Ambassador Eric Goosby serves as U.S. Global AIDS Coordinator.
This week at the United Nations General Assembly in New York, world leaders are coming together to move the world’s health and development agenda forward.
Among the key agenda items is securing a better future for children — which is also a central focus of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Meeting the needs of children, including both children living with HIV and those affected by the disease in other ways, is not peripheral to PEPFAR’s mission — it is central.
The reality is that PEPFAR is the largest contributor to the global response to the needs of vulnerable children affected by AIDS. It’s a responsibility, and an opportunity as part of our push toward an AIDS-free generation.
But what does achieving an AIDS-free generation look like? Of course, a key part of this is expanding treatment. Since 2004, the number of people PEPFAR supports on treatment has grown to nearly 4.5 million. Treatment is keeping parents not only alive, but also healthy and productive. It is enabling parents to survive to raise and protect their children, from the very early years right through to late adolescence and early adulthood. Keeping parents alive is the best thing we can do for a child.
An AIDS-free generation also means preventing HIV from entering into the family unit in the first place. The dramatic reduction in new adult HIV infections globally over the past decade is a remarkably hopeful sign. Even more striking is the 24 percent reduction in infant infections over just the past two years. That is wonderful news for children, and indeed for all of us.
Yet more is needed to achieve an AIDS-free generation — we must build a future where children are also free of the other destructive effects of HIV in their lives.
For people infected and affected by the epidemic, HIV is not only a medical experience. It is also a social and emotional experience that profoundly affects their lives and their futures.
PEPFAR has promoted resilience in children and the broader society by reducing adversity, and building services and systems that reach people directly in their households and communities. And the evidence, which is increasing both in quantity and in rigor, shows that these interventions are working. These orphans and vulnerable children (OVC) programs have kept kids in school and improved education and psychosocial outcomes at the child level. They have developed household economic strengthening initiatives, parent and caregiver education and support groups, and increased health care access and food and nutrition outcomes at the family and household level. Over 4 million children benefited from these efforts in 2011 alone.
OVC programs also support the medical goals of the global AIDS response in mutually-beneficial ways. For example, work to keep children in school has positive impacts on prevention. Economic strengthening activities help remove barriers to accessing facility-based services, and child-focused health interventions are important platforms for targeting mothers for prevention of mother-to-child transmission of HIV.
In addition, community-based programming for children creates a platform that reaches people in their homes and communities, where they live. These programs reduce stigma and discrimination and create an enabling environment for people living with and affected by HIV to access services.
Finally, by addressing socio-emotional effects of the epidemic, OVC programs reduce the likelihood of children and adolescents moving from being affected by the epidemic to living with HIV. This is especially true for adolescent girls who have lost a mother, which evidence shows makes them more likely to engage in risky sexual behavior. By responding across a child’s lifespan and using a multi-sectoral approach, we reduce the social and emotional effects of HIV to protect children and build their resilience.
In July, PEPFAR issued our new guidance for OVC programming. This is the product of an interagency development process that also drew on civil society, the faith sector, and multi-lateral partners.
We are urging a greater emphasis in OVC programming on family strengthening approaches. While programs must continue to improve child outcomes, the primary strategy for achieving this is strengthening parents and caregivers so they can better provide for their children’s basic needs.
Another key message is the need to focus on sustainability through capacity-building, systems strengthening and transfer of program responsibility to promote country ownership. These approaches must be balanced with careful planning and monitoring to ensure children’s immediate needs are met.
Finally, the new guidance demonstrates that there is a growing evidence-base for OVC programming. Programs should be designed on evidence-based practice wherever that evidence exists. And partners should also help expand and strengthen the evidence base by including rigorous impact evaluation of specific efforts.
In this era of limited resources, PEPFAR — and all of us — must continue to improve the impact and efficiency of our programs, so that we maximize the human impact of each dollar entrusted to us while meeting high standards for child-focused programming.
But it goes without saying that PEPFAR cannot meet all the needs on our own. Achieving a generation that is truly free from AIDS and its devastating effects requires that we all support families and communities together.
First, governments must play an orchestrating role to ensure that there is a coordinated continuum of response to the needs of children affected by HIV/AIDS. We must partner with governments to expand their capacity to do so, working with all relevant ministries to ensure a comprehensive response. Our efforts in social welfare workforce strengthening have had a dramatic impact on governments’ capacity to respond to children affected by HIV/AIDS.
Second, civil society, including NGOs as well as community and faith-based groups, must continue to play a central role in providing essential services and in advocating on behalf of this vulnerable population. Again, we must support them in growing their capacity to do so, and international NGOs remain central to this capacity-building.
Finally, as is true across the global AIDS response, this is a shared responsibility. Partner countries, bilateral programs like PEPFAR, and multilateral partners must each do our part. We must provide resources in collaborative ways that strengthen, not undermine, countries, families, and communities. It is only by us all working together that we have hope of a sustainable and effective response.
Achieving a generation that is free from AIDS and its devastating social and emotional effects requires a renewed emphasis on families and the communities and systems that surround them. Together, all of us must meet our shared responsibility to make smart investments to ensure a positive future for children living with and affected by HIV/AIDS.