AIDS Orphans In Kenya.

Maureen Waithaka B.Sc.; M.P.H.

PLACEMENT SITE

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

• Site: Kenya (East Africa)

• Location: Nairobi and Mombasa

• On-site: 3 weeks

• Target group : AIDS orphans between the ages of 13 and 18 years

GOAL

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

DEFINITION

AIDS orphan

4 types:

• Single orphan- a child who has lost one parent

• Double orphan- a child who has lost both parents

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

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

Source: African Orphaned and Vulnerable Generations, 2006.

PRIMARY CONTACTS

• Governmental organizations

• Non-governmental organizations

• Faith-based organizations

• Community-based organizations

• AIDS orphanages

SUB-SAHARAN STATISTICS

Presently:• Home : app > 48 million orphans

• 12 million of these orphans = AIDS epidemic

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

Future projections: Estimated that AIDS orphan population will increase

by 20 million by 2010:

Overall 68 million in continentSource: UNAIDS Estimates, 2006.

“WHO IS CARING FOR AIDS ORPHANS IN KENYA?”

In 2006:

• Prevalence rates: levelling out

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

- ARVs

• -AIDS is a leading cause of death among adults between the 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 STATISTICS

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

• 2.2 million people were infected with HIV by the year 2003

• 1.5 million people have already died from AIDS related illness leaving behind 800,000 orphans

• This number is expected to increase to 2.3 million by 2010

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

Source: KICOSHEP Training Manual, 2004

HOW CHILDREN ARE INFECTED

• Mother- To- Child Transmission (MTCT): – During pregnancy– Labor– Vaginal delivery– Breastfeeding

Risk of HIV transmission:

• during pregnancy app

5- 10 %

• during labor and vaginal delivery app

10 - 20 %

• during breastfeeding app 10 –20%Source: National Policy on Orphans and Vulnerable Children, 2005

DIRECT AFFECTS OF HIV/AIDS

• In poverty stricken areas

• Dependency Ratios• Property

Dispossession• Stigmatization,

discrimination and isolation

• Psychological Distress• Withdrawal From School• Child Labor• Malnutrition and Illness• Extended families

INDIRECT AFFECTS OF HIV/AIDS

• Strain on human resources• Depletion of human resources

RESPONSIBILITIES

• To investigate:– Formulation of

discussion questions– Formulation of survey– Application to the

research and ethics committee

– Personal booking of appointments

RESPONSIBILITIES

• Chose forums for data collection– Lectures

– Seminars

– Presentations

– Discussions

RESPONSIBILITIES

• 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 CHALLENGES

• Approval from ethics and research committee

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

• Faced stigmatization upon request to be transported to the orphanages

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

DATA COLLECTION CHALLENGES

• Key informants difficult to find in order to be directed into homes

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

CURRENT PROGRAM LIMITATIONS

• Prevention and Advocacy

• Institutional arrangements, managements and coordination

• Mitigation of Socio-economic impact

• Community Empowerment

• Human Resource and Development

• Evidence-based Interventions

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: Community-based Approach

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

Why?• Communities are at the foundation of affordable,

equitable and effective health care.

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

RECOMENDATION II: From Community –based Approach

to Child-to-Child Approach

• Use a KANCO model:

-Child –to child approach- (CTC)

– An educational process that links children’s learning with taking action.

– A rights based approach to children’s participation in health promotion and development that is grounded in the United Nations Convention on the Rights of Children- principles of inclusion and non-discrimination- be inclusive and involve as many children without selection or exclusion on the basis of gender, disability, ethnicity and religion.

CONCLUSION

Benefit of CTC approach:• Builds self-confidence• Provides useful knowledge• Empowers them with life skills• Builds on their personal

development• Builds on their social

development• Positive channel of energy and

creativity

CONCLUSION

Challenges to CTC approach.

• Display of power relation between adults and children

• Display of power relations among children (bullying)

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

• A child’s competencies and age of children

• Culture

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

ill health increases poverty

Thank You

SPECIAL THANKS.(Inside Kenya Contacts)

• Program Coordinator and Contact liaison in Kenya: Mr. SAMUEL KAHIU WAITHAKA

• Program Supervisor in Kenya: MRS ELIZABETH NYAMBURA WAITHAKA

REFERENCES

• Ansell, Nicola and Young, L. (2004, January). Enabling Household to Support Successful Migration of AIDS Orphans in South

Africa. AIDS Care, 16(1), and 3-10.  • Case, Anne, Parson M, et al. (2004, August). Orphans of Africa:

Parental Death, Poverty and School Enrollment. Demography, 4 (3), 483-508.

 • Chatterrji, Minki, et al. (2005). The Well-being of Children affected by

HIV/AIDS in Lusaka, Zambia and Gitarama province, Rwanda. Community REACH Work. Washington D.C. Paper No.2.

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

REFERENCES

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

• Evans, D. (2005, December). The Spillover Impacts of Africa’s Orphans. Rand Corporation Working Paper. Santa Monica.10-11.

 • Floyd, Sian, et al. (2005, September). HIV and Orphan hood. UNICEF Project. • Monasch, Roeland and Boerma, J. cit pp S55-S65. • Nhate, Virgulion, et al. (2005). Orphans and Discrimination in Mozambique. An Outlay

Equivalence Analysis. International Policy Research Institute, 1-2, 12. • 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.  • Verbose, Heidi. (2005). A child Has Many Mothers. Views of Child Fostering in

Northwestern Cameroon. Childhood. 12(3), 369-390. 

LIST OF CONTACTS IN KENYA.

• UNAIDS (United Nations AIDS)Dr. Wainaina- Supervisor and coordinator of HIV/AIDS.

• UNICEF (United Nations Children’s Fund)Ms. Catherine Kimotho- Project Officer, OVC.

• UNDP ( United Nations Development Program). Dr. Elly Oduol- Assistant Resident Representative.

• UNESCO (United Nations Educational, Scientific and Cultural Organization).Dr. Susan Nkinyangi- Senor Educative Advisor.

• KAWI (Kenya Aids Watch Institute)Mr.Geoffrey O..Orero- Head of Operations.

• NACC (National AIDS Control Council)Mr. Peter Muite- Head of Communication

• KANCO (Kenya AIDS NGOs Consortium) Mrs. Joyce.

• KICOSHEP (Kibera Community Self-Help Programme; Mrs. Anne Owiti- Director.

• Nyumbani Children’s Home; Sister Theresa- Matron.

• Tumaini Children’s Home; Ms. Joan Smith- Founder and Executive

• Kenyatta National Hospital

• Aga Khan Hospital.

• Kenya Medical Training Institute

• University of Nairobi; Gidraph G. Wairire- Lecturer and consultant.

ACKNOWLEGEMENTS

• Dr. G. PraterDean of College of Public Service

• Dr. M. AzevedoChairperson of the Department of Epidemiology and Biostatistics

• Dr. M. ShahbaziProfessor and Major Advisor

• Dr. R. WilliamsAssociate Dean for the School of Social Work

• Dr. Chris ArthurProfessor and Preceptor

• All Contact People in Kenya.