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close this bookCall to Action for 'Children Left Behind' by AIDS: A plea for communities, governments, civil society, the private sector and international partners to vigorously address the plight of children who are affected by the AIDS epidemic (UNAIDS, 1999, 5 p.)
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View the documentBackground
View the documentCall to Action
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Issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS),
The United Nations Children's Fund (UNICEF) and the
National Black Leadership Commission on AIDS, Inc. (BLCA)


The new millennium dawns on a world facing an unprecedented human tragedy - the loss of millions of people to the AIDS epidemic. More than 16.3 million people have died. By the end of the year 2000, a cumulative total of 13 million children will have lost their mother or both parents to AIDS, and 10.4 million of them will still be under the age of 15.

More than 90 per cent of children orphaned by AIDS are in sub-Saharan Africa, and the numbers are increasing daily. In the next decade, the numbers of orphans are also expected to increase in Asia, the Americas, Central and Eastern Europe and the countries of the Commonwealth of Independent States. In industrialized countries, deaths have declined significantly, but AIDS remains a deadly menace in the absence of an effective cure.

The onslaught of AIDS on people of reproductive age is increasing the numbers of orphans at such a rate that communities cannot rely on traditional means of caring for these children. This is particularly true in many sub-Saharan African countries lacking adequate basic social welfare services. The inability of communities to respond adequately and appropriately to the situation has resulted in social, psychological and economic deprivation for the children, and this is likely to continue for the long term. Such deprivation is worse for girls whose parents have died, as these girls often have to care for their siblings and take on extra work, thereby reducing their opportunities for schooling.

Of course, AIDS affects children long before their parents die. The toll taken by the disease begins during the period of illness, continues through death and bereavement and will likely persist into adulthood if adequate support and protection are lacking. These extremely vulnerable children can suffer myriad problems and human rights abuses: the terrible stress of watching parents fall ill and die, grief for lost family members; a decline in nutritional status; loss of health care; increased demands for their labour; reduced opportunities for education; loss of inheritance; homelessness; discrimination; physical abuse; and sexual abuse, which in turn exposes them to HIV infection.

The absence of parental protection and care, combined with HIV-related illnesses, has contributed significantly to the increase in deaths of children under five in the countries most affected. AIDS has undermined the capacity of communities and households to cope and is hindering efforts to achieve goals for the survival and development of children, including the year 2000 goals agreed to by world leaders at the 1990 World Summit for Children.

Specific needs of children and families affected by HIV/AIDS

The onset of AIDS, in many developing countries, marks the beginning of a transition from poverty to complete destitution. The reality is most bleak in the worst-affected areas of sub-Saharan Africa, where over 50 per cent of the population lives below the poverty line.

Despite many obstacles, however, threatened communities around the world are struggling to support orphans and families affected by HIV and AIDS. However, among the constraints are the sheer numbers of orphans, which have the potential to overwhelm these efforts, the urban focus of many programmes, which therefore reach relatively few people, and limited coordination with government. These constraints have prevented the needs and rights of many children and families from being addressed.

With the relentless toll of AIDS reducing the ability of families and communities to support and care for children, we now face troubling scenarios: grandmothers struggling to care for orphans; households headed by children, many of them primary-school age, who are caring for younger siblings; and worse, children with nowhere at all to turn. Often compounding the devastation caused by AIDS is armed conflict, which poses the additional challenges of forced migration, displaced populations and further violations of rights.

These multiple crises surrounding AIDS call for the urgent and full engagement of all levels of society, which have a guide for action in two key international conventions: the Convention on the Rights of the Child (CRC), ratified by 191 countries, and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), ratified by 165 countries as of November 1999. By ratifying, countries have made themselves accountable for addressing the rights and needs of children and women, including those affected by HIV or AIDS.

Call to Action

This call is a plea for communities, governments, civil society, the private sector and international partners to vigorously address the plight of children who are affected by AIDS epidemic. Urgent action to meet their needs and ensure the realization of their rights is needed at three levels: family and community, government and global.

1. Family and community level

'Keep families and communities at the front line' by empowering and supporting them to care for orphans. Lessons from community initiatives over the past 15 years point to the following actions as essential:

· Foster active participation of the community, including people living with HIV or AIDS, in identifying and implementing actions to strengthen community-based care and support for orphans.

· Increase women's access to credit, income-generating activities and property, including land, because the burden of care tends to fall on poor women with few resources. In many cases, such action will require changing laws and policies regarding inheritance and property ownership.

· Establish widespread confidential counselling and voluntary testing for HIV. The benefits of such counselling include prevention of mother-to-child-transmission, promotion of the rights of girls and women to make informed decisions and realization of people's right to know their HIV status.

