**U.S. Agency for International Development**

**Highlights from the XIV International AIDS Conference**

# July 31, 2002

# "Children on the Brink"

***Linda Sussman of USAID*** introduced the session by giving the
background of USAID's involvement since 1999 with orphans and other
children affected by AIDS. Today, USAID supports 77 activities in 24
countries. At the Barcelona conference, USAID, UNAIDS, and UNICEF
released *Children on the Brink: A Joint Report on Orphan Estimates and
Program Strategies*. USAID also released *Project Profiles: Children
Affected by HIV/AIDS*, a summary of USAID's programs for children
affected by AIDS. In his speech closing the conference, Nelson Mandela
took note of the growing recognition of the need to address the issues
of orphans and vulnerable children, who lack parental love and care and
face abuse, stigma, exploitation, discrimination, and the loss of basic
rights. "There is nothing more urgent than AIDS orphans," Mandela said.

## Children Orphaned by AIDS. Karen Stanecki of the U.S. Census Bureau reported on the demographics of HIV/AIDS orphanhood as presented in Children on the Brink. The report contains the broadest and most comprehensive statistics yet on the historical, current, and projected number of children orphaned by HIV/AIDS. A staggering 13.4 million children orphaned by AIDS (defined as children who have lost one or both parents to AIDS) are living in the three regions of sub-Saharan Africa, Asia, and Latin America and the Caribbean. This number will increase to 25 million by 2010, when nearly one-quarter (24 percent, compared with 12 percent today) of the total orphan populations in these regions will comprise children orphaned by AIDS. 

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## Sub-Saharan Africa has 11 million children orphaned by AIDS, or more than 80 percent of the global total, despite having only 20 percent of the world's population under age 15. About one-third of Africa's orphan population consists of children orphaned by AIDS. (In Asia, the percentage of the orphan population orphaned by AIDS -- 2.8 percent -- is much smaller, but the absolute numbers are still large, with 1.8 million children orphaned by AIDS out of a total orphan population of 65 million.) The number of "double" orphans who have lost both parents to AIDS will increase in sub-Saharan Africa from about 5.5 million today to 8 million by 2010. As already seen in Uganda, orphan rates can continue to increase even after HIV prevalence rates begin to decline, because of the length of time between HIV infection and death from AIDS.

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## Children's Issues at Barcelona. Sara Bowsky of Family Health International gave an overview of how children's issues were treated at Barcelona. There was a higher level of recognition of children's issues than at past conferences. Peter Piot of UNAIDS called the data relating to children "the most shocking" of the new statistics released at the conference. However, there were no plenary sessions devoted to children, so the attention was not of the magnitude it could have been. There were many good oral presentations and excellent posters sessions related to children. A satellite session on UNGASS goals and how to attain them was well attended. There was a lot of media coverage of children's issues and a great deal of informal networking.

### In terms of care and support programs for children, Barcelona focused on community care and mobilization and holistic, multisectoral models for providing care. There are good programs in operation but they are still fragmented, and there is not yet a formal mechanism for bridging the gaps between them. The current challenge is to overcome this fragmentation so that children's issues can be addressed through the prevention--care and support continuum and children's programs scaled up to meet the growing need. An especially important issue is continued care for children who acquire HIV infection through mother-to-child transmission. Families and communities that are supporting programs need to receive recognition and credit. The lessons learned in programs in Uganda and Senegal need to be transferred and applied in countries like Lesotho and Swaziland, where the numbers of children affected by HIV/AIDS already pose crisis situations.

## Questions and Comments. Before questions and comments from the audience, Linda Sussman noted that the AIDS Orphans Task Force and the Children Affected by AIDS Web listserv could be used for networking. Questions and comments addressed the HIV risks of orphans and vulnerable children (noting that it is not just orphans nor just children under age 15 who are vulnerable); the difficulties in estimating orphan populations, which may be tracked and counted at different levels for different purposes; psychosocial concerns, including grief and bereavement (Family Health International's work with these issues in Zambia and Nigeria was the subject of oral and poster presentations at Barcelona); early child development issues in the context of HIV/AIDS orphanhood; and orphans from other causes, whose needs must also be considered and balanced into care and support equations.