AIDS Orphans In Kenya.

1. AIDS Orphans In Kenya. Maureen Waithaka B.Sc.; M.P.H.

2. Sponsorship: Jackson State University, College of Public Service, Department of Epidemiology and Biostatistics Site: Kenya (East Africa) Location: Nairobi and Mombasa On-site: 3 weeks Target group : AIDS orphans between the ages of 13 and 18 years PLACEMENT SITE

3. GOAL • To investigate the effectiveness, accessibility and quality of personal health services for AIDS orphans in Kenya between the ages of 13-18 years

4. DEFINITION AIDS orphan 4 types: • Single orphan- a child who has lost one parent • Double orphan- a child who has lost both parents • Maternal orphan- a child whose mother has died (includes double orphans) • Paternal orphan – a child whose father has died (includes double orphans) Source: African Orphaned and Vulnerable Generations, 2006.

5. PRIMARY CONTACTS Governmental organizations Non-governmental organizations Faith-based organizations Community-based organizations AIDS orphanages

7. Presently: Home : app > 48 million orphans 12 million of these orphans = AIDS epidemic Mostly between the ages of 0-17 years have lost one or both parents to AIDS Future projections: Estimated that AIDS orphan population will increase by 20 million by 2010: Overall 68 million in continent SUB-SAHARAN STATISTICS Source: UNAIDS Estimates, 2006.

8. “WHO IS CARING FOR AIDS ORPHANS IN KENYA?” In 2006: • Prevalence rates: levelling out • Incident rates (number of new infections) increasing with population growth - ARVs • -AIDS is a leading cause of death among adults between the ages of 15-59 years Source : Analysis of HIV Prevalence trends in Kenya 2003, KDHS

9. HIV/AIDS was declared a national disaster by the former President of the Republic of Kenya on 25 November 1999 2.2 million people were infected with HIV by the year 2003 1.5 million people have already died from AIDSrelated illnessleaving behind 800,000 orphans This number is expected to increase to 2.3 million by 2010 App. 700 people die each day from AIDS related illness KENYA STATISTICS Source: KICOSHEP Training Manual, 2004

10. Mother- To- Child Transmission (MTCT): During pregnancy Labor Vaginal delivery Breastfeeding Risk of HIV transmission: during pregnancy app 5- 10 % during labor and vaginal delivery app 10 - 20 % during breastfeeding app 10 –20% HOW CHILDREN ARE INFECTED Source: National Policy on Orphans and Vulnerable Children, 2005

11. In poverty stricken areas Dependency Ratios Property Dispossession Stigmatization,discrimination and isolation Psychological Distress Withdrawal From School Child Labor Malnutrition and Illness Extended families DIRECT AFFECTS OF HIV/AIDS

12. INDIRECT AFFECTS OF HIV/AIDS • Strain on human resources • Depletion of human resources

13. RESPONSIBILITIES • To investigate: • Formulation of discussion questions • Formulation of survey • Application to the research and ethics committee • Personal booking of appointments

14. RESPONSIBILITIES • Chose forums for data collection • Lectures • Seminars • Presentations • Discussions

15. Locate the target population (AIDS Orphans) Challenge: Children’s homes are not distributed equally within countries Many children in grandparent headed homes. Extreme cases – headed by child In (remote) rural areas RESPONSIBILITIES

16. Approval from ethics and research committee Could not take pictures of older AIDS orphans for fear of stigmatization, discrimination and isolation if recognized Faced stigmatization upon request to be transported to the orphanages Mistrust, competition, suspicion and unwillingness to share information among different groups in different organizations DATA COLLECTION CHALLENGES

17. Key informants difficult to find in order to be directed into homes Difficult to find homes since many are not listed on local maps and local address books DATA COLLECTION CHALLENGES

18. Prevention and Advocacy Institutional arrangements, managements and coordination Mitigation of Socio-economic impact Community Empowerment Human Resource and Development Evidence-based Interventions CURRENT PROGRAM LIMITATIONS Source: A review of reports prepared by civil society groups (NGOs, CBOs and FBOs) and showed that a number of obstacles and constraints have been implicated for the current Kenya National HIV/AIDS Strategic Plan ,2000-2005 

19. All activities will be focused on ensuring that individuals, households and communities carry out appropriate healthy behaviors and recognize signs and symptoms of conditions that need to be managed at other levels of the system- in this case, HIV/AIDS. Each level unit is to take care of 5,000 persons Why? Communities are at the foundation of affordable, equitable and effective health care. The Kenya Essential Package for Health Proposal in the second National Health Sector Strategic Plan 2005-2010 RECOMENDATION I: Community-based Approach

