1. To prepare as we care? The need for new approaches to linking protection for children to HIV prevention Findings from JLICA LG4 Jerker Edstrom Institute of Development Studies, UK

2. Setting the stage The response to HIV and AIDS initially focused on people’s ‘vulnerability’ to HIV infection. Then, on treatment and rights Children have been seen mainly as vulnerable to the impacts of AIDS in families and communities The two perspectives rarely meet, as institutional and disciplinary ‘silos’ have no common language of ‘vulnerability’ JLICA LG4 asked: “What is the evidence for connections across these senses of vulnerability for children?” “What are the needs for joined-up policies between prevention and protection and care of vulnerable children, including those affected by HIV and AIDS?”

3. Four studies carried out Two qualitative studies on vulnerability to HIV of (primarily) adolescent girls in poor areas of Tanzania, by Mabala et al. ( TAMASHA and TADREG ) and India (SEWA) A review of evidence for intergenerational linkages from impact of HIV (esp. orphaning) and vulnerability to infection, by Cluver and Operario (Oxford) A review of recent studies on the social and economic determinants of vulnerability to HIV amongst adolescents in South Africa, by Hallman (Pop Council) –Forthcoming in the IDS Bulletin, Nov 08, ‘Children and AIDS’

4. Impacts of being affected on chances of becoming infected Orphans are typically more sexually vulnerable than other children – orphan girls more than orphan boys The death of a parent of the same sex as the child is particularly significant – for both boys and girls Parental illness and death can impact psychosocial well-being and risk behaviour of adolescent children

5. Poverty, inequality and vulnerability to infection Adolescent girls are particularly affected by a combination of orphaning and poverty, making them particularly vulnerable to sexual risk Poorer adolescents display earlier sexual debut, higher rates of “transactional sex”, lower levels of control in negotiations and condom use and experience higher levels of sexual violence The Tanzania study found that out of adolescents working as sex workers, 75% were orphans

6. Education and social inclusion Parental illness and death impact children’s education –particularly with maternal orphaning Some research shows that schools can be places of sexual risk and exploitation for vulnerable adolescents However, overall, participation in education lowers sexual risks, early pregnancies or vulnerability to HIV Importantly, sexual vulnerability is mitigated by children’s social capital, or participation in groups, clubs, sports etc., beyond the family or the classroom

7. Implications We need joined-up policy and programming between OVC impact mitigation and adolescent HIV prevention and sexual and reproductive health Common prevention strategies relying on generic messages (e.g. ‘ABC’) are often poorly targeted –and worse.. They are irrelevant to the personal, social and structural sources of vulnerability of the most affected children Solutions need to be tailored to the specific context and to specific groups of vulnerable kids: We can not give blue-print solutions to problems shaped by context

8. Targeting: let form follow function Findings do not suggest targeting ‘AIDS orphans’, but to identify the most vulnerable children for prevention Social Protection for poor families should be concerned with orphans and children with seriously ill carers and link to programmes aimed at empowering them Support households in ways that strengthens continuous support between carers and children Vulnerable children need to be supported to engage in positive social peer-groups away from home and school Schools and other community institutions also matter and they need to be able to identify kids in trouble

9. Summary Adolescents are a major proportion of vulnerable children and they are inadequately supported Those affected by HIV or other family crises are highly vulnerable to HIV and sexual and reproductive ill-health We should not target ‘AIDS orphans’, but need to identify the most vulnerable children, in local contexts Make policy in social protection, education and prevention complementary and sensitive to both impacts and dynamics of HIV involving children

10. Summary Invest in access to schooling for the most vulnerable and root out sexual abuse in particular schools We need structural prevention approaches for vulnerable adolescents, which: –better target the children most vulnerable to infection –involve context-specific, social and structural analyses –emphasise social inclusion and capital beyond the home –aim to transform inequitable attitudes to gender and sexuality The relevant children most vulnerable to HIV need to actively participate in designing empowering solutions

11. Thank you With special thanks to: Kelly Hallman Richard Mabala Lucie Cluver Don Operario Doug Webb Masuma Mamdani Alex DeWaal and innumerable others involved in the studies and in JLICA