Current and New Trends in OVC Programming: The 16th ICASA
Session-Addis Ababa Dec 4th -8th 2011
Living Positively: How best to build resilience
among young people living with or affected by HIV
and AIDS.
A systemic approach: (Uganda-Save the Children and
Health Alert-Uganda HAU)
Presented at the 16th ICASA Session-Addis Ababa Dec 4th
-8th 2011
Jennifer Opoka Abalo – Health Alert - Uganda
Benon Orach Odora – Save the Children in Uganda
Context of Uganda and Mid northern Uganda
Total population
31.7 million
Nationally, 14% are total
Orphans i.e. 2.4m of the
total OVC population
National HIV
prevalence 6.4%
N. Uganda HIV Prevalence 8.2%
OVC is 19.7%
MTCT account for 2025% infections
1.2M PLHIV in Uganda
55% are Women
13% are children
Drivers-Poverty, complacency or ‘AIDS-fatigue’, Alcohol and substance abuse, moral
Decay. N.Uganda recovering from 22 Years of civil war which destroyed socio-cultural
set up of community
46% of the total orphans are
due to AIDS
Population Mid N. Central Uganda
Gulu, Amuru and Nwoya 521,628
Most at Risk/Key Populations
All Sexually Active, Commercial sex workers
and Partners, Mobile workers – drivers, bodas,
Mobile business (traders, fish mongers), Bar
/hotel attendants, Civil servants and Politicians
2
95% of N.Uganda population have
Returned home from IDP camps
<5 MR
137/1000
Description of the intervention
• The problem. Children living with HIV & AIDS growing in to adolescence face physical,
psychological (stigma), emotional challenges; lack social, political and economic
empowerment.
• Most services within HIV, sexual and reproductive health and family planning are not
designed to respond to the specific needs of children and youth living with or affected by
HIV.
• Response: SC and HAU designed a 3 year intervention titled ‘Positive Prevention project’
focused on addressing these needs and promote positive and healthy living among
children and youth living with HIV in Northern Uganda.
2. Children and young people empowered
•1.Objectives.
Children and youth infected or affected
and accepted as actors with resilience
by HIV and AIDS have better access to
against the social, political and economic
child/youth-friendly
health
services
impact of HIV & AIDS including HIV-related
based on their situation and needs
stigma and discrimination
3. Partners and local government structures capacities built in advocacy, documentation
and institutional learning for improved service delivery.
3
Description of Intervention Contd….
• Reach. The project is at scale level (phase II), and in its second year of implementation
• Mode of implementation: Systemic model (systems strengthening, partnership,
coordination and referral) through partnership with a local NGO and relevant Local
government departments (District Health Office, Community Services Dept, Education,
Production and Police) in collaboration with community structures (Village Health Team,
peer educators, mothers groups, male groups). And through focus on addressing specific
needs of children and youth impacted by HIV, promotion of positive and healthy living,
empowerment and resilience building with children and youth.
Targets:
• Primary. 2,000 (1000M & 1000F) children and youths living with HIV and AIDS; 100
mothers baby pairs PMTCT with delivery kits and post natal follow up, 2,000
parents/caregivers oriented on care and support for children; 30,000 (5000M & 5000F) in
and out of school infected and affected children & youth targeted with HIV and AIDS
awareness-raising, sexual and reproductive health rights. (Reached far beyond planned!)
• Secondary
 100 Male spouses empowered to support their spouses (wives) to access safe deliveries
4
(motherhood) at health facilities; VHT, teachers,
Health workers.
Intervention results and how its measured
• Social & political empowerment. Over 1,064 children and young people’s resilience built
against stigma and discrimination; (Tool that captures disclosure, decisions affecting their
own lives, participation in community, school and club activities, training and activities
within advocacy, media, behavior change, leadership and peer education, intervals of free
interaction, play, school retention, reporting ill health; Case studies/documentaries on life
stories)
• Economic empowerment. 52 youth enrolled for vocational training and supported to find
apprentices/jobs, 6 IGA groups (141 members) given VSLA schemes, 40 households
supported with small scale IGAs (Home visit tool that captures fulfillment of basic needs at
the family level, support to medical fees, school fees, clothing, adequate nutrition, clean
water, assessment of needs and opportunities within IGAs, jobs and apprenticeships)
• Improved health of 2,566 Children and youth living with or affected by HIV & AIDS now
have better access to child/youth-friendly health services (Tool captures adherence to
treatment, incidence of opportunistic infections, #of child counselors in a treatment site,
#of children coming to treatment centers and receiving children formulas, level and quality
of services provided to children/youth)
• Strengthening systems at all levels-capacity building through training of health workers
and VHT in child friendly health care, teachers, peer educators, Child protection
committee and Care givers in HBC and anti-stigma approaches (Tools-reports from needs
assessments, training, peer educators, teachers
and Care givers)
5
Results-contd…..
• Improved reproductive health choices, behaviors and outcome among 328 (170M & 150
F) young people. This is as a result of dialogues with youth provided by health workers,
volunteer counselors and family support systems. (tools that Capture access to
reproductive health information and services, disclosure, family planning, safe sexual
behavior, attending all the ANCs, episode of sex in the last one month, gender based
sexual violence and access to Post Exposure Prophylaxis PEP)
• 547 mothers accessed safe delivery services at health facilities which has reduced cases
of new infection through MTCT among the HIV positive adolescents as a result of
increased male support (tools that captures youth in sexual relationships, youth attending
couple counseling, number of ANC attendance by each of the expecting adolescents,
couple disclosure, mothers receiving mama kits, number of mothers delivering at health
facilities, Follow-up on PMTCT mothers, young mothers on post natal care, infants due for
EID)
• Advocacy: Advocated for spaces and furnished Child/Youth friendly spaces at health
facilities, engaged health facilities to designate child ART days, Children and young people
were supported and participated in annual national paediatric Aids Conference and other
advocacy activities at local level.
