From Affected to Infected: Categories of Interventions to Reduce Vulnerability

15 epidemic. They have a unique and powerful ability to mobilize resources and faith communities at the local level for the benefit of children. FBOs are also central to the spiritual elements of response to the epidemic that often undergird emotional and social responses for individuals and communities. Private Sector Private sector entities have been actors in the response to the AIDS pandemic in several notable ways. They provide health care and other social services to employees and area residents; they provide job opportunities for families that contribute to economic strengthening of households and youth empowerment; and many undertake corporate social responsibility actions that contribute to community infrastructure. Opportunities to partner with private sector entities to expand access to market opportunities and health and social services for children and families should be considered.

2.2.3 Governments

Government actors include publicly funded ministries and departments at the national, regional, and local levels. They contribute to the welfare and protection of children and families by developing large- scale and long-term government-endorsed policies and action plans. They coordinate all actors in the response to vulnerable children, provide public benefits and services, and collect and manage official data. Government actors have the authority to ensure the safe and equitable delivery of essential services and to provide safety nets that alleviate poverty. The many needs of children and families affected by HIVAIDS require a multisectoral effort that le e ages a hole of go e e t espo se. All government actors are concerned to some extent with the elfa e of hild e , i ludi g allied ministries, such as ministries of education, health, justice, etc. However, social welfare ministries play a central role in the overall HIVAIDS response by ensuring the welfare and protection of marginalized groups, including persons living with and children affected by HIV AIDS. OVC programs should engage all child-serving government agencies in the AIDS response and provide focused systems-strengthening efforts to social welfare agencies. They should also partner with governments to support AIDS-sensitive social welfare and child protection policies and programs that benefit all highly vulnerable children

2.3 From Affected to Infected: Categories of Interventions to Reduce Vulnerability

In addition to the above principles and approach, multiple types of interventions must be employed to address the vulnerability of children in the epidemic. Vulnerability is multifaceted and, as the diagram below shows, the destructive social effects of HIVAIDS also contribute to children moving from being affected by the virus to infected. Addressing issues included in the accompanying figure entails a multisectoral approach that assesses the complexities of vulnerability at the individual level while understanding contextual and collective effects. Descriptions of evidence-based sectors that can address these effects are included in this guidance and also reflected in brief in the diagram below color-coded to reflect where sectors correspond to the illustrative effects of HIV above. The sectors are: 16 Child protection Health and nutrition Capacity building Education Household economic strengthening Legal protection Psychosocial care and support Social protection The various sectors should be integrated in program designs along with other interventions in the HIV continuum of response to serve the needs of children and help achieve an AIDS-free generation. The OVC approach calls for program designs to intentionally consider the types of interventions to be HIV infection of Parents Possible distancing by parent, disclosure Children may become caregivers Psychosocial Deaths of parents Increasingly serious illness Children withdraw from school Inadequate food Problems with shelter material needs Economic problems Problems with inheritance Reduced access to health services Children without adequate adult care Discrimination Increased vulnerability to HIV Life on the street Institutionalization Sexual exploitation Exploitative child labor How HIV Affects Children adapted from John Williamson Figure 2: How HIV Affects Children 17 Figure 3: Sectors that Address Child Vulnerability included across the levels of society to create an overall protective environment for children in the epidemic. Addressing these multiple effects due to vulnerability resulting from HIVAIDS also includes enhancing integration with and coordination among prevention, care, and treatment activities. While the majority of care for children in the epidemic happens in the home and in communities, programs should not miss opportunities for integration, especially with PMTCT, antiretroviral therapy ART, and other health services that are critically important for children to survive, thrive, and avoid infection. The strong presence of OVC programs in the home and community provide a foundation to actualize a true continuum of response across the PEPFAR portfolio. Numerous opportunities exist to ensure that care provided in clinical settings is complemented by socioeconomic, psychological, and spiritual support. Section 3 of this guidance on strategic portfolio development is central to designing programs or solicitations and includes more detail on integration and general guidelines for strategic planning for OVC portfolios. The technical sections that follow outline specific sectoral interventions as well as linkages to other sectors and across the continuum of response to reach the goal of an AIDS-free generation. 18

3. STRATEGIC PORTFOLIO DEVELOPMENT