Office of Global Health and HIV (OGHH)

Office of Overseas Programming & Training Support (OPATS)

HealthCommunity Care of OVC Overview

Overview: Community Care of OVC

What are we talking about?–What do we mean by “Orphans and

Vulnerable Children” (OVC)?–What do we mean by “Community

Care”?–Broad Definitions and Important

Terminology in this field of work

Addressing HIV: More Than Treatment

“For people affected and infected by the epidemic, HIV is primarily a social and emotional experience that, for some, includes physical/ medical needs.”

Programming for children orphaned and made vulnerable by HIV/AIDS contributes to the achievement of an AIDS-free

generation by responding to the social (including economic) and emotional consequences of the disease on children, their families,

and communities that support them. PEPFAR’s Response

Clinical services

Social and community

services

HIV

AIDS

epi

dem

ic

“For the people affected by the epidemic, HIV is a medical, social, and emotional event”

•Infection•Loss of energy and productivity•Loss of life

•Loss of income & assets•Family separation•Reduced educational outcomes

•Adolescents engage in survival sex•Child abuse/GBV•Depression from loss

CAUSE EFFECTS RESPONSECLINIC Community

AI

DS F

ree

Gene

ratio

n

Emotional effects

Treatment allows continued economic productivity of caregivers and ability to care for children

Infected children referred to community support

Social effects

Physical effects

HES gives money for transport to clinics and for access fees

Food security & psychosocial support promote treatment adherence for children

Reduced stigma promotes condom use, VMMC, PMTCT

Home visits reduce loss to follow-up

Teen clubs promote adherence & psychosocialwell-being

Social Ecological Model

Ages and Stages of Child Development

0 – 2 Years Safety and security, stimulation of the senses

Children need protection and love. At about 6 months, they begin to take control of their movements and express basic needs and attachments.

3 – 4 Years Curiosity Children begin to develop imagination and want more involvement in family life. They always need reassurance and praise when they are doing well.

5 – 9 Years Learning Children begin to test their caregivers, gain insights, learn right from wrong, and develop a conscience.

10 – 14 Years Peer Acceptance and a Time of Change

Youth need to conform to their peers and begin to challenge rules with adults. Youth are often insecure and confused, critical of family and friends. They have raging hormones and a focus on “me-me-me,” but still need care and support.

15 – 17 Years Decision - Making Youth are prone to risk-taking behaviors. They face issues and begin to take responsibility for their future.

PEPFAR Definition of Orphans and Vulnerable Children (OVC)

“Children who have lost a parent to HIV/AIDS, who are otherwise directly affected by the disease, or who live in areas of high HIV

prevalence and may be vulnerable to the disease or its socioeconomic effects1.”

Children: 0-17 years old (under 18) Orphaned: Has lost one or both parents to HIV/AIDS Directly affected by the disease: Is more vulnerable because of any or all of the

following factors that result from HIV/AIDS: – Is HIV-positive; – Lives without adequate adult support (e.g., in a household with chronically ill parents, a

household that has experienced a recent death from chronic illness, a household headed by a grandparent, and/or a household headed by a child);

– Lives outside of family care (e.g., in residential care or on the streets); or – Is marginalized, stigmatized, or discriminated against.

(continued on next slide)

1. Hyde-Lantos Act (2008)

PEPFAR Definition of Orphans and Vulnerable Children (OVC) (cont.)

…who live in areas of high HIV prevalence and may be vulnerable to the disease or its

socioeconomic effects.

High HIV prevalence: 5 percent or higher of ALL children are considered affected and therefore are considered Vulnerable. – In communities hard hit by HIV/AIDS, there are

millions of children who may not be orphans, but who are affected by the disease due to a loss of teachers, community members, and other support personnel.

