Orphaned by AIDS in Africa: Hope for Millions of Children.

Childreach
Thursday, 21 March 2002

Speech delivered by Childreach/Plan National Executive Director Sam Worthington at the National HIV/AIDS Update Conference, American Foundation for AIDS Research (amFAR), San Francisco, March 21, 2002.

Today, I would like to share with you one international NGO's perspective on the current realities of HIV/AIDS prevention, treatment, and care efforts in Africa. I will try to set the stage for an understanding of the context of AIDS in rural Africa and offer one example of a positive solution to support the work of local communities-based organizations.

My message is a story of hope: Hope based upon current NGO efforts to strengthen local communities in Africa to help them meet the challenge of AIDS using their own best solutions. Hope based on the NGO sectors ability to help communities respond to AIDS in an integrated manner, addressing not just prevention, but treatment, care and support for those affected by the disease. Hope that we can raise global awareness of the gap in health services, particularly prevalent in rural villages, and direct resources to increase access to these services in a way that will combat a number of deadly diseases, AIDS among them. And finally, hope because NGOs, religious institutions, government and the UN are working together with community-based organizations to enable them to provide a future for their children despite the devastating obstacles.

The stories I will share with you today are unfortunately depressing as the fact remains that a large portion of a generation will die throughout Africa. Our focus needs to be on the hope of a future generation we can help. We have seen in case after case programs that do work, that do stop the spread of the disease, and that do help children in concrete ways. These programs work because they have local communities behind them. Our challenge is in bringing real success stories on the ground into a major initiative that can make a difference for millions. It is with this in mind that we have launched the Hope for African Children Initiative to take steps to help save the next generation.

As a child-focused development organization, Childreach/Plan works in 46 of the world's poorest countries to address issues like health, education, livelihood, and gender equity. Over the past ten years, one crisis, the AIDS crisis, has permeated its way into every area of our community development work, impacting the lives of children, women, and men across the globe.

As an organization that works to link people, encouraging them to build relationships and to foster understanding between and among different cultures, my message to you is to act on the need to build bridges with communities in Africa. Working together we need to establish a world community that enables all people to live with dignity and allows children to grow to their full potential.

About five years ago, I was in Kenya, outside Embu, in a rural village where Plan was coordinating an HIV/AIDS prevention program. During my visit I spent time with a woman who was bedridden in a small hut, with a dirt floor. She was dying of AIDS. As we talked she kept bringing our conversation back to the needs of her nine-year old daughter, a little child who was quietly peering at us from a hut inside the housing compound. The mother's entire energy was solely focused on how to help her child, a child she knew would soon be left without parents. I learned that she would go to live with an aunt and uncle. They would take care of her along with their own children. After saying goodbye, I met the child's aunt, her mother's sister, and uncle. We shook hands and exchanged greetings. These people were the next hope for this young girl.

As I left the village, the Plan doctor accompanying me asked if I noticed their lesions. That they too, were HIV-infected, that they too would soon be sick, and the process of finding caretakers for this child would begin again. It is difficult to understand the scope and impact of the AIDS pandemic in Africa without understanding stories like this one.

Unlike any other human epidemic, HIV/AIDS spreads silently, surrounded by a stigma making it difficult to address in many parts of the developing world. Unlike any disease before it, AIDS targets young adults, killing the most productive members of society, and it has far-reaching ripple effects on a generation of children left without parents. The face of AIDS in Africa is the face of a teenage girl. But for all its devastation, this pandemic is still in its early stages. Twenty years is but the blink of the eye in an epidemic. Its spread is still preventable and we are in a position to bring the epidemic under control. There is still hope for the long run.

To understand the impact of AIDS in Africa, we must first look at the reality of health care on the continent overall. Throughout Africa as in most developing countries, measles is still a major killer of children. Here in the US, we think of measles as just another childhood immunization, a disease of the past, but in Africa, it takes lives everyday. The reality is that a number of preventable infectious diseases – malaria, TB, and dysentery – are all global killers. AIDS and poverty are intimately intertwined. Five hundred million people live on less than a dollar a day. Two billion people live on less than two dollars a day. And AIDS is just one more burden atop the daily struggles to acquire food, water, and education.

