1. AIDS Orphans In Kenya Maureen Waithaka Jackson State University Jackson, MS

2. PLACEMENT SITE Sponsorship: Jackson State University, College of Public Service, Department of Epidemiology and Biostatistics Site: Kenya (East Africa) Location: Nairobi and Mombasa On-site: 3 weeks Target group : AIDS orphans between the ages of 13 and 18 years

3. GOAL To investigate the effectiveness, accessibility and quality of personal health services for AIDS orphans in Kenya between the ages of 13- 18 years

4. DEFINITION AIDS orphan 4 types: Single orphan- a child who has lost one parent Double orphan- a child who has lost both parents Maternal orphan- a child whose mother has died (includes double orphans) Paternal orphan – a child whose father has died (includes double orphans) Source: African Orphaned and Vulnerable Generations, 2006.

5. PRIMARY CONTACTS Governmental organizations Non-governmental organizations Faith-based organizations Community-based organizations AIDS orphanages

7. SUB-SAHARAN STATISTICS Presently: Home : app > 48 million orphans 12 million of these orphans = AIDS epidemic Mostly between the ages of 0-17 years have lost one or both parents to AIDS Future projections Estimated that AIDS orphan population will increase by 20 million by 2010: Overall 68 million in continent Source: UNAIDS Estimates, 2006.

8. WHO IS CARING FOR AIDS ORPHANS IN KENYA? WHO IS CARING FOR AIDS ORPHANS IN KENYA? In 2006: Prevalence rates: levelling out Incident rates (number of new infections) increasing with population growth - ARVs - ARVs -AIDS is a leading cause of death among adults between the ages of 15-59 years Source : Analysis of HIV Prevalence trends in Kenya 2003, KDHS

9. KENYA STATISTICS HIV/AIDS was declared a national disaster by the former President of the Republic of Kenya on 25 November 1999 2.2 million people were infected with HIV by the year 2003 1.5 million people have already died from AIDS related illness leaving behind 800,000 orphans This number is expected to increase to 2.3 million by 2010 App. 700 people die each day from AIDS related illness Source: KICOSHEP Training Manual, 2004

10. HOW CHILDREN ARE INFECTED Mother- To- Child Transmission (MTCT): During pregnancy During pregnancy Labor Labor Vaginal delivery Vaginal delivery Breastfeeding Breastfeeding Risk of HIV transmission: during pregnancy app 5- 10 % during labor and vaginal delivery app 10 - 20 % during breastfeeding app 10 –20% Source: National Policy on Orphans and Vulnerable Children, 2005

11. DIRECT AFFECTS OF HIV/AIDS In poverty stricken areas Dependency Ratios Property Dispossession Stigmatization, discrimination and isolation Psychological Distress Withdrawal From School Child Labor Malnutrition and Illness Extended families

12. INDIRECT AFFECTS OF HIV/AIDS Strain on human resources Depletion of human resources

13. RESPONSIBILITIES To investigate: Formulation of discussion questions Formulation of discussion questions Formulation of survey Formulation of survey Application to the research and ethics committee Application to the research and ethics committee Personal booking of appointments Personal booking of appointments

14. RESPONSIBILITIES Chose forums for data collection Lectures Lectures Seminars Seminars Presentations Presentations Discussions Discussions

15. RESPONSIBILITIES Locate the target population (AIDS Orphans) Challenge: Childrens homes are not distributed equally within countries Many children in grandparent headed homes. Extreme cases – headed by child In (remote) rural areas

16. DATA COLLECTION CHALLENGES Approval from ethics and research committee Could not take pictures of older AIDS orphans for fear of stigmatization, discrimination and isolation if recognized Faced stigmatization upon request to be transported to the orphanages Mistrust, competition, suspicion and unwillingness to share information among different groups in different organizations

17. DATA COLLECTION CHALLENGES Key informants difficult to find in order to be directed into homes Difficult to find homes since many are not listed on local maps and local address books

