Over the last decade there have been many lively -- even heated -- debates surrounding best approaches to support children affected by HIV and AIDS. At last year's International AIDS Conference, there was one issue most could agree on -- thank goodness for PEPFAR!
While many aid agencies are shifting their HIV funding to a narrower set of biomedical interventions, PEPFAR has shown unwavering commitment, not only to reducing new HIV infections and massively scaling up HIV treatment, but also to addressing the devastating social and economic consequences of the epidemic.
HIV continues to decimate communities -- causing both economic distress and social exclusion -- the effects of which are felt across generations. Globally, there are over 17 million children who have lost one or both parents to AIDS with the vast majority in Sub-Saharan Africa. Despite amazing advances in treatment access for adults, the decline in the number of children orphaned due to HIV will be a gradual one.
Thankfully, the recent PEPFAR Blueprint and PEPFAR Guidance on Orphans and Vulnerable Children which is closely aligned with the broader USG Children in Adversity Strategy shows continued commitment to tackle the most pressing needs of children affected by AIDS. These include economic support programs for the poorest HIV affected households, interventions to keep children in family based care rather than orphanages, social grants to keep children in school and support for child protection systems to reduce all forms of physical, sexual and emotional abuse.
Despite the daunting numbers of children affected by AIDS, global resources for such programs are declining. PEPFAR's 10 percent commitment for Orphans and Vulnerable Children (OVC) remains one of the last earmarked sources of funding for these critical program. It is imperative that this commitment to OVC remains to address the unfinished agenda of children affected by HIV.
Following a thorough review of the OVC portfolio in 2011, PEPFAR made some welcome shifts in its approach to OVC. While community based interventions continue to be a critical part of the program and provide direct support to families and communities, there is now greater recognition of the need to strengthen sustainable national systems of child protection and social protection. These programs can reach vulnerable children affected by HIV at scale and can be funded through national governments and community based organizations well into the future.
There is also a growing commitment by PEPFAR to early childhood development, supported by compelling evidence that reaching the youngest children with economic support, good parenting and nutrition has life-long benefits, and is also highly cost-effective. Another significant shift has been the growing response to violence and sexual abuse against children, including those affected by HIV. The U.S. government is a key partner with UNICEF and others in the Together for Girls Initiative -- a public private partnership dedicated to eliminating sexual violence against children with a particular focus on girls.
There are, of course, many remaining challenges. We collectively need to do a better job at monitoring these efforts more systematically, as well as improving efficiencies in linking prevention, treatment care and protection for children and families living with HIV. For example, successful HIV treatment outcomes will not be addressed by drugs and health systems alone. We also need to tackle social and economic barriers to treatment access - ensuring families have access to affordable health care as well as treatment literacy, food security and a supportive environment free from stigma and discrimination. Similarly we need to better build the linkages between economic support and child protection programs to reduce susceptibility to HIV infection amongst adolescents -- particularly girls. Unless we understand and respond to the underlying vulnerabilities and inequalities which drive new infections, our prevention goals will remain elusive.
The considerable funding provided for the protection, care and support of children affected by HIV, along with the policy shifts we have seen from PEPFAR over the last few years should be loudly applauded. In an era of growing scrutiny of international development budgets, it is important that we recognize the enormous impact PEPFAR funding has had in supporting millions of HIV affected and infected children and their families. I very much hope that both the U.S. public, whose tax dollars have funded these efforts, and budget holders within the U.S. Government, also recognize this impressive contribution in the challenging, fiscally constrained, years ahead.