AIDS Orphans In KenyaAIDS Orphans In Kenya

Maureen WaithakaMaureen WaithakaJackson State UniversityJackson State University

Jackson, MSJackson, MS

PLACEMENT SITEPLACEMENT SITE

Sponsorship:Sponsorship:Jackson State University, College of Public Service, Jackson State University, College of Public Service, Department of Epidemiology and BiostatisticsDepartment of Epidemiology and Biostatistics

Site: Site: Kenya (East Africa)Kenya (East Africa)

LocationLocation: Nairobi and Mombasa: Nairobi and Mombasa

On-siteOn-site: 3 weeks: 3 weeks

Target groupTarget group : : AIDS orphans between the ages AIDS orphans between the ages ofof

13 and 18 years13 and 18 years

GOALGOAL

To investigateTo investigate the the effectiveness, accessibility and effectiveness, accessibility and quality of personal health quality of personal health services for services for AIDS orphans in AIDS orphans in Kenya between the ages of 13-Kenya between the ages of 13-18 years18 years

DEFINITIONDEFINITION

AIDS orphanAIDS orphan

4 types: 4 types:

Single orphan-Single orphan- a child who has lost one a child who has lost one parentparent

Double orphan-Double orphan- a child who has lost both a child who has lost both parentsparents

Maternal orphan-Maternal orphan- a child whose mother a child whose mother has died (includes double orphans)has died (includes double orphans)

Paternal orphanPaternal orphan – a child whose father – a child whose father has died (includes double orphans) has died (includes double orphans)

Source: African Orphaned and Vulnerable Generations, 2006.

PRIMARY CONTACTSPRIMARY CONTACTS

Governmental organizationsGovernmental organizations

Non-governmental organizationsNon-governmental organizations

Faith-based organizationsFaith-based organizations

Community-based organizationsCommunity-based organizations

AIDS orphanagesAIDS orphanages

SUB-SAHARAN STATISTICSSUB-SAHARAN STATISTICS

Presently:Presently:

Home : app > 48 million orphansHome : app > 48 million orphans

12 million of these orphans = AIDS epidemic12 million of these orphans = AIDS epidemic

Mostly between the ages of 0-17 years have lost one or Mostly between the ages of 0-17 years have lost one or both parents to AIDSboth parents to AIDS

Future projectionsFuture projections Estimated that AIDS orphan population will increase by Estimated that AIDS orphan population will increase by

20 million by 2010:20 million by 2010:

Overall 68 million in continentOverall 68 million in continentSource: UNAIDS Estimates, 2006.

““WHO IS CARING FOR AIDS ORPHANS IN WHO IS CARING FOR AIDS ORPHANS IN KENYA?”KENYA?”

In 2006: In 2006:

Prevalence rates: levelling out Prevalence rates: levelling out

Incident rates (number of new Incident rates (number of new infections) increasing with infections) increasing with population growthpopulation growth

- ARVs- ARVs

--AIDS is a leading cause of AIDS is a leading cause of death among adults between death among adults between the ages of 15-59 yearsthe ages of 15-59 years

HIV prevalence by Province (based on latest population based estimates, KDHS 2003

Greater than national average

Less than national average

No significant

prevalence of HIV(*No HIV positive tests among the sample of 108)

5.3%

4.9%

9.9%

4.9%

5.8%

4.0%

0%

15.1%

Kenya: 6.7%

NairobiMlololonga

Machakos

MombasaMariakani

Kisumu

Busia

Malaba

Eldoret

Kapenguria

Nakuru

Mai Mahiu

Nyeri

Malindi

Lamu Black lines = Provincial boundaries

Blue lines = Main highways cutting through Kenya to Uganda and Sudan

Source : Analysis of HIV Prevalence trends in Kenya 2003, KDHS

KENYA STATISTICSKENYA STATISTICS

HIV/AIDS HIV/AIDS was was declared a declared a national disasternational disaster by the by the former President of the former President of the Republic of Kenya on Republic of Kenya on 25 25 November 1999November 1999

2.2 million2.2 million people were people were infected with HIV by the infected with HIV by the year 2003year 2003

1.5 million1.5 million people have people have already already died from AIDSdied from AIDS related illnessrelated illness leaving leaving behind 800,000 orphansbehind 800,000 orphans

This number is expected to This number is expected to increase to increase to 2.3 million by 2.3 million by 20102010

App. 700 people die each App. 700 people die each day from AIDS related illnessday from AIDS related illness

Source: KICOSHEP Training Manual, 2004

HOW CHILDREN ARE INFECTEDHOW CHILDREN ARE INFECTED

Mother- To- Child Mother- To- Child Transmission (MTCT):Transmission (MTCT): During pregnancyDuring pregnancy LaborLabor Vaginal deliveryVaginal delivery BreastfeedingBreastfeeding

