What Works for Women and Girls

What Works—Care and Support: Orphans and Vulnerable Children1. Accelerating treatment access for adults with children can reduce the number oforphans, improve pediatric mortality and social well-being.2. Programs that promote the strength of families and offer family-centered integratedeconomic, health and social support result in improved health and educationoutcomes for orphans.3. ARV treatment with good nutritional intake and regular medical care can improvehealth and survival of HIV-positive children in resource-poor settings.4. Psychological counseling and mentoring for OVC improves their psychological wellbeing.5. Programs that provide microenterprise opportunities, old age pensions or othertargeted financial and livelihood assistance can be effective in supporting orphans.Promising Strategies:6. Programs for OVC should keep siblings together if at all possible.7. Providing community development projects, rather than a narrowly defined HIV/AIDS program, may reduce the stigma against OVC.8. Community meetings may reduce stigma against OVC.EVIDENCE1. Accelerating treatment access for adults with children can reduce the number of orphans,improve pediatric mortality and social well-being. [See also Chapter 7. Treatment]A prospective cohort study with 1,373 HIV-positive and 4,601 HIV-negative householdmembers (over 70% respondents were women) conducted from 2001–2005 in Ugandashowed that access to antiretroviral therapy (ART) and co-trimoxazole prophylaxis treatmentprogram led to large reduction in mortality among HIV-positive adults livingin resource-poor settings and in the rate of orphanhood. Compared with no intervention,ART and co-trimoxazole were associated with a 95% reduction in mortality inHIV-positive adult participants, an 81% reduction in mortality in their uninfected childrenyounger than 10 years and a 93% estimated reduction in orphanhood. During thestudy periods households were visited every week by lay trained paid providers whoresupplied medicine and monitored drug adherence, hospital admissions, potentialsymptoms of drug toxicity, death of a household member in the preceding 7 days, andorphanhood. No routine clinic visits were scheduled after enrollment and home-based358 CHAPTER 12 CARE AND SUPPORT