· Target social assistance to all families in need, not just those grappling with AIDS, as a way of ensuring equity and discouraging discrimination against orphans and others affected by AIDS.

· Reduce demands on the labour of girls and women: In many parts of Africa, for example, improving access to water and fuel for heating and cooking would free up more time for girls and women, allowing more girls to obtain a basic education, as is their right.

· Respond to the psychosocial needs of orphans through counselling services for children and families in need. School and home-based care and services should ensure in particular that children develop emotionally and intellectually through play and other activities and that they feel a sense of belonging to their communities.

· Encourage community leaders to protect the legal rights of children and women, especially those of widows and orphans. This will involve changing harmful practices and customary laws that are discriminatory or exploitative.

II. Government level

‘Break the conspiracy of silence’: The success of governments will be measured by their ability to prevent HIV and to enable families and communities to cope with the effects of the epidemic. Governments need to take action in three key areas:

Advocacy and social mobilization

· Actively combat discrimination. Raise the visibility of AIDS while combating the shame and stigma associated with the disease.

· Raise public awareness of the nature of the crisis and mobilize resources locally and internationally.

· Encourage the full participation of communities in all aspects of the response to AIDS. Ensure that people living with HIV or AIDS and those caring for them are involved at every step - including planning, implementation, monitoring and evaluation.

Priorities and reform

· Develop priority national policies in support of HIV prevention and mitigation of the impact of AIDS. Focus on protecting younger children and girls and on providing young people with effective education on HIV and AIDS and on related reproductive health issues. Encourage prevention programmes involving peer educators.

· Mobilize widespread support for the fight against AIDS and establish frameworks linking efforts of government, civil society, including religious organizations, non-governmental organizations, the private sector and communities to use resources most efficiently.

· Ensure access to education, especially for girls, by introducing specific measures such as subsidies, scholarships and the provision of alternative avenues for high-quality education, such as community schools.

· Reform the education sector to respond better to the needs of orphans and their communities. The traditional approach to education needs to be overhauled to make schools more participatory and responsive to the everyday needs of students and more relevant to their lives. It is essential that schools help students acquire skills that can enable them to make informed decisions and avoid risks. Teacher training and support is pivotal to this effort.

· Reform the health sector to emphasize HIV prevention and the provision of quality health care services that can address the needs of children and communities affected by AIDS.

· Introduce and enforce laws that realize the rights of children and women, emphasizing social welfare and the best interests of the child. Focus on protection issues such as child abuse and rape, children in commercial sex work, exploitative child labour, juvenile justice, and children and women who lack secure tenure and are denied property ownership.

Monitoring and evaluation

· Identify, assess and document successful community-based initiatives with a view to expanding them into effective national or intercountry programmes.

· Monitor the impact of HIV and AIDS on children and families at all levels and use the information gathered to take targeted action.

· Equip communities to monitor the local impact of the epidemic, facilitate action and evaluate interventions.

III. Global level

‘Keep children orphaned by AIDS high on the global agenda’: Governments, donors, the private sector and international organizations have a moral obligation to act comprehensively and quickly in addressing the rights and needs of AIDS orphans. Their efforts can focus on these actions:

· Make AIDS central to development assistance, especially for the most affected countries in Africa. Ensure that resources are allocated in such a way that countries can do more than merely stave off increased poverty and the deterioration of social services.

· Make AIDS orphans a priority in plans to accelerate debt relief and also in sector-wide lending initiatives.

· Provide financial support for long-term human development projects.

· Promote and advocate for the rights of children and women as articulated in CRC and CEDAW.

· Encourage the development of resource networks to facilitate the sharing of human, technical and financial resources regionally and globally.


This Call for Action is a clarion call for a new vision of solidarity and partnership at all levels. The facts are self-evident: The human suffering brought on by AIDS will only continue to multiply. Even if the rate of new infections declines in the near future, the suffering will remain, and the proportion of children orphaned by the epidemic will continue to increase for decades. The recommended action to address problems and protect the rights of children and women must therefore be sustained over a very long time. Such action is not only morally imperative but economically sound.

The experiences of severely affected countries have made it clear that no single action can make a meaningful and lasting impact on the AIDS crisis. Nor can the governments of these countries, working on their own, ensure the well-being of their populations. Partnerships are key, as are increased resources, policy development, review and reform of laws, social mobilization and coordination among the various sectors of government, the private sector and civil society.

Equally crucial, there needs to be very close involvement of those most affected by the epidemic – children, families and communities – whose role in tackling this still unfolding tragedy will continue to be indispensable. Efforts must focus strongly on supporting families. When solutions are weighed against the best interests of the child, it will become ever more apparent that the family remains the primary cradle of care for children and their most cherished and valuable safety net.