In Africa, there is an enormous gap in access to health care. There is no health equity. Here in the U.S., people living with HIV or AIDS receive antiretroviral treatment; cocktails that help extend lives indefinitely, while also preventing the assault of opportunistic infections. In many African communities there are no health centers or clinics to cover even basic health needs – not to mention treatment for a disease as complex and pervasive as AIDS. For example, in Bulawayo, Zimbabwe, one million people in one district share one doctor.

Money alone cannot solve this problem but we certainly need the resources. We welcome Kofi Annan's United Nation's efforts to have the world commit billions to address the crisis. Yet, only $1.9 billion in new funding has been committed. In addition to resources, we need to close the gap between local health care systems, infrastructure and affected populations. Work is being done on this front by USAID to build the capacity of government health systems and by NGOs, working from the bottom up – from the individual in a community – to promote local, practical solutions. Within many projects we are working on solutions that work at the community-level but these efforts need to be scaled-up across countries, across Africa.

On top of this reality of poverty, of lack of access to a health infrastructure, there is a stigma attached to sex and the disease that makes it difficult to address. This is particularly true in conservative agrarian societies where the typical infected person, the face of AIDS, is a young woman in her teens. To put the epidemic in perspective we have all heard the statistics. Over 40 million people in the world are infected with HIV. Every day 8,000 people die, that's 22 million deaths to date. Before AIDS, life expectancy had greatly improved throughout the developing world. Now, in some countries it has already dropped from 60 years to 35.

From a development perspective, we are losing much of the progress of the last two decades. Seventy percent of HIV cases are in Africa, but the problem is global. In the red light district of Bombay, India, it is estimated that hundreds of thousands of condoms would be needed each night to prevent the spread of HIV. The resources to cover this need are just not available. The demand cannot be met.

Earlier this year, I was in Tororo, Uganda visiting our field office. Like any one of our 250 field offices, located in some of the poorest communities in 46 developing countries, the office is staffed by 20 local professionals dedicated to helping poor children. The Tororo district of Uganda borders Kenya and has some 100,000 people. People who live off the land, trade across the border and try to eek out a substantive living on dry land and a per capita income of one to two dollars a day. While Uganda remains a model in Africa's fight against AIDS, the Tororo district has been particularly hard hit. Two years ago the infection rate among adults was 51 percent. This year it is about 38 percent. Some of this decline may be the result of a prevention program; clearly people are dying.

Communities are made up of hundreds of small round earth huts - or tukuls - with thatch roofs. There is no electricity, getting water is a considerable walk, and in one area I visited, the only school, which was built by Plan, had 600 students and 12 teachers, who also served as administrators. There are no medicines and people live a reality where each day they are threatened by malaria –still the biggest killer of children – influenza, TB and HIV/AIDS. We visited and talked with family after family; each family had one or two graves, most families' one caregiver, for 10 to 15 children.

What I found striking was the exuberance of the children, their desire to play, their will to go on, their will to have a normal life in conditions that anyone would have difficulty accepting. How do you tell a child who has lost a father, whose mother is dying, that they have to go live with cousins near by, relatives who have also lost their parents and live under the care of an elderly grandfather?

Some 5,000 people die of AIDS in Africa every day, as thousands of children are orphaned or rendered vulnerable. And unless we do something now, over the next ten years, some 30 to 40 million children will be orphaned. It's as if the entire US adult population east of the Mississippi died and all of us who remained would have to take their children into our homes.

Loss of the scale has no meaning unless it is expressed through the life of one child, one family; one child in a village outside Meru, Kenya. To respond to this loss in Africa, many mothers or fathers are creating memory books. In these books an individual who is HIV infected, shares his or her life, the first songs shared with a child, the family history, dreams, expectations. When the parent dies the book is handed on to the children who will survive. There is nothing more difficult to come to terms with than a mother dying of AIDS putting her last energies into her memory book so that her daughter would have something tangible and would have some understanding of her mother's life.

It is in the midst of these challenges that one is always struck by the power of human compassion. The ability of one neighbor, one family member to reach out to take in a child, to help repair a roof of a thatch hut that is leaking on a sick mother who is unable to rise from her bed.

AIDS can have an enormous impact on a child's development and identity. An entire generation of African children will have grown up under the shadow of the disease, losing family members, friends, and neighbors. Psychosocial impacts include distress and grieving over the loss of family, taking on the role of caregiver for younger siblings, inadequate nutrition, "property grabbing" by other family and community members, loss of inheritance, less access to education, risk of sexual abuse, and early marriage.

