What Works for Women and Girls

their parent’s status (from 16% to 25%) as well as an increase in the proportion ofHIV-positive children aware of their parent’s status (from 12% to 19%) and their ownHIV status (from 10% to 20%). Among HIV-positive children who were enrolled inschool at baseline, 95% continued going to school at 12 months. The proportion ofaffected children (one or both parents HIV-positive) who missed more than five schooldays per month significantly decreased (Sreevidya et al., 2008). (Gray III) (children,community-based care, education, India)Services that are “provided through integrated, family-centered delivery models” workbest for children, according to the Joint Learning Initiative on Children and HIV/AIDSfinal report on children, AIDS and poverty (Irwin et al., 2009: 47). “Programmesobtain the best results for children when they adopt integrated intervention strategiesproviding a range of services to the whole family. The most effective delivery systemsintegrate HIV and AIDS services with family-centered primary health care and socialservices provided through community-based models,” (Irwin et al., 2009: 48). JLICAhighlights Rwanda’s National Policy and Strategic Plan for Orphans and VulnerableChildren, which looks beyond AIDS to provide a “minimum package of services” ofhealthcare, nutrition, formal education, livelihood training, protection, and psychologicaland socioeconomic support. The decentralized, rights-based system “can connectfamilies to such opportunities through referral systems and linkages to public supportor NGO programmes,” (Irwin et al., 2009: 49 citing Binagwaho et al., 2008). (Gray V)(orphans, community-based care, Rwanda)An orphan day care center in Botswana provides centralized care to over 355 orphansages 2 to 18 with pre-school aged children cared for in a safe, supervised environmentduring the workday, relieving the caregiving burden for guardians and facilitating theirability to work or care for relatives with HIV. Older children come to the center afterschool to receive meals, participate in activities and receive counseling. The familyoutreach program delivers counseling to children’s guardians during home visits. Thecenter in Botswana has quality control measures in place to ensure that orphans benefit,but the labor-intensive efforts are more challenging to scale up (Kidman et al., 2007).(Gray V) (orphans, counseling, Botswana)3. ARV treatment with good nutritional intake and regular medical care can improve healthand survival of HIV-positive children in resource-poor settings.A study with 103 (61 male, 42 female, age range: 3–127 months) institutionalizedHIV-infected orphaned children in Tanzania showed that after one year of being onHAART, children with severe malnutrition and declined CD4 values had significantincreases in their CD4 counts. Their CD4 cell percentages increased from 10.3 to 25.3percent and absolute count, from 310 to 660/mm 3 . Their nutritional status improvedsignificantly. Two out of 27 untreated children became eligible for antiretroviral treatment.The study also showed that institutionalized children who do not meet the criteria360 CHAPTER 12 CARE AND SUPPORT