HIV: Not enough attention given to children

Children constitute about 40% of South Africa’s population and it is therefore critical that the National Strategic Plan (NSP) for the Prevention and Management of HIV, STIs and TB, focuses on the needs of this large and vulnerable group.

In the midterm review of the 2007-2011 NSP, the Yezingane Network (a civil society network of organisations working to address the impact of HIV and AIDS on children), noted that the first NSP lacked specific indicators for the management and prevention of the HIV pandemic among children.

At a workshop in 2008, the Network therefore proposed the development of a list of indicators to address this weakness, as well as an indicator scorecard for children living with HIV and AIDS. A scorecard of well-defined, child-oriented indicators, it argued, would enable the collection of qualitative and quantitative information specific to measuring the pandemic’s effects on children. Each of the ten indicators, chosen in consultation with technical experts, was also intended to provide critical information on the extent to which South Africa had met its obligations to children in accordance with the NSP’s objectives. Measuring these indicators annually, the Network suggested, would help to:

• focus attention on children in the national HIV/AIDS agenda
• monitor success in addressing the impacts of HIV and AIDS and the NSP on children
• highlight gaps in the information we need in order to monitor progress, and
• provide an advocacy tool for addressing service and data gaps.

The scorecard was launched in August 2009, but the impetus behind this first initiative slowed in the later years of the 2007-2011 NSP. During the development of the second plan (2012–2016), indicators relating to the success of the NSP in relation to children were, once again, not given adequate attention.

The core indicators of the new NSP, and some of the specific indicators that relate to the NSP’s first three Strategic Objectives, do address issues related to the well-being of children. However, there is a need to extend the scope of these indicators so that they relate more explicitly to the needs of children – and even to develop indicators that are specific to children. This way, we will be able to measure more precisely the impact the NSP is having on this vulnerable group.

As yet, no specific indicators have been developed for the fourth strategic pillar of the NSP which relates to ensuring the protection of human rights and greater access to justice. This is of particular concern given that the needs of children require particularly careful tracking in relation to these issues. The protection of children’s rights is dependent on adults, and the access children have to justice may therefore be facilitated or blocked by the adults in their world.

Children are vulnerable to HIV infection through sexual abuse and neglect. Without child-specific indicators to measure the protection of their rights, it will remain difficult to measure the progress we are making in improving their access to justice.

Specific measures that could be implemented to help protect the rights of children include the clear disaggregation of ages in police statistics so that it is clear how many children are affected [by crime]. The measurement of compliance with ARV regimens following sexual assault is also important. The outcomes for children who are victims of crime and who are dealt with by the criminal justice system also need to be tracked. Many children remain insufficiently supported by the legal system, especially when cases involving children are withdrawn from court.

Although the NSP addresses the issue of stigma with regard to discrimination in the workplace and access to services, the plan fails to consider this issue more widely in relation to children and their experiences of prejudice at schools. It is important that children who are affected by the pandemic, or who are HIV-positive, are helped to cope with social stigma or negative responses. Childhood is a time during which social skills are developed and these are strongly shaped by interactions with other children and adults. Adverse social experiences during childhood may have a profound impact on adult functioning. It is therefore particularly important that we protect children from alienation and social exclusion.

Further meaningful indicators must be developed to ensure that the NSP also succeeds in addressing the health needs of children. The midterm review of the NSP should be used as an opportunity to do so.