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Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
Wing sie cheng
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Wing sie cheng

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  • Some epidemiologists argue that Asia will never reach the stage of Africa. But the concerns here is with Asia’s huge population size. India’s 0.8% already means an estimated 5 million infected. About one-fourth of Africa’s total 22 million. South Africa’s 21.5% represents 4.8 million people, lower than India’s 0.8%.
  • Some epidemiologists argue that Asia will never reach the stage of Africa. But the concerns here is with Asia’s huge population size. India’s 0.9% already means an estimated 5 million infected. About one-fourth of Africa’s total 22 million. South Africa’s 21.5% represents an estimated 4.8 million people, lower than India’s 0.9%.
  • Transcript

    • 1. Universal Access Children as the Missing Faces of AIDS Asia-Pacific
    • 2. How many children are affected in Africa?
    • 3. How many children are affected in Asia? Generalized Source: pg 199, 2004 Report on the Global AIDS, UNAIDS ?
    • 4. Low Prevalence – East Asia & Pacific High Prevalence - Africa Source: 2004 Report on the Global AIDS, UNAIDS Concentrated Low-level Low Prevalence High Generalized “ 99% of the popula-tion in Asia are still HIV negative. Let’s just keep it that way.” Peter Piot to ADB President and staff in Manila, 22 Feb 2005 0.1 Pakistan 0.5 Nepal 0.1 China 1.2 Myanmar 1.9 Cambodia 0.4 Vietnam 0.4 Malaysia 1.5 Thailand 1.7 Papua New Guinea 0.1 Fiji 0.1 Lao PDR 0.1 Indonesia 0.9 India <0.1 Timor-Leste <0.1 Mongolia No data DPR Korea < 0.1 Philippines HIV Prevalence % (end 2003) Countries
    • 5. Low Prevalence – East Asia & Pacific High prevalence – Africa Source: 2004 Report on the Global AIDS, UNAIDS Low Prevalence High Generalized Low Prevalence Generalized Concentrated Low-level High 38.8 Swaziland 37.3 Botswana 28.9 Lesotho 24.6 Zimbabwe 21.5 South Africa 21.3 Namibia 16.5 Zambia 14.2 Malawi 13.5 Central African Republic 8.8 Tanzania HIV Preva-lence % (end 2003) Countries 0.1 Pakistan 0.5 Nepal 0.1 China 1.2 Myanmar 1.9 Cambodia 0.4 Vietnam 0.4 Malaysia 1.5 Thailand 1.7 Papua New Guinea 0.1 Fiji 0.1 Lao PDR 0.1 Indonesia 0.9 India <0.1 Timor-Leste <0.1 Mongolia No data DPR Korea < 0.1 Philippines HIV Prevalence % (end 2003) Countries
    • 6. Low Prevalence – East Asia & Pacific High prevalence – Africa Source: 2004 Report on the Global AIDS, UNAIDS Low Prevalence High Generalized Low Prevalence Generalized Concentrated Low-level High India: 0.9 % ≈ 5.1 million South Africa: 21.5% ≈ 4.8million 38.8 Swaziland 37.3 Botswana 28.9 Lesotho 24.6 Zimbabwe 21.5 South Africa 21.3 Namibia 16.5 Zambia 14.2 Malawi 13.5 Central African Republic 8.8 Tanzania HIV Preva-lence % (end 2003) Countries 0.1 Pakistan 0.5 Nepal 0.1 China 1.2 Myanmar 1.9 Cambodia 0.4 Vietnam 0.4 Malaysia 1.5 Thailand 1.7 Papua New Guinea 0.1 Fiji 0.1 Lao PDR 0.1 Indonesia 0.9 India <0.1 Timor-Leste <0.1 Mongolia No data DPR Korea < 0.1 Philippines HIV Prevalence % (end 2003) Countries
    • 7.  
