Commission 4.2 - 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
27-29 September 2010
Moscow, Russian Federation
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, 27 – 29 September 2010
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
BACKGROUND- BOTSWANA
• Population: 1.8 million
• HIV Prevalence: 17.6%
• ANC HIV Prevalence 15-49 yrs:
31.8%
• PMTCT access to ART: 95%
• Children needing and accessing
ART: (80%)
• Registered Orphans : 45 000
• 6 % of patients on HAART are
children.
Sources: BAIS 2008, UNGASS Report 2010, MOH, BFHS 2007
SUB SAHARAN
• Home to over 24million
AFRICA
•
•
•
•
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.
430 000 were infected.
280 000 died of AIDS.
The extent to which young children are affected by HIV and AIDS (in Botswana) Background
• The AIDS Epidemic is shattering Children’s lives and reversing many hard won gains on children’s rights.
In settings of high HIV prevalence U5 mortality attributable to HIV is very high Global
4.0%
Botswana
57.7%
Zimbabwe
42.2%
Swaziland
40.6%
Namibia
36.5%
Zambia
0%
33.6%
10%
20%
30%
(WHO statistics – 2006)
40%
50%
60%
UNDER 5 MORTALITY RATE
80
U5MR (Deaths per 1000 population)
70
60
50
40
30
20
10
0
1990
1995
2000
2005
2010
2015
Years
Pa th to MDGs
Pa th to V2016
Actua l Li nea rl y Projected Va l ue
INFANT MORTALITY RATE
70
IMR (Deaths per 1000 population)
60
50
40
30
20
10
0
1990
1995
2000
2005
2010
Ye a r
Pa th to MDG
Pa th to V2016
Actua l
Li ne a rl y Proje cte d Va l ue
2015
Major issues and challenges related to ECCE and HIV/AIDS (Global Context)
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.
INSTITUTIONAL CHALLENGESS
ƒ Lack of coordintion, harmonisation & alignment among govt intitutions, civil society, private sector and donor organisations.
ƒ Poor program coordination/integration btn Education, Health, HIV/AIDS, malaria and others: ‐MDG 2, 4, 5 ,6.
ƒ Lack of comprehensive school health programme targeting HIV infected children.
OTHER ISSUES AND CHALLENGES
ƒ 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.
ƒ 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.
ƒ HIV‐infected mothers avoid breastfeeding:
Exclusive breastfeeding for the first 6 months reduces risk of mortality and fosters cognitive development.
ƒ Lack of family and psychosocial support
Examples of practices that have been particularly effective in addressing the above challenges
GOOD PRACTICES
MTCT of HIV <4% ( and 2.2% in the reporting quarter) GOOD PRACTICES
Estimated PMTCT UPTAKE
PMTCT is near to universal coverage with over 95% of women attending ANC being tested for HIV & receiving treatment.
GOOD PRACTICES
Availability of HIV testing technology (PCR) for early HIV detection among children between 6 and 18 mts.
Enabling Factors
Sources of Funds for HIV/AIDS in Botswana (2003-2005)
1,200,000,000
1,000,000,000
P ula
800,000,000
600,000,000
400,000,000
200,000,000
0
2003
2004
2005
International Funds
74,461,453
186,947,219
228,251,150
Private funds
4,262,832
10,305,885
10,852,044
Public funds
669,896,574
788,594,044
899,152,324
Strong domestic financial commitment.
Enabling Factors
• Maintaining Political commitment.
• Good policies and enabling legal environment
• Democracy and good governance
• Adherence to National Vision and Development Plans .
• Financial transparency.
GOOD PRACTICES
OVC support to ensure parity in school enrolment with non‐orphans
GOOD PRACTICES
Est. New infections among Children (0‐14 years)
GOOD PRACTICES
Estimated Annual AIDS Deaths Children 0‐14 years
90% of children aged 12‐23 months vaccinated against all preventable childhood diseases.
Annual Pediatric HIV/AIDS Deaths
5%
5%
4%
4%
3%
3%
2%
2%
1%
1%
0%
4.7%
2.1%
1.1%
0.3%
2003
2004
2005
2006
Universal access to ARVs for treatment
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
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.
Provide up to 5 recommendations for further action and research 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
Integration of MDG 2,4,5,6 is key
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.
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. 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. 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
‘I want to live’
NO CHILD SHOULD BE BORN HIV POSITIVE
‐ It is possible‐
BOTSWANA’s Road to AN HIV FREE GENERATION
ACKNOWLEDGEMENTS
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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. . www.globalhealth.org