Health

1. Health Community Care of OVC Overview

2. 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

3. Addressing HIV: More Than Treatment

4. CAUSE EFFECTS RESPONSE CLINIC Community AIDS Free Generation “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 HIV AIDS epidemic • Clinical services Treatment allows continued economic productivity of caregivers and ability to care for children Physical effects Infected children referred to community support Food security & psychosocial support promote treatment adherence for children Social effects Teen clubs promote adherence & psychosocial well-being HES gives money for transport to clinics and for access fees Emotional effects • Social and community services Reduced stigma promotes condom use, VMMC, PMTCT Home visits reduce loss to follow-up

5. Social Ecological Model

6. Ages and Stages of Child Development

7. 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)

8. 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.

9. 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)

10. Single and Double Orphan • 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. • 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.  • Contrasts with concepts of orphan in many industrialized countries, where a child must have lost both parents to qualify as an orphan. • 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)

11. 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.

12. 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.

13. Defining Family: Outside of the U.S. • Africa: • “Everyone who shares the same cooking pot.” • Very broad concept with significant variations across the continent. • Traditional family often consists of several “nuclear units” held in association by a common parent. • May be matrilineal, patrilineal; monogamous or polygamous. • Many unique terms for family relationships convey the importance of family.

14. Context: Parenting Networks in Malawi Cousins Senior brothers Senior brothers Senior Uncles Senior Mothers Senior fathers Senior sisters Senior sisters Grand Parents Father Grand Parents Mother Child Junior brothers Junior brothers Junior fathers Junior Mothers Junior Uncles Junior sisters Junior sisters Cousins

15. 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.

16. 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.

17. 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.

18. 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.