icasa2011addis.org

2. Effective and rights based approaches for CABA

3. Purpose of presentation Global progress for CABA Opportunities to ensure evidence based scale Good practice related to ensuring more effective and rights-based social service programming for CABA in Africa Importance of African leadership for sustainable nationally owned approaches

4. Scale of problem: Estimated number of children who lost one or both parents to AIDS & adult HIV prevalence - Africa & global, 1990-2009

5. SIGNS OF PROGRESS T RENDS IN ORPHAN AND NON - ORPHAN SCHOOL ATTENDANCE RATIOS IN SELECTED COUNTRIES, 1997–2008

6. Community & faith-based organisations at the forefront of responding to affected children – but often in isolation from government policy & services, small scale. Inadequate support reaching households with OVC: median 11% of households receive external support, Lead Ministries of CABA response have insufficient human, financial, & institutional capacity; BUT Still need for more effective and accelerated response for CABA

7. New evidence based Guidance on good practice for CABA 1.Child vulnerability in the context of HIV. 2.Child-sensitive social protection to broaden coverage & sustain responses for children affected by AIDS 3.Strengthening national social welfare systems for all vulnerable children. 4.Increase aid effectiveness of programmes, services & funding. 5.Families and communities at the center of response. 6.Equity and rights – reaching the unreached TAKING EVIDENCE TO IMPACT: MAKING A DIFFERENCE FOR VULNERABLE CHILDREN LIVING IN A WORLD WITH HIV AND AIDS

8. 1: Evidence based approaches to vulnerability and targeting Being a single or double orphan is not consistently a useful predictor of child vulnerability A combination of variables should be used to identify and reach vulnerable children including household wealth, education levels in household, residency of children – in addition to orphaning Targeting of orphans in isolation of other vulnerable children can lead to stigma and discrimination Need for HIV sensitive as opposed to HIV exclusive interventions Give greater attention to drivers of social exclusion (disability, displacement, ethnicity and punitive laws) which make children vulnerable Age and gender analysis need to be integrated into vulnerability assessments.

9. 2: HIV and child sensitive social protection UNAIDS identified social protection as priority area for increasing social and economic resilience of households Cash transfers scaling up in many countries in Africa as CABA/HIV response Social transfers important but not sufficient In Malawi comprehensive set of initiatives including cash transfers, ECD and community child protection workers households New UNAIDS guidance document on HIV and social protection highlighting best practice

10. 3: supporting National Social Welfare systems Investments in social welfare and child protection systems are essential for nationally owned, sustainable responses to CABA and other vulnerable children. Greater investments needed in human resources. Investments needed in district and sub-district social welfare systems (both government and non- governmental) Need for better referrals between social welfare and health systems – help reach the unreached. Families and communities need to be central to the effort to improve health and social welfare systems

11. 4: Equitable and rights based responses HIV driver of poverty and social exclusion CABA interventions address economic and social consequences of epidemic (economic strengthening, reducing including stigma and discrimination etc) Interventions for CABA can be bridge from community to clinic Targeted interventions needed for most socially marginalized children may be needed (street children, children of sex workers, displaced ) Need to respond more to the gender specific needs of boys and girls – e.g. Tanzania and Swaziland work on gender based violence. Promote participation of children and their families in identifying appropriate interventions

12. 5: Roles of African Leadership for accelerating Action 17 countries in East & Southern Africa have National Plans of Action for CABA But little scale up & not integrated with national development plans. Good opportunities to link programmes for CABA with national social protection scale up (Zimbabwe, Malawi, Kenya, Ghana) Response needs cross-governmental commitment, health, finance, education. High level co-ordination can help e.g. under Vice Presidents. 2010 Parliamentarians have critical role – Namibian Parliament convened meeting 13 parliamentarian delegations from East and Southern Africa on child and HIV sensitive social protection. Community leadership essential – transparent mechanisms for identifying most vulnerable, holding gvmts to account, reducing stigma and discrimination

13. THANK YOU