The role of ECD services in reaching Children Affected by HIV/AIDS Sonja Giese Technical Workshop of the Africa ECCD Initiative Cape Town, South Africa July 26-28, 2010

Presentation SA policy at the intersect btw HIV and ECD The way in which HIV/AIDS amplifies the need for early childhood interventions in South Africa Opportunities within ECD for impacting HIV- and AIDS-affected children and families

ECD and HIV in policy Since 1994, major policy developments in all spheres in SA, including ECD Government commitment to ECD - identified as apex priority (2008), with commitment to massively upscale ECD services ECD policy environment in SA particularly complex (DSD, DOH and DOE). National Integrated Plan for ECD ( ) aims “to ensure access to an appropriate and effective integrated system of prevention, care and support services for children infected and affected by HIV and AIDS” HIV/AIDS and STI National Strategic Plan ( ): –Promotes comprehensive ECD package –Calls on the DOE to develop and distribute national guidelines on children and HIV in preschools (to reach 90% preschools by 2011) –Calls on DOE to develop capacity of ECD centres to provide psychosocial, educational, and adherence support to children in need (80% centres by 2011) –Calls on DOH to implement biannual developmental screening for all children <5 years (60% children <5 years by 2011)

HIV/AIDS and poverty in SA Approximately 6 million people in South Africa are living with HIV HIV prevalence among women (15-49 years) attending antenatal clinics is almost 30% AIDS is leading cause of death in women (mothers) below 49 years There are ~3.7 million orphans in SA In most instances, these children live in severely deprived communities – HIV/AIDS therefore amplifies existing burdens 2/3rds of children under 5 years of age live in poverty Children under 5 years have the highest mortality rate in the South African population (57.6 per 1,000) And SA’s infant mortality rate has increased over the past 10 years

HIV/AIDS amplifies need for support in early childhood HIV-positive infants and children are extremely vulnerable and, without treatment and care, 40% die before their first birthday For those who survive, there is high risk of mental and physical disabilities HIV-affected children are at greater risk of maltreatment HIV increases risk of maternal depression, leading to reduced capacity to care and poorer child outcomes Children in families affected by AIDS may be at particular risk for under and malnutrition Where caregivers are absent or ill, young children often take responsibility for caring for younger siblings - increasing risks for both The financial burden of AIDS on a family often means reduced access to essential services (including health care) The psychosocial impact of HIV/AIDS on a child can impact all spheres of his / her development

Programmes that have the greatest impact on child growth and development * Commence prenatally and extend into infancy and early childhood as a continuous chain of support Combine interventions in a ‘package of services’ eg. child nutrition, parental education on diet and feeding practices, supplementary foods or micronutrient supplements, and parenting and child development education Utilise several simultaneous ‘delivery channels’ e.g. home visits, group counselling, childcare centres and mass media *Dawes, Biersteker, Irvine (2010)

ECD – a window of opportunity Birth registration PMTCT services HIV treatment Child protection Social Grants Early screening for disability

The best way to support children affected by HIV/AIDS is to strengthen circles of care for all children

Summary of key points 1.HIV ‘ticks all the boxes’ when it comes to factors that negatively impact early childhood outcomes 2.ECD services offer a window of opportunity to respond to these risks at a stage when the greatest positive impact can be made 3.However – ECD interventions in vulnerable communities should NOT be inappropriately targeted at AIDS-affected children to the exclusion of other vulnerable children