Risk of HIV Risk of HIV transmission:transmission:• during pregnancy appduring pregnancy app 5- 10 % 5- 10 % • during labor and vaginal during labor and vaginal

delivery app delivery app 10 - 20 %10 - 20 %

• during breastfeeding app during breastfeeding app 10 –20%10 –20%

Source: National Policy on Orphans and Vulnerable Children, 2005

DIRECT AFFECTS OF HIV/AIDSDIRECT AFFECTS OF HIV/AIDS

In poverty stricken In poverty stricken areasareasDependency RatiosDependency RatiosProperty Property DispossessionDispossessionStigmatization, Stigmatization, discrimination and discrimination and isolationisolation

Psychological DistressPsychological Distress

Withdrawal From Withdrawal From SchoolSchool

Child LaborChild Labor

Malnutrition and Malnutrition and IllnessIllness

Extended familiesExtended families

INDIRECT AFFECTS OF HIV/AIDSINDIRECT AFFECTS OF HIV/AIDS

Strain on human resourcesStrain on human resources

Depletion of human resourcesDepletion of human resources

RESPONSIBILITIESRESPONSIBILITIES

To investigate:To investigate: Formulation of Formulation of

discussion questionsdiscussion questions Formulation of surveyFormulation of survey Application to the Application to the

research and ethics research and ethics committeecommittee

Personal booking of Personal booking of appointmentsappointments

RESPONSIBILITIESRESPONSIBILITIES

Chose forums for Chose forums for data collectiondata collection

LecturesLectures SeminarsSeminars PresentationsPresentations DiscussionsDiscussions

RESPONSIBILITIESRESPONSIBILITIES

Locate the target population (AIDS Orphans)

Challenge: Children’s homes are not distributed equally within countries

Many children in grandparent headed homes.

Extreme cases – headed by child

In (remote) rural areas

DATA COLLECTION CHALLENGESDATA COLLECTION CHALLENGES

Approval from ethics and research Approval from ethics and research committee committee

Could not take pictures of older Could not take pictures of older AIDS orphans for fear of AIDS orphans for fear of stigmatization, discrimination and stigmatization, discrimination and isolation if recognized isolation if recognized

Faced stigmatization upon request Faced stigmatization upon request to be transported to the orphanagesto be transported to the orphanages

Mistrust, competition, suspicion and Mistrust, competition, suspicion and unwillingness to share information unwillingness to share information among different groups in different among different groups in different organizationsorganizations

DATA COLLECTION CHALLENGESDATA COLLECTION CHALLENGES

Key informants difficult to find Key informants difficult to find in order to be directed into in order to be directed into homeshomes

Difficult to find homes since Difficult to find homes since many are not listed on local many are not listed on local maps and local address books maps and local address books

CURRENT PROGRAM LIMITATIONS CURRENT PROGRAM LIMITATIONS

Prevention and AdvocacyPrevention and Advocacy

Institutional arrangements, Institutional arrangements, managements and managements and coordinationcoordination

Mitigation of Socio-Mitigation of Socio-economic impacteconomic impact

Community Community EmpowermentEmpowerment

Human Resource and Human Resource and DevelopmentDevelopment

Evidence-based Evidence-based InterventionsInterventions

Source: A review of reports prepared by civil society groups (NGOs, CBOs and FBOs) and showed that a number of obstacles and constraints have been implicated for the current Kenya National HIV/AIDS Strategic Plan ,2000-2005 

RECOMENDATION I: RECOMENDATION I: Community-based Approach Community-based Approach

All activitiesAll activities will be focused on ensuring that will be focused on ensuring that individuals, households and communities carry individuals, households and communities carry out appropriate healthy behaviorsout appropriate healthy behaviors and and recognize recognize signs and symptoms of conditions that need to signs and symptoms of conditions that need to be managedbe managed at other levels of the system- in this at other levels of the system- in this case, HIV/AIDS. case, HIV/AIDS. Each level unit is to take care of Each level unit is to take care of 5,000 persons5,000 persons

Why?Why?Communities are at the foundation of affordable, Communities are at the foundation of affordable, equitable and effective health care. equitable and effective health care.

The Kenya Essential Package for Health Proposal in the second National Health Sector Strategic Plan 2005-2010

RECOMENDATION II: RECOMENDATION II: From Community –based Approach to From Community –based Approach to

Child-to-Child ApproachChild-to-Child Approach

Use a KANCO model Use a KANCO model

-Child –to child approach- (CTC)-Child –to child approach- (CTC) An educational process that links children’s An educational process that links children’s

learning with taking action.learning with taking action. A rights based approach to children’s participation in health A rights based approach to children’s participation in health

promotion and development that is grounded in the United promotion and development that is grounded in the United Nations Convention on the Rights of Children- principles of Nations Convention on the Rights of Children- principles of inclusion and non-discrimination- be inclusive and involve as inclusion and non-discrimination- be inclusive and involve as many children without selection or exclusion on the basis of many children without selection or exclusion on the basis of gender, disability, ethnicity and religion.gender, disability, ethnicity and religion.

