Review of Existing Child Related Policies: Toward a Child Centred Approach to HIV/AIDS

1. Review of Existing Child Related Policies: Toward a Child Centred Approach to HIV/AIDS Commissioned by India HIV/AIDS Alliance Conducted by MAMTA Health Institute for Mother and Child & Tarun Roy

2. Objective of the current review: • The mapping and review of the existing national policies (explicit and implicit) related to children and HIV/AIDS • The identification of policy gaps and recommendations for addressing the concerns and needs of children affected and infected by HIV/AIDS with a rights-based perspective. • Developing an advocacy plan for the promotion of child related policies

3. Policy Review Methodology • Primarily qualitative in nature • Desk review of the epidemiological data about children infected and affected by HIV and / or AIDS in India to identify related issues • Identification and review of existing child related national policies, guidelines, plan documents, reports • Assessment of current situation and responses in conjunction with the current policies and programmes • Deriving policy recommendation

4. Scope and limitation • A step ahead to strengthen already initiated dialogue towards a policy for child-centred approach to HIV/AIDS voiced by various stakeholders in Policy Forum meetings • Could only identify the strengths and weaknesses of existing national policies to fill in the current gap in responses to children vulnerable, infected and affected with HIV/AIDS • To recommend specific policy requirements to scale up national response towards child focussed HIV/AIDS prevention, care and impact mitigation – • a detailed review of state policies and programmes needs to be carried out and • inputs from policy makers and program personnel is yet to be taken into consideration as a next step

5. Current status of children vulnerable, infected and affected with HIV and / or AIDS in India: • NACO estimated 55,145 children till the end of 2004 (only captures possible perinatal transmission) • No data available regarding children infected through other modes of transmission. • Inadequate data to cumulatively project the number of vulnerable children • Child workers [official estimate -Working children - 11.28 million 1991 census and 13.5 million by NSS conducted during 1995-96; unofficial estimate 44 million and 110 million] • Street-children • Drug use and sexual behaviour among children • Inadequate data to project the number of affected children. Contd.

6. Although the number of AIDS orphans has not been adequately measured, but some calculate as many as 1.2 million children under age fifteen in India have lost one or both parents to AIDS. • There is enough evidence suggesting violation of rights of children who either themselves living with HIV or because they are living with family member/s infected with HIV or living with AIDS. • STI/HIV vulnerabilities of working children (including street children) due to sexual abuse / exploitation and early initiation of risky sexual behaviour and drug use, needs to be prevented. [official estimate -Working children - 11.28 million 1991 census and 13.5 million by NSS conducted during 1995-96; unofficial estimate 44 million and 110 million] • Out of school ‘girl children’, particularly of 6-18 years are extremely vulnerable to HIV because prevailing early age marriage and larger number being trafficked either to work as child labour (prone to sexual abuse) or imbibed into prostitution (this include vulnerability of girl children of female sex workers residing in the sex work settings) contd…..

7. Children who are in need of frequent blood or blood product are yet not completely protected from the risk of blood-borne infection including HIV. • Majority of known paediatric HIV cases are due to failure in prevention of perinatal transmission (3.45% of all known AIDS cases till end Dec. 2004) in India. • Children who are already made orphan (single or double) because of HIV/AIDS are facing the adverse consequences and their fundamental rights are being violated in every walk of life. • Initiation of early sexual activity among school children establishes the vulnerability of elderly school children in major metropolitan cities in India. • There is insufficient documentation to influence the policy makers to focus on reducing the impact of HIV/AIDS among children.

8. Implication of lack of data in advocating for a policy towards a child-centred approach to HIV/AIDS: • The politically viable approach to influence the policy almost always calls for a number. If one considers the ‘number of HIV infected children’ for this purpose then we must remind ourselves that politically convincing number of HIV infected children gets reported – much later in the process of progression of HIV epidemic. • Projection of the number of adults in the reproductive age group, who are infected with HIV and their number of children must guide us to advocate for child centred policy making to address the effect of HIV and / or AIDS on children including other specific HIV vulnerability factors and impact on children.

9. Current responses to reduce STI/HIV vulnerability, provision of care and support to infected and affected children: National AIDS Control Programme II • PPTCT – for prevention of perinatal transmission of HIV - extremely low scale • TI with streetchildren – 26 (among 933 TIs supported till March 2004) • SAEP – targets students of class IX to XII – primarily awareness and life skills - implemented in most of the states (quality of reach and impact not known) • ‘Youth to youth’ and ‘campus to community’ – primarily awareness, not known whether includes adolescents (upto 18 years) and what is the number reached? • Reaching rural youth through Nehru Yuva Kendra • Family Health Awareness Campaign targets 15-49 years

10. Responses other than NACP II, to Children vulnerable, infected and affected with HIV and / or AIDS: • Ministry of Women and Child Development • included HIV/AIDS in their ICDS program – NIPCCD has trained all staffs – reach to adolescents not known • Supports NGOs in running orphanages – scope of accommodating HIV infected and affected children • UNICEF is collaborating with WCD including various other ministries for developing a strategy child-centred HIV/AIDS intervention • Ministry of Social Justice and Empowerment – NISD - Child Protection Division of NISD is responsible for building capacities of service providers, promoting research and documentation in the areas of child protection & juvenile justice. It implements National Initiative for Child Protection (NICP) which is a major national initiative in the areas of child protection and juvenile justice in collaboration with Childline India Foundation. • Ministry of Health and Family Welfare – RCH Program contd…..

11. International donors and UN agencies (major players): • UNICEF – assisting NACPII in countrywide implementation of PPTCT, coordinating with WCD and other ministries • WHO – technical assistance in 3 by 5 (ART), scaling up of VCTCs, second generation surveillance of HIV INGOs: • FHI, India • India HIV/AIDS Alliance • Save the Children (UK) – • Richard Gere Foundation • Railway Children Federation • Catholic Relief Service

12. Relevance of Existing Public policies and legal framework to build up child centred approach to HIV/AIDS: • All policy documents of Government of India, related to child, including the recent one the National Charter for Children (Feb. 2004) has endorsed the importance of taking all measures for protecting the child from different vulnerabilities, provision of child friendly services and ensuring the rights of the child in every sphere, through legal, welfare and social service. • Department of Women and Child Development under Ministry of Human Resource Development is the lead ministry in this direction and are coordinating and collaborating with all concerned ministries like Health and Family Welfare, Labour Ministry, Ministry of Social Justice and empowerment etc to ensure the child development, implemented through the state government. So review of state programs and guidelines related to children needs to be reviewed to identify the gaps. • Child welfare and development is not the mandate of NACO. National AIDS Control Policy has no strategic focus towards children vulnerable, infected and affected with HIV/AIDS

13. Broad Recommendations: • Develop a data base for planning and to influence the child-centered policy making • Based on generated data, inform the policy makers on the estimated number of vulnerable, infected and affected children with HIV/AIDS and about the impact of HIV and /or AIDS on children. • Document the small scale intervention experiences and recommend a comprehensive intervention model. Which may help in revisiting the available child-related policies. • Analyse the barriers in translating the child related policies into action at the state level and come up with recommendation, based on programmatic review. • Reduction of legal barriers for children in accessing the services e.g. VCT, ART • Sensitisation of concerned ministries and departments for an internal review of the policies, in the light of establishment of rights of children vulnerable, infected and affected with HIV and / or AIDS • A collaborative effort – NACO and WCD – for child centred interventions

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