    • 8. Estimated # between Sub-Saharan Africa &amp; Asia <ul><li>HIV circulating within 3 major sub-populations: IDU, SW &amp; MSM – </li></ul><ul><li> with pockets of generalized epi (ANC &gt;1%) </li></ul><ul><li>Recent trend: ↑ clients of sex workers infected </li></ul><ul><li>Increased % of women - 23% (East Asia-Pacific), 26% (South Asia) </li></ul><ul><li> - 57% (Sub-Saharan Africa) </li></ul><ul><li>Plus increased evidence of high risk of infection during pregnancy </li></ul>
    • 9. International OVC framework <ul><li>Strengthen the capacity of families </li></ul><ul><ul><li>Small scale projects, not at national policy stage except for Thailand &amp; Cambodia through income-generation, drug, food and school assistance </li></ul></ul><ul><li>Mobilize community-based responses to support affected families </li></ul><ul><ul><li>Thailand &amp; Cambodia (National models); India &amp; Papua New Guinea (NGO &amp; FBO) </li></ul></ul><ul><li>Ensure equal access to essential services </li></ul><ul><ul><li>Thailand, most recently “Health Thailand” 30-Baht Scheme that also covers ARV (including 2 nd line regimen) </li></ul></ul><ul><li>Policy, legislation, standards and enforcement </li></ul><ul><ul><li>China “4 Frees 1 Care”, Thailand, Cambodia &amp; Vietnam (legal review) </li></ul></ul><ul><li>Raise awareness to create supportive environment (from angle of children affected) </li></ul><ul><ul><ul><li>Cambodia, China, Laos, Vietnam &amp; Thailand </li></ul></ul></ul>
    • 10. Knowledge, capacity, commitment &amp; leadership <ul><li>Defining the target pop. – identifying beneficiaries </li></ul><ul><ul><ul><li>PHIV prefers to remain anonymous, and children affected are invisible </li></ul></ul></ul><ul><li>Stigma &amp; discrimination – AIDS as Social Evil </li></ul><ul><li>Approaches to programming </li></ul><ul><ul><ul><li>Spectrum of care – Info on families, foster care, adoption, and alternative types of residential care – still not well examined (only Vietnam conducted a study) </li></ul></ul></ul><ul><ul><ul><li>Integrating children affected by HIV/AIDS into broader community initiatives (selected countries: Thailand &amp; Cambodia) </li></ul></ul></ul><ul><ul><ul><li>Linking activities for children with other HIV/AIDS efforts (not much beyond PMTCT Prong III) </li></ul></ul></ul><ul><ul><ul><li>Addressing fundamental needs – food security &amp; nutrition, education, economic stability &amp; protection (Thailand &amp; Cambodia – not much elsewhere) </li></ul></ul></ul><ul><ul><ul><li>Prevention among the most vulnerable children &amp; youth </li></ul></ul></ul>Source: Lynn Sussman, Providing Support to Children Affected by HIV/AIDS &amp; their families in Low Prevalence Countries of India and Cambodia: Programmeing Issues, Policy Project, Washinton DC, Jan 2006
    • 11. &nbsp;
    • 12. Coming to grip – not only with children affected but also those Infected
    • 13. Growing up alone 生存问题
    • 14. Children affected by AIDS – an emerging issue <ul><li>Regional estimation conducted in 2005 – 1.5 million in Asia-Pacific (10% of global total) </li></ul><ul><li>National data – not systemically collected – largely derived from initial assessments </li></ul><ul><li>Estimation of orphans compounded by stigma – denial of deaths as related to AIDS </li></ul><ul><li>Lack of clarity on definitions of vulnerable children &amp; spectrum of vulnerabilities </li></ul><ul><li>Conservative estimates favoured in some instances due to budgetary implications – subsidies to affected families with children </li></ul>
    • 15. Children affected by AIDS – an emerging issue Source: Various country assessments by MOPH, UNICEF or UNCT -- 76,000 -- -- 30,000 Double orphans 19,200 283,000 Vietnam 9,000 (in 2005 alone thru MTCT) -- China 10,964 9,400 Papua New Guinea 12,000 60,000 Cambodia -- 300,800 Thailand Children living with HIV At least one parent died of AIDS Country
    • 16. Low Prevalence – East Asia &amp; Pacific High Prevalence - Africa Concentrated Low Prevalence High Generalized Conducted – final report due Feb 2006 Bangladesh 1.5 1.7 1.2 1.9 0.4 0.1 0.4 0.5 0.1 0.1 0.1 0.9 0.1 HIV Preva-lence % (end 2003) -- Pakistan Conducted in 2002 Nepal Planned - 2006 + Baseline initiated in Henan, Hubei &amp; Yunnan China Small scale assessment – 2003 Myanmar Conducted, policy in place, national OVC working group set up Cambodia Conducted 2003, along with legal review &amp; assessment of alternative &amp; inst. Care Vietnam Planned – 2006 Malaysia Policy &amp; programmes in place – Good modes in Sanpatong, Chiang Mai Thailand Conducted 2005 Papua New Guinea -- Fiji Conducted in 2004 Lao PDR Planned – 2006 Indonesia Exploring multiple forms of assess. at different levels India National assessments - children affected by AIDS Countries
    • 17. Diverse cultures, local practices &amp; governing systems
    • 18. Diverse cultures, local practices &amp; governing systems Tengatenga Care Centre for Children Papua New Guina – 800 languages Kartanim Care Centre Kenan Care Centre Peace Care Centre
    • 19. Universal Access <ul><li>Global campaign in the context of scaling up: </li></ul><ul><li>Asia-Pacific Universal Access Conference, Pattaya, Thailand, 14 – 16 Feb </li></ul><ul><li>Review of National HIV/AIDS Strategic Plan – are children given sufficient policy attention &amp; programme support? </li></ul><ul><li>East Asia-Pacific Regional Consultation on Children and HIV/AIDS, Hanoi, Vietnam, 22 – 24 March </li></ul>
    • 20. Universal Access <ul><li>Estimated resource needs for HIV/AIDS – Asia-Pacific </li></ul><ul><li>$4 billion - 2006 </li></ul><ul><li>$5 billion – 2007 </li></ul><ul><li>Eg. Thailand, 85% on treatment and care, including ARV </li></ul><ul><li>Current annual spending, including both public and private out-of-pocket expenditures, about $700 million </li></ul><ul><li>Region as a whole spends $100 billion a year on health care alone. Three-quarters (75%) of each dollar spent on health care right now are private payments to private providers </li></ul><ul><li>Long-term financing of care &amp; welfare support – a major issue </li></ul><ul><li>Competing priorities: Recent threat of avian &amp; pandemic human influenza </li></ul>.