Can we make a difference in the lives of these children? The answer is clearly yes. Childreach/Plan spends over $100 million per year of private philanthropy on community-level initiatives in Africa affecting thousands of lives. Worldwide we deliver some 5,000 community-based projects that impact the lives of 9 million children. But the work of one international NGO is only a drop in the bucket when it comes to meeting the challenges of AIDS.

To address a problem of this magnitude, a radically new approach is required, one that holistically addresses the issues impacting the people of Africa. Traditional NGO approaches to deliver isolated projects just do not reach enough people and traditional prevention efforts that work solely through government infrastructures often do not reach the communities most in need. They do not address the acute need for care and support.

As you know, HIV/AIDS touches every sector, every aspect of human life and has an impact on all household members, infected or not, child or adult. The problems do not divide themselves into neat boxes and cannot be addressed by any single intervention or by only dumping large sums of money into government programs. Multiple, all-encompassing interventions are needed to respond to the broad range of need among children, their families, and their communities. HIV/AIDS prevention must be linked to home-based care and efforts to support orphaned children.

The Hope for African Children Initiative was designed to address these challenges, the needs of children orphaned by AIDS from a community perspective, building on existing community-based capacities to help address the problem. Key elements of the initiative are its focus on the child and community, an integrated response to HIV/AIDS, and one that involves partnerships at local, national, and international levels. The chief partners are Plan, CARE, Save the Children, the World Conference for Religion and Peace and local African NGOs such as the Society of Women AIDS in Africa. The Bill and Melinda Gates Foundation is providing major seed funding. Our initiative is not happening in isolation, we are working with the World Bank, UNICEF, UNAIDS, USAID and other governments, advocacy groups like the Global AIDS Alliance and U2's Bono as part of Artists Against AIDS Worldwide. All service delivery in this initiative is through existing, local, community-based institutions.

Our approach is both local and practical. It begins by mobilizing the community, designating a guardian for each child, ensuring that children go to school, securing access to food, providing legal assistance to ensure property rights, and preparing children for their future.

The strategic objectives of Hope for African Children are described as a "Circle of Hope," for they focus on building hope for the children's future. There are four key components: Building Awareness, Extending the Life of the Parent/Child Relationship, Preparing the Family for Transition, and Ensuring the Child's Future.

Projects under the initiative begin by building awareness and reducing stigma to prevent the spread of the disease through education and behavior change. Community health workers engage with the religious community to promote sensitization to the issues around AIDS. They offer voluntary counseling and testing including communications about the need for behavior change.

Extending the duration of the parent-child relationship focuses on treatment and palliative care for those infected. Outreach also includes addressing the challenges of malnutrition and food security as well as basic health care among family members, particularly when the primary caretaker is no longer able to provide for the family.

Preparing the family for transition is part of the holistic approach of this initiative. The memory book project I mentioned earlier helps families retain a sense of history and continuity. Workers help families establish wills and birth registration for children so they are entitled to inherit their family property. Guardians are designated for the children to care for them until they are old enough to care for themselves. In some instances, economic support is provided to guardians. From a psychosocial perspective, health workers encourage children to express their grief and come to terms with their changed realities.

Finally, the initiative addresses ways to ensure a positive future for children. Programs include physical and mental health care, continued education and life skills training from childhood into adulthood. Caregivers are supported with income generating projects, micro-credit, and other resources to help them in their new role.

To find out more about our initiative please visit the HACI web site at www.hopeforafricanchildren.org.

AIDS is preventable – we know how to prevent its spread. We have the capacity to empower African communities to cope with HIV/AIDS using examples from success stories already in existence. We must share information about these best practices with the rest of the world. We can't simply write this problem off as too big, or overwhelming.

We must move from a position of global inaction, to a role of prevention, care and support for Africa. We are inescapably part of a larger world requiring us to think and act differently than in the past. We must do something to help a child or parent whose life is being threatened by AIDS. The world needs to wake up and realize that we cannot turn our backs on the need to address the realities of the global AIDS pandemic. The time for action is now.

For more information, or to contact Childreach, see their website at: www.childreach.org