CONCLUSIONCONCLUSION

Benefit of CTC Benefit of CTC approach:approach:Builds self-confidenceBuilds self-confidenceProvides useful knowledgeProvides useful knowledgeEmpowers them with life Empowers them with life skillsskillsBuilds on their personal Builds on their personal developmentdevelopmentBuilds on their social Builds on their social developmentdevelopmentPositive channel of energy Positive channel of energy and creativityand creativity

Challenges to CTC approach.Challenges to CTC approach.

Display of power relation Display of power relation between adults and childrenbetween adults and children

Display of power relations Display of power relations among children (bullying)among children (bullying)

The role children play in their The role children play in their families, communities and families, communities and the societythe society

A child’s competencies and A child’s competencies and age of childrenage of children

CultureCulture

Eradication of poverty is essential because poverty compounds powerlessness and increases ill health, as ill health increases poverty.

Thank You

REFERENCES REFERENCES

Ansell, Nicola and Young, L. (2004, January). Enabling Household to Ansell, Nicola and Young, L. (2004, January). Enabling Household to Support Successful Migration of AIDS Orphans in South Africa. AIDS Support Successful Migration of AIDS Orphans in South Africa. AIDS Care, 16(1), and 3-10. Care, 16(1), and 3-10.

  

Case, Anne, Parson M, et al. (2004, August). Orphans of Africa: Case, Anne, Parson M, et al. (2004, August). Orphans of Africa: Parental Death, Poverty and School Enrollment. Demography, 4 (3), Parental Death, Poverty and School Enrollment. Demography, 4 (3), 483-508.483-508.

  

Chatterrji, Minki, et al. (2005). The Well-being of Children affected by Chatterrji, Minki, et al. (2005). The Well-being of Children affected by HIV/AIDS in Lusaka, Zambia and Gitarama province, Rwanda. HIV/AIDS in Lusaka, Zambia and Gitarama province, Rwanda. Community REACH Work. Washington D.C. Paper No.2.Community REACH Work. Washington D.C. Paper No.2.

  

Chatterrji, Minki, et al. (2004-2005). Orphan and Other Vulnerable Chatterrji, Minki, et al. (2004-2005). Orphan and Other Vulnerable Children in Rural and Urban High Density Zimbabwe. United Nations Children in Rural and Urban High Density Zimbabwe. United Nations Children’s Fund and Ministry of public service, Labor and Social Children’s Fund and Ministry of public service, Labor and Social Welfare Survey.Welfare Survey.

REFERENCESREFERENCES

Chatterrji, Minki, et al. (2005, June). Report on the Pilot survey on Orphans and OtherChatterrji, Minki, et al. (2005, June). Report on the Pilot survey on Orphans and Other Vulnerable Children in Blantyre, Malawi. United Nations Children’s FundVulnerable Children in Blantyre, Malawi. United Nations Children’s Fund

  Evans, D. (2005, December). The Spillover Impacts of Africa’s Orphans. Rand Evans, D. (2005, December). The Spillover Impacts of Africa’s Orphans. Rand Corporation Working Paper. Santa Monica.10-11.Corporation Working Paper. Santa Monica.10-11.  Floyd, Sian, et al. (2005, September). HIV and Orphan hood. UNICEF Project.Floyd, Sian, et al. (2005, September). HIV and Orphan hood. UNICEF Project.  Monasch, Roeland and Boerma, J. cit pp S55-S65.Monasch, Roeland and Boerma, J. cit pp S55-S65.  Nhate, Virgulion, et al. (2005). Orphans and Discrimination in Mozambique. An Outlay Nhate, Virgulion, et al. (2005). Orphans and Discrimination in Mozambique. An Outlay

Equivalence Analysis. International Policy Research Institute, 1-2, 12.Equivalence Analysis. International Policy Research Institute, 1-2, 12.  Seaman, Petty .J, Petty .C, Acidri. J. 2005. The Impact of HIV/AIDS on household Seaman, Petty .J, Petty .C, Acidri. J. 2005. The Impact of HIV/AIDS on household Economy in two villages in Salima District. Save the Children. Economy in two villages in Salima District. Save the Children.   Verbose, Heidi. (2005). A child Has Many Mothers. Views of Child Fostering in Verbose, Heidi. (2005). A child Has Many Mothers. Views of Child Fostering in Northwestern Cameroon. Childhood. 12(3), 369-390.Northwestern Cameroon. Childhood. 12(3), 369-390.  

ACKNOWLEGEMENTSACKNOWLEGEMENTS

Dr. G. PraterDr. G. PraterDean of College of Public ServiceDean of College of Public Service

Dr. M. AzevedoDr. M. AzevedoChairperson of the Department of Epidemiology and BiostatisticsChairperson of the Department of Epidemiology and Biostatistics

Dr. M. ShahbaziDr. M. ShahbaziProfessor and Major AdvisorProfessor and Major Advisor

Dr. R. WilliamsDr. R. WilliamsAssociate Dean for the School of Social WorkAssociate Dean for the School of Social Work

Dr. Chris ArthurDr. Chris ArthurProfessor and PreceptorProfessor and Preceptor

All Contact People in Kenya.All Contact People in Kenya.