20. Use a KANCO model: -Child –to child approach- (CTC) An educational process that links children’s learning with taking action. A rights based approach to children’s participation in health promotion and development that is grounded in the United Nations Convention on the Rights of Children- principles of inclusion and non-discrimination- be inclusive and involve as many children without selection or exclusion on the basis of gender, disability, ethnicity and religion. RECOMENDATION II: From Community –based Approach to Child-to-Child Approach

21. Benefit of CTC approach: Builds self-confidence Provides useful knowledge Empowers them with life skills Builds on their personal development Builds on their social development Positive channel of energy and creativity CONCLUSION

22. CONCLUSION Challenges to CTC approach. • Display of power relation between adults and children • Display of power relations among children (bullying) • The role children play in their families, communities and the society • A child’s competencies and age of children • Culture

23. Eradication of poverty is essential because poverty compounds powerlessness and increases ill health, as ill health increases poverty Thank You

24. SPECIAL THANKS.(Inside Kenya Contacts) • Program Coordinator and Contact liaison in Kenya: • Mr. SAMUEL KAHIU WAITHAKA • Program Supervisor in Kenya: • MRS ELIZABETH NYAMBURA WAITHAKA

25. REFERENCES • Ansell, Nicola and Young, L. (2004, January). Enabling Household to Support Successful Migration of AIDS Orphans in South Africa. AIDS Care, 16(1), and 3-10. • Case, Anne, Parson M, et al. (2004, August). Orphans of Africa: Parental Death, Poverty and School Enrollment. Demography, 4 (3), 483-508. • Chatterrji, Minki, et al. (2005). The Well-being of Children affected by HIV/AIDS in Lusaka, Zambia and Gitarama province, Rwanda. Community REACH Work. Washington D.C. Paper No.2. • Chatterrji, Minki, et al. (2004-2005). Orphan and Other Vulnerable Children in Rural and Urban High Density Zimbabwe. United Nations Children’s Fund and Ministry of public service, Labor and Social Welfare Survey.

26. REFERENCES • Chatterrji, Minki, et al. (2005, June). Report on the Pilot survey on Orphans and Other Vulnerable Children in Blantyre, Malawi. United Nations Children’s Fund • Evans, D. (2005, December). The Spillover Impacts of Africa’s Orphans. Rand Corporation Working Paper. Santa Monica.10-11. • Floyd, Sian, et al. (2005, September). HIV and Orphan hood. UNICEF Project. • Monasch, Roeland and Boerma, J. cit pp S55-S65. • Nhate, Virgulion, et al. (2005). Orphans and Discrimination in Mozambique. An Outlay Equivalence Analysis. International Policy Research Institute, 1-2, 12. • Seaman, Petty .J, Petty .C, Acidri. J. 2005. The Impact of HIV/AIDS on household Economy in two villages in Salima District. Save the Children. • Verbose, Heidi. (2005). A child Has Many Mothers. Views of Child Fostering in Northwestern Cameroon. Childhood. 12(3), 369-390.

27. UNAIDS (United Nations AIDS)Dr. Wainaina- Supervisor and coordinator of HIV/AIDS. UNICEF (United Nations Children’s Fund) Ms. Catherine Kimotho- Project Officer, OVC. UNDP ( United Nations Development Program). Dr. Elly Oduol- Assistant Resident Representative. UNESCO (United Nations Educational, Scientific and Cultural Organization). Dr. Susan Nkinyangi- Senor Educative Advisor. KAWI (Kenya Aids Watch Institute) Mr.Geoffrey O..Orero- Head of Operations. NACC (National AIDS Control Council) Mr. Peter Muite- Head of Communication KANCO (Kenya AIDS NGOs Consortium) Mrs. Joyce. KICOSHEP (Kibera Community Self-Help Programme; Mrs. Anne Owiti- Director. Nyumbani Children’s Home; Sister Theresa- Matron. Tumaini Children’s Home; Ms. Joan Smith- Founder and Executive Kenyatta National Hospital Aga Khan Hospital. Kenya Medical Training Institute University of Nairobi; Gidraph G. Wairire- Lecturer and consultant. LIST OF CONTACTS IN KENYA.

28. ACKNOWLEGEMENTS • Dr. G. Prater Dean of College of Public Service • Dr. M. Azevedo Chairperson of the Department of Epidemiology and Biostatistics • Dr. M. Shahbazi Professor and Major Advisor • Dr. R. Williams Associate Dean for the School of Social Work • Dr. Chris Arthur Professor and Preceptor • All Contact People in Kenya.