Aiding Children in AIDS-Afflicted Countries
Questions for Alex de Waal
The SSRC program director and Sudan expert discusses why so little has been done for children and HIV/AIDS in the 25 years since the outbreak of the epidemic, why the prevention approach doesn't work, and what kinds of policies will be needed in the coming 25 years.
The Joint Learning Initiative on Children and HIV/AIDS (JLICA) recently launched its report, the culmination of two years of research, calling for new directions in global AIDS policies to meet the needs of children and families. Can you tell us more about the initiative? The initiative was established in 2006 with the aim of providing the foundation for evidence-based policies on children and AIDS. Experts from more than a dozen countries came together for a two-year period to review available research, commission studies in under-researched areas, and make policy recommendations. Our feeling was that the lack of good data, coupled with the failure to mobilize existing knowledge, has led to a lot of well-intentioned but misguided policies that have failed to address the needs of children in AIDS-afflicted countries. We are 25 years into the epidemic, but millions of children and their families continue to be neglected. Responses to date have not been sufficiently grounded in either evidence about children’s circumstances, or a clear understanding of the root causes of children’s vulnerability.
Many people are moved by the plight of children orphaned by AIDS, made famous by Madonna's adoption of a Malawian child. Some 12 million African children are estimated to have lost one or both parents to the disease, but in many respects, this figure understates the magnitude of the problem. The challenge for policy is not to reach 12 million individual children in need of assistance, but to design policies and interventions that address the diverse needs of a range of poor and vulnerable children in societies affected by AIDS.
It sounds like a daunting task to accomplish in just two years. How did you break up the work and what part did you play in it? We organized the work according to the four areas discussed in the widely endorsed Framework for the Protection, Care, and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS (UNICEF/UNAIDS, 2004): the family, the community, access to services, and social and economic policies. Along with Masuma Mamdani, a research specialist with UNICEF, Tanzania, I co-chaired Learning Group 4, on social and economic policies.
We understand that the final reports are available on the JLICA Web site. Can you give us an example of your group's most important findings? One of our key findings was that paradigms focusing on behavioral change--what some call ABC, Abstain, Be faithful, or use a Condom--aren’t working. This approach misses the critical issue of the powerlessness of young people, especially teenage girls, in many situations that create HIV risk. Other kinds of measures are urgently needed, such as increasing efforts to ensure girls' physical safety at school, at work, on public transport, and in places of recreation. On a broader level, we need to look for ways to tackle the behaviors and attitudes that protect or promote sexual abuse of women and girls, and to improve the economic independence of young women.
You said that many of the efforts by the international community were misguided or misdirected. What conditions are necessary for good policy? According to the findings of the learning group that I co-directed, failed policies tend to be those adopted by governments in order to please foreign donors or acquire funds, which involve complex institutional procedures and do not latch on to existing priorities. We recommend that moving forward, policies should be institutionally simple to implement, and readily monitored by the public.
What are the costs of the interventions you recommend, and how can they be borne? There is no straightforward answer to this, and my group did not put forward a headline figure for the total bill. But we did come to the conclusion that money spent on basic social protection measures (including cash transfers to the poor) is cost effective and a good way of disbursing aid resources. Cash-based social protection programmes have relatively minor distorting impacts, and therefore should be considered a priority candidate for receiving assistance.
Are you worried about the impact of the global economic crisis on these vulnerable groups? The global economic crisis aggravates the hardships experienced by those affected by HIV/AIDS and extreme poverty, and makes action to expand and sharpen our responses all the more imperative.
Interview conducted, condensed, and edited by Mary-Lea Cox.
To download the JLICA final report, “Home Truths: Facing the Facts on Children, AIDS, and Poverty,” as well as synthesis papers from the four learning groups, go to: http://www.jlica.org/resources/publications.php.