Children Affected By HIV/AIDS CABA - Children Affected By

HIV/AIDS (CABA) are defined by UNICEF, UNAIDS, and PEPFAR as children living with HIV, and children whose well-being or development is threatened by HIV and AIDS in their families or communities. (Same as Orphan or Vulnerable Child)

Single and Double Orphan

1. UNICEF and global partners define an orphan as a child who has lost one or both parents. By this definition, there are over 132 million orphans (due to all causes) in sub-Saharan Africa, Asia, Latin America, and the Caribbean.

2. This large figure represents not only children who have lost both parents, but also those who have lost a father but have a surviving mother or have lost their mother but have a surviving father.

3. Contrasts with concepts of orphan in many industrialized countries, where a child must have lost both parents to qualify as an orphan.

4. UNICEF and numerous international organizations adopted the broader definition of orphan in the mid-1990s as the AIDS pandemic began leading to the death of millions of parents worldwide.

(http://www.unicef.org/media/media_45279.html)

Defining Family: U.S.-Based Family, U.S. Census Bureau:

“A family includes a householder and one or more people living in the same household who are related to the householder by birth, marriage, or adoption. All people in a household who are related to the householder are regarded as members of his or her family.”

Three Views of "Family," by the U.S. Supreme Court:1. A traditional “nuclear family” of two parents and their children, and where the parents are presumed to be acting in the best interests of their children. In such a family, there is no need to give the children their own voice – even when parents do such things as institutionalize their children; 2. An extended-kind model of family made up of a community of parents, siblings, grandparents, and other relatives, which should be recognized as a primary family, even if the blood-ties are not as strong as a nuclear family; and 3. An individualist model where family members are fairly autonomous and that individuality should be respected.

Defining Family: Outside of the U.S.

Arabic: equivalent to American concept of family is “aila,” meaning “to support.”

Japan: – Family unit defined, until the mid-1800s, as all those who worked

together in a single village.– In 1889, Japanese law defined a family to be based on blood lineage,

with a father as head of the household, passing on down to his eldest son. Since based on paternal blood relations, this included polygamous families: all children who had the same father were considered to be in the same family.

Greece: The National Statistical Service counts all the people who live under the same roof as a family – even if they aren't related.

Defining Family: Outside of the U.S. Africa:

1. “Everyone who shares the same cooking pot.”2. Very broad concept with significant variations

across the continent.3. Traditional family often consists of several “nuclear

units” held in association by a common parent.4. May be matrilineal, patrilineal; monogamous or

polygamous.5. Many unique terms for family relationships convey

the importance of family.

Context: Parenting Networks in MalawiCousins

Senior brothers

Senior sisters

Senior brothers Senior UnclesSenior Mothers

Senior fathers Senior sisters

Grand Parents

Grand ParentsFather Child Mother

Junior brothers

Junior sisters

Junior sisters

Junior fathers

Junior brothers

Junior MothersJunior Uncles

Cousins

Defining Those Who Parent: Parenting – or Child Rearing

– The process of promoting and supporting the physical, emotional, social, and intellectual development of a child from infancy to adulthood.

– Raising a child. Good parenting skills help children become both physically and emotionally healthy, productive, and successful adults.

– Many different people may be involved in the role of parenting.

Caregiver – A parent, guardian, foster parent who has primary responsibility in the home for caring for a child affected by HIV/ AIDS. Someone who provides parenting.

Kinship Care – The care provided to children by a relative or extended family member. It is most often an informal arrangement and a common form of care for children who are no longer with their parents.

Defining those who Parent (cont.) Foster care – usually short-term care of children and young

people, while permanent placements are being explored. Adoption

– Permanent care – where parenting responsibilities are taken on by someone other than the child’s parents.

– A legal process that gives an adopted child entitlement to all privileges belonging to a natural child of the adoptive parents, including inheritance rights.

– It is important to ensure that all options to reunite children with their families have been fully explored and that decisions about permanent placements are made in full consultation with the child.

Orphanage

Institution that houses children who are orphaned, abandoned, or whose parents are unable to care for them.

Orphanages/Institutional Care/Residential Care should be considered as a last resort.

Defining Community Community – A social group of any size whose

members reside in a specific locality, share government, and often have a common cultural and historical heritage.