    • 21. Programmes &amp; coverage Source: “Coverage of Selected Services for HIV/AIDS Prevention, Care and Support in Low and Middle-Income Countries in 2003”, USAID, UNAIDS, WHO, UNICEf and the Policy Project, June 2004 No data – global coverage survey of OVC due in 2006 Not available Orphans and vulnerable children receiving care and support services 22 20 Southeast Asia region Western Pacific region Children living on the streets covered by prevention programs 64 33 Southeast Asia region Western Pacific region HIV/AIDS education among secondary school students 13 73 Southeast Asia region Western Pacific region HIV/AIDS education among primary school students 0.1 0.0 Southeast Asia region Western Pacific region Voluntary Counseling &amp; Testing Services &lt; 1.0 Asia &amp; Pacific Pediatric AIDS treatment 8 3 Southeast Asia region Western Pacific region Prevention of mother-to-child-transmission % Global coverage survey (2004) Programme area
    • 22. Universal Access <ul><li>Key messages – children affected by AIDS – shared with UNAIDS &amp; Sec-Gen’s Special Representative on HIV/AIDS in Asia – Nafis Sadik </li></ul><ul><li>National consultations taking place: </li></ul><ul><ul><li>Indonesia: Revised Presidential decree No. 30/1994 on HIV/AIDS prevention and care to include children </li></ul></ul><ul><ul><li>Myanmar: National Strategic Plan should address children affected &amp; infected </li></ul></ul><ul><ul><li>Vietnam: Multi-sectoral response for children affected by AIDS (9 NAP currently place children under Community Response) </li></ul></ul><ul><li>Regional Consultation on Children and HIV/AIDS, Hanoi, Vietnam, 22 – 24 March </li></ul><ul><ul><li>First of its kind (regional) in Asia </li></ul></ul><ul><ul><li>USAID/OGAC/FHI, WHO, UNESCO, Save the Children, UNICEF/UNAIDS </li></ul></ul><ul><ul><li>Defining needs, emphasizing rights of marginalized children, </li></ul></ul><ul><ul><li>International framework, coordination, integration &amp; partnership </li></ul></ul><ul><ul><li>Hanoi Call to Action </li></ul></ul>
    • 23. Hanoi Call to Action, 22 – 24 Mar 2006 <ul><li>Develop country-specific targets and action plans for rapidly scaling up HIV prevention, including the prevention of maternal to child transmission, HIV testing and counseling, pediatric and adult antiretroviral treatment, family-oriented clinical care, psychosocial support and child and family protection services with accelerated effort targeted specifically for children by 2010. </li></ul><ul><li>Allocate a dedicated proportion of national HIV/AIDS budgets to the rapid scale up of responses targeted for children. </li></ul><ul><li>A quantitative and qualitative assessment of the situation of children and HIV/AIDS in each country to strengthen and scale up the response. </li></ul><ul><li>Establish systems for monitoring key indicators over time, including numbers of children infected and affected by HIV/AIDS and the core global indicators for monitoring the national response to children orphaned and made vulnerable by HIV/AIDS. </li></ul>
    • 24. Hanoi Call to Action, 22 – 24 Mar 2006 <ul><li>5. National multi-sectoral working group that focuses on child welfare and coordinates the scaled up response for children vulnerable to, infected and affected by HIV/AIDS. </li></ul><ul><li>6. Eliminate HIV/AIDS-related stigma and discrimination, financial and other barriers to ensure that all children have access to essential services, including a continuous basic education. </li></ul><ul><li>7. Expanded efforts to ensure that all children are provided with the most family-like care environment and that institutional care is used for children without caregivers only as a temporary measure or option of last resort. </li></ul><ul><li>Over 200 government &amp; NGO representatives from 17 countries in East Asia &amp; Pacific </li></ul>
    • 25. Thank you Wing-Sie Cheng Regional Adviser, HIV/AIDS UNICEF East Asia &amp; Pacific Regional Office Bangkok, Thailand Email: wscheng@unicef.org

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