The Extent to Which Young Children are affected. by HIV and aids in Botswana

Transcription

1 Commission ECCE and HIV/AIDS The Extent to Which Young Children are affected by HIV and aids in Botswana Richard K. Matlhare National AIDS Coordinating Agency, Botswana World Conference on Early Childhood Care and Education September 2010 Moscow, Russian Federation

2 EARLY CHILDHOOD CARE AND HIV/AIDS -THE BOTSWANA EXPERIENCE- Presented by Mr. Richard K. Matlhare National Coordinator National AIDS Coordinating Agency Republic of Botswana WORLD CONFERENCE ON EARLY CHILDHOOD CARE AND EDUCATION: Moscow, September 2010

3 Outline Background Extent to which young children are affected by HIV and AIDS Issues & Challenges of HIV / AIDS on ECCE Good Practices/ Enabling Factors Recommendations for Further Action & Research CONCLUSIONS

4 BACKGROUND- BOTSWANA Population: 1.8 million HIV Prevalence: 17.6% ANC HIV Prevalence yrs: 31.8% PMTCT access to ART: 95% Children needing and accessing ART: (80%) Registered Orphans : % of patients on HAART are children. Sources: BAIS 2008, UNGASS Report 2010, MOH, BFHS 2007

5 SUB SAHARAN AFRICA Home to over 24million people living with HIV/AIDS Accounts for over 2/3 or 67% of all people living with HIV. In 2009, 15milion children had lost one or both parents due to AIDS were infected died of AIDS.

6 The extent to which young children are affected by HIV and AIDS (in Botswana)

7 Background The AIDS Epidemic is shattering Children s lives and reversing many hard won gains on children s rights.

8 In settings of high HIV prevalence U5 mortality attributable to HIV is very high Global Botswana Zimbabwe Swaziland Namibia 4.0% 36.5% 42.2% 40.6% 57.7% Zambia 33.6% 0% 10% 20% 30% 40% 50% 60% (WHO statistics 2006)

9 UNDER 5 MORTALITY RATE U5MR (Deaths per 1000 population) Years Path to MDGs Path to V2016 Actual Linearly Projected Value

10 INFANT MORTALITY RATE IMR (Deaths per 1000 population) Year Path to MDG Actual Path to V2016 Linearly Projected Value

11 Major issues and challenges related to ECCE and HIV/AIDS (Global Context)

12 MAJOR ISSUES AND CHALLENGES Children without parents are at greater risk of inadequate schooling, malnutrition, illness and death. Orphans become care givers & attend school less AIDS affected children poorly attend school Taking ARVs at school stigmatises them. Stigma & discrimination make them dislike school Poor school performance means poor progression & bleak future.

13 INSTITUTIONAL CHALLENGESS Lack of coordintion, harmonisation & alignment among govt intitutions, civil society, private sector and donor organisations. Poor program coordination/integration btn Education, Health, HIV/AIDS, malaria and others: MDG 2, 4, 5,6. Lack of comprehensive school health programme targeting HIV infected children.

14 OTHER ISSUES AND CHALLENGES Cognitive impairment due to the effect of HIV on the brain: Low birth wait infants face greater susceptibility to illness and may have impaired cognitive development & congenital defects. Increase in infant and child mortality rates: Children under 5 who lose their mothers are 3 10 times more likely to die than those with living mothers. HIV infected mothers avoid breastfeeding: Exclusive breastfeeding for the first 6 months reduces risk of mortality and fosters cognitive development. Lack of family and psychosocial support

15 Examples of practices that have been particularly effective in addressing the above challenges

16 GOOD PRACTICES MTCT of HIV <4% ( and 2.2% in the reporting quarter)

17 GOOD PRACTICES Estimated PMTCT UPTAKE PMTCT is near to universal coverage with over 95% of women attending ANC being tested for HIV & receiving treatment.

18 GOOD PRACTICES Availability of HIV testing technology (PCR) for early HIV detection among children between 6 and 18 mts.

19 Enabling Factors Sources of Funds for HIV/AIDS in Botswana ( ) 1,200,000,000 1,000,000, ,000,000 Pula 600,000, ,000, ,000, International Funds 74,461, ,947, ,251,150 Private funds 4,262,832 10,305,885 10,852,044 Public funds 669,896, ,594, ,152,324 Strong domestic financial commitment.

20 Enabling Factors Maintaining Political commitment. Good policies and enabling legal environment Democracy and good governance Adherence to National Vision and Development Plans. Financial transparency.

21 GOOD PRACTICES OVC support to ensure parity in school enrolment with non orphans

22 GOOD PRACTICES Est. New infections among Children (0 14 years)

23 GOOD PRACTICES Estimated Annual AIDS Deaths Children 0 14 years 90% of children aged months vaccinated against all preventable childhood diseases.

24 Annual Pediatric HIV/AIDS Deaths 5% 5% 4% 4% 3% 3% 2% 2% 1% 1% 0% 4.7% 2.1% 1.1% 0.3% Universal access to ARVs for treatment

25 Botswana s Social Protection Programmes Free nutrition support infant formula, food coupon/food basket. About 95% of HIV infected mothers are giving formula to their babies

26 Other GOOD PRACTICES Orphanages like House of Hope provide care & support to orphans & vulnerable children. BAYLOR Children s Clinical Centre of Excellence provides Care & Treatment to HIV infected children & families.

27 Provide up to 5 recommendations for further action and research

28 Recommendations for further Action The challenge in child survival is to transfer what we already know into action. No need to wait for New vaccines, New drugs and New technology Child under nutrition (underweight) Affects all causes of death Unsafe water and sanitation Diarrhoea Indoor air pollution from solid fuels Lower respiratory tract infection Malaria Immunisation

29 Integration of MDG 2,4,5,6 is key

30 Recommendations for Research Determine cause specific child mortality rates Establish acceptability/ desirability of breastfeeding + ARVs by HIV infected mothers Strengthen studies to block MTCT and preserve breast feeding for better child survival Establish correlations between types of vulnerabilities and ECCE.

31 CONCLUSIONS EDUCATION IS HIV PROTECTIVE Each additional year of education leads to approximately 7% reduction in the likelihood of acquiring infection. Children at school have safer social and sexual networks than out of school youth Better educated women are more likely than their less educated peers to delay sex, childbearing, tend to use condoms more often, have fewer children and healthier babies. The AIDS and MGDs Approach: UNDP 2010.

32 WE NEED CIRCLES OF SUPPORT Teachers, police, social workers, human rights activists, health workers etc reach, identify and assist children at school. Children provide each other with psycho social support at school A meal a day at school contributes to that nutritional value.

33 CONCLUSIONS In spite of these recorded successes there are still challenges that must be addressed to restore the gains lost on children s rights as a result of HIV & AIDS

34 I want to live NO CHILD SHOULD BE BORN HIV POSITIVE It is possible

35 BOTSWANA s Road to AN HIV FREE GENERATION

36 ACKNOWLEDGEMENTS UNICEF Botswana. Botswana Baylor Children s Clinical Centre of Excellence UNAIDS Botswana Country Offic National AIDS Coordinating Agency: Botswana Ministry of Health, Botswana Ministry of Local Government DSS: Botswana Ministry of Finance & Dev. Planning: Botswana Global Health Council..