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Children - 5.4 Gaps in meeting needs
   Last updated: 23.08.01
 
Despite being able to describe a number of existing resources, a significant number of gaps in addressing the needs of children affected by AIDS were identified by participants. Many