• Collaboration and referral has increased access to comprehensive health care and
community based OVC service intake for children and young people (tools-coordination
meetings, referrals with feedbacks, follow up of referrals, member of Aids actors
GUNASO)
Promising Practices –Strategies
1.
Systemic model (systems strengthening, partnership, coordination and referral). Providing
care to children relies on structures and duty bearers, incl. governmental, non-governmental
and community-based. Focus on mechanisms to coordinate and perform functions like
information sharing, reporting, monitoring and referrals in order to be better able to respond
to specific situation/needs of children/youth.
2.
Addressing the transition of HIV positive children into adolescence. Knowing that this
transition comes with medical, reproductive health and psychological challenges (e.g. the
wish to plan a family/have children; Difficulties in disclosing HIV status due to fear of
rejection, stigma and discrimination; Increasing incidences of STIs, unwanted pregnancies,
unsafe/unassisted births).  Focus is on Positive Health Dignity and Prevention (PHDP) and
acknowledging age and gender specific needs of the children and youth.
3.
Children peer support clubs. Youth as counselors/change agents. Children/youth play
central role in developing social- and family support networks, undertaking follow-up and
home visits to offer counseling, mediation, promoting disclosure, monitor drug adherence
and opportunistic infections, ensure referrals, acting as role models.  Results in physical,
emotional and psychosocial strengthening of children and youth living with HIV.
4.
Prevention of Mother to Child Transmission (PMTCT) strengthens integration of PMTCT into
ANC, delivery and Post Natal Care services. This reduces loss to follow up of mothers on
PMTCT, reduces the # of children born with HIV, strengthens male involvement/support as
well as the links between community support mechanisms and the public health system.
Promising Practices Contd……
5.
Strengthening systems at all levels. With the aim to support children and youth
impacted by HIV and AIDS, SC and HAU have strengthened coordination and built
capacity of local government, health workers and Village Health Teams, as well as
strengthened community based structures and care for children and young people living
with or affected by HIV and AIDS.
6.
Using Media (Radio) to generate Reflection, and dialogue. Designed and run by and for
young people, radio programs allay negative perceptions, attitudes and behaviors
related to HIV positive children and their sexual and reproductive health. Resilience
building is enhanced by voluntarily stories, testimonies and dialogue.
7.
Social, political and economic empowerment of children/youth. Simultaneous focus on
building ‘soft’ and ‘hard’ skills of children and youth. Through training in leadership, life
skills, behavior change, positive living; Club and recreational activities; Active youth
involvement in awareness raising, campaigning and advocacy; Strengthening formal
education, vocational skills, access to IGAs, loans and savings, apprenticeships and job
opportunities.
8.
Advocacy. The project advocates for active involvement of children/youth living with
HIV, improvement of quality delivery of Child/youth friendly health services and
comprehensive community based OVC services.
9.
Institutional learning. Documentaries on the project are developed for further learning
and advocacy, with a view to scale up effective models.
Remaining Challenges/Questions
• Stigma, labeling and discrimination continue to be a challenge which continues to
hinder disclosure and adherence to treatment and further infections – or even death
• Most children are living with elderly care takers and Child Headed families who can
not fend for their basic needs. This is due to a generation gap as a result of death of
biological parents
• As a result of the return process from Internally Displaced person camps, most
treatment centres have remained urban based in District of Health Sub districts.
This inaccessibility is affecting drug refills and referrals
• High number of young people engaging in commercial Sex Work fueled by mobile
population in Uganda – South Sudan business boom. This is increasing cases of
new STI/HIV infections among HIV negative young people, HIV re-infections
• The cost of ASRH services is very high and adolescent friendly SRH services are
few and far between
• Difficulties in tracking patients, mothers and exposed children. Incidence of loss to
follow up of mothers on PMTCT as a result of the return process
• Prevalence among adults (married couples) is rising rapidly due to multiple sexual
partners. This will subsequently affect many infants and children exposed to HIV
Remaining Challenges/Questions Contd……
• There has been high level of inflation and thus prices have raised but
funding has not increased accordingly
• Drug Stock out (ART and Cotrimoxazole). A high number of the
population including children on ART are having adherence challenges
due to stock outs.
• Unfortunately, actors at the national level remain detached and do not
collaborate meaningfully/effectively. This hinders opportunity for a wider
advocacy effort. Most such efforts have remained at district level
Programmatic Recommendations & Next Steps
• Integrated Programming. Integrate HIV & AIDS intervention with
livelihoods and educating youth for employment initiatives to empower
extremely vulnerable households and individuals to become self reliant.
• Strengthening systems at all levels – including various community
based structures and families - with the aim to support children and
youth impacted by HIV and AIDS. Also including: Advocacy to lobby the
Ministry of Health to strengthen the health system (to increase
child/youth friendly services and reduce incidences of drug stock out
etc)
• School Intervention. Need to support schools to implement the
Presidential initiative on Aids Strategy Communication for Youth
(PIASCY) to scale up HIV intervention in schools
• Resource Mobilization. Continued fund raising will be conducted to
bridge the challenges
• The PHDP program is being shared in country by Baylor College of
Medicine-Uganda, Mild may Uganda, The Aids Support Organization
(TASO).