Opinion: Moving Beyond AIDS Orphan

Occasionally, we will link to media opinions on aspects of adoption and child welfare that you may never have thought about. This opinion piece discusses the portrayal of children with AIDS as well as the different types of efforts to assist them.

The opinion can be found Moving Beyond “AIDS Orphans” [Huffington Post 6/7/11 by Mark Canavera]

It begins with “What comes to your mind when you hear the words “AIDS orphans”? Do you imagine a skinny, destitute African child with matchstick legs? Is he or she young — maybe 7- or 8-years-old? Are there flies in the child’s eyes? What do you think would be the best way to help this child? Should you send money to an orphanage that can provide food, shelter, clothing, and education? How about a mission trip to bring soccer balls and medicine? What about international adoption as an option?

Popular American conceptions about so-called “AIDS orphans” are based largely on well-intentioned but ultimately inaccurate portrayals about who children affected by HIV and AIDS really are. We are also misguided about how best to help them. A recent Grey’s Anatomy plotline saw the character Karev fly a bunch of thickly accented “Africans” (no country specified) to Seattle for advanced surgeries in a ploy that would help him become chief resident at Mercy West. (It didn’t work out for him.)  Madonna notoriously chose her first adopted child out of a line-up at an “orphanage” in Malawi, only to learn later that his father was still alive. (In an open letter, she claimed to want to “help one child escape an extreme life of hardship, poverty and in many cases death.”)”

AIDS Assistance Links

He links to some organizations and papers that frame the needs of children from the international development point of view instead of the international adoption point of view.

Two of those are Better Care Network and Interagency Task Team on Children Affected by Adoption.

The Better Care Network links to the   International Social Services(ISS) report The Rights of the Child in Domestic and Intercountry Adoption: Ethical Principles and Guidelines for Practice from 1999.

This should be required reading for all prospective parents.

Taking Evidence to Impact

His opinion piece also links to the UNICEF report. Some Excerpts worth reading include the following:

• Page 12, Figure 3 entitled  Supporting Families and Children Affected by HIV and AIDS, Building on the Framework Strategies
• Page 13 “Meaningful child participation is a child‟s right, allowing them to play an active part in their communities and increasing programming effectiveness. A review of child participation in Eastern and Southern Africa found a gap between policy regarding child participation and its practice, despite the sense of urgency about effective CABA responses. To improve child participation in the region, the reviewers recommended:

•  Page 14-You may need to sit down to read this as this flies in the face of adoption agency ads.

“Global analysis of commonly used definitions of HIV-related vulnerability show that being a single or double orphan is not consistently a useful predictor of child vulnerability. Analysis of household data shows that orphaning alone is a poor predictor of other outcomes, including nutritional status and sexual debut, although double orphans (who lost both parents) usually have worse educational attendance than non-orphans. The same analysis shows that poverty intensifies the impact of HIV and AIDS on children‟s lives and that vulnerability is shaped by many factors, such as age and gender. Non-residence with living parents may have a similar negative impact as orphaning in some settings.”

“In concentrated epidemic settings, HIV clusters in key populations at higher risk of HIV infection, such as sex workers, people who use drugs, and men who have sex with men. Children living among key population groups may be excluded from education, health and other social services due to their parents‟ or their own marginalized and often illegal status. The term “most-at-risk adolescents‟ (MARA) includes people who use drugs – especially injectable drugs – men who have sex with men, and children who are exploited in sex work. Other categories of adolescents at high risk of infection are defined based on patterns of HIV incidence or vulnerability to exploitation. They include adolescent girls, young people working in potentially exploitative situations (e.g., domestic workers), and those living and working in communities of sex workers or on the street.”

“As policymakers and programmers increasingly approach HIV as one of many dimensions of vulnerability, they seek to ensure that services for vulnerable children – including child protection, education, health, social protection, psychosocial support and legal protection – are inclusive of vulnerable CABA. This approach is often described as HIV-sensitive rather than HIV-specific programming.”

• Figure 4, page 15 How HIV and AIDS Can Affect Children Across the Life Cycle
• Page 21 WHOLE FAMILY CARE

“A package of HIV-related services for the entire family within a continuum of care is missing. Family centred practices tend to be overlooked, such as those involving men in PMTCT and infant-feeding counselling or risk assessments for intimate partner violence. These additional services could have a positive impact on PMTCT and the wider family, as in Swaziland, where an MTCT-Plus community-based treatment project reported lower transmission rates to infants when male partners were involved and participated in a support group.26 Couples counselling and testing to facilitate early detection of serodiscordance in partners and prevention of HIV transmission are other promising family based approaches”

•  Home-based care and palliative care are also discussed
• Page 41 For all you suffering from EUBS that think UNICEF wants kids in orphanages

“The majority of children in residential care facilities have at least one living parent, which points to the need for early family-centred interventions to prevent separation, and to support reintegration where this is in the best interest of the child.

The Guidelines for the Alternative Care of Children were adopted by the UN General Assembly in 2010 and provide guidance on the protection and well-being of children who are deprived of parental care or who are at risk of being so. The Guidelines emphasize the importance of preventing family separation in the first place, and, for children who do need alternative care, of helping to determine the most appropriate form of care. The Guidelines also emphasise that alternative care for children under the age of 3 years should be provided in family-based settings.

Types of alternative care include (but are not limited to) family-based formal and informal care, foster care, residential care and supervised independent living arrangements. The guidelines urge States to ensure special efforts are made to tackle discrimination, including on the basis of HIV and AIDS, and to support the provision of appropriate care and protection for all vulnerable children, including children living with or affected by HIV and AIDS.

In addition to guidelines, social mobilization and campaigns targeting opinion leaders and community members are needed to combat widely held beliefs that residential care facilities are the best option for children without sufficient care arrangements.”

Wow, it sounds like they DON’T want kids in orphanages after all. Remember that solving this problem is more complicated than the easy-UNICEF-blaming marketing line.

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