What Works for Women and Girls

Chapter 12.Care and SupportA. Women and GirlsB. Orphans and Vulnerable ChildrenPossibly no other aspect of HIV and AIDS is as “gendered” as care and support (Esplen, 2009).Care and support generally includes both care of people living with HIV and AIDS and offamilies and children affected by HIV and AIDS. UNAIDS includes in its definition home- andcommunity-based care (HCBC), palliative care, psychological support, carer support, and nutritionsupport. Among these, HCBC is meant to be the foundation on which national antiretroviraltreatment programmes are built (UNAIDS 2009c). A 2004 UNAIDS report estimatedthat in Africa, only 12% of HIV-positive people in need of home-based care actually receivedit (UNAIDS, 2004 cited in Newman et al., 2009). Under PEPFAR, the term palliative carecovers clinical services for opportunistic infections, social care (community mobilization, leadershipdevelopment, legal services, linkages to food support and income-generating programs,among other activities to strengthen families and communities), psychological services, spiritualcare, and positive prevention efforts (PEPFAR, 2009).Of particular concern is the care and support of the growing number of orphans and vulnerablechildren. Worldwide, the number of orphans (children under age 18 who have lost oneor both parents) to AIDS stands at approximately 17.5 million (UNICEF et al., 2009). Manymore children live with one or more chronically ill parent. The vast majority of these childrenlive in sub-Saharan Africa. The Joint Learning Initiative on Children and HIV/AIDS, whichcompiled over 50 systematic reviews by working groups of world orphan and vulnerable children(OVC) experts, contend that the definition of ‘orphan’ leads the international communityto assume that these children are without family support. “The UN definition of an orphan, ‘achild who has lost one or both parents,’ distorts the global response to children affected by HIVand AIDS. Instead, “some 88% of children designated as ‘orphans’ by international agenciesWHAT WORKS FOR WOMEN AND GIRLS341