18. CURRENT PROGRAM LIMITATIONS CURRENT PROGRAM LIMITATIONS Prevention and Advocacy Institutional arrangements, managements and coordination Mitigation of Socio- economic impact Community Empowerment Human Resource and Development Evidence-based Interventions Source: A review of reports prepared by civil society groups (NGOs, CBOs and FBOs) and showed that a number of obstacles and constraints have been implicated for the current Kenya National HIV/AIDS Strategic Plan,2000-2005

19. RECOMENDATION I: Community-based Approach All activities will be focused on ensuring that individuals, households and communities carry out appropriate healthy behaviors and recognize signs and symptoms of conditions that need to be managed at other levels of the system- in this case, HIV/AIDS. Each level unit is to take care of 5,000 persons Why? Communities are at the foundation of affordable, equitable and effective health care. The Kenya Essential Package for Health Proposal in the second National Health Sector Strategic Plan 2005-2010

20. RECOMENDATION II: From Community –based Approach to Child-to-Child Approach Use a KANCO model -Child –to child approach- (CTC) An educational process that links childrens learning with taking action. An educational process that links childrens learning with taking action. A rights based approach to childrens participation in health promotion and development that is grounded in the United Nations Convention on the Rights of Children- principles of inclusion and non-discrimination- be inclusive and involve as many children without selection or exclusion on the basis of gender, disability, ethnicity and religion. A rights based approach to childrens participation in health promotion and development that is grounded in the United Nations Convention on the Rights of Children- principles of inclusion and non-discrimination- be inclusive and involve as many children without selection or exclusion on the basis of gender, disability, ethnicity and religion.

21. CONCLUSION Benefit of CTC approach: Builds self-confidence Provides useful knowledge Empowers them with life skills Builds on their personal development Builds on their social development Positive channel of energy and creativity Challenges to CTC approach. Display of power relation between adults and children Display of power relations among children (bullying) The role children play in their families, communities and the society A childs competencies and age of children Culture

22. Eradication of poverty is essential because poverty compounds powerlessness and increases ill health, as ill health increases poverty. Thank You

23. REFERENCES Ansell, Nicola and Young, L. (2004, January). Enabling Household to Support Successful Migration of AIDS Orphans in South Africa. AIDS Care, 16(1), and 3-10. Case, Anne, Parson M, et al. (2004, August). Orphans of Africa: Parental Death, Poverty and School Enrollment. Demography, 4 (3), 483-508. Chatterrji, Minki, et al. (2005). The Well-being of Children affected by HIV/AIDS in Lusaka, Zambia and Gitarama province, Rwanda. Community REACH Work. Washington D.C. Paper No.2. Chatterrji, Minki, et al. (2004-2005). Orphan and Other Vulnerable Children in Rural and Urban High Density Zimbabwe. United Nations Childrens Fund and Ministry of public service, Labor and Social Welfare Survey.

24. REFERENCES Chatterrji, Minki, et al. (2005, June). Report on the Pilot survey on Orphans and Other Vulnerable Children in Blantyre, Malawi. United Nations Childrens Fund Vulnerable Children in Blantyre, Malawi. United Nations Childrens Fund Evans, D. (2005, December). The Spillover Impacts of Africas Orphans. Rand Corporation Working Paper. Santa Monica.10-11. Floyd, Sian, et al. (2005, September). HIV and Orphan hood. UNICEF Project. Monasch, Roeland and Boerma, J. cit pp S55-S65. Nhate, Virgulion, et al. (2005). Orphans and Discrimination in Mozambique. An Outlay Equivalence Analysis. International Policy Research Institute, 1-2, 12. Seaman, Petty.J, Petty.C, Acidri. J. 2005. The Impact of HIV/AIDS on household Economy in two villages in Salima District. Save the Children. Verbose, Heidi. (2005). A child Has Many Mothers. Views of Child Fostering in Northwestern Cameroon. Childhood. 12(3), 369-390.

25. ACKNOWLEGEMENTS Dr. G. Prater Dean of College of Public Service Dr. M. Azevedo Chairperson of the Department of Epidemiology and Biostatistics Dr. M. Shahbazi Professor and Major Advisor Dr. R. Williams Associate Dean for the School of Social Work Dr. Chris Arthur Professor and Preceptor All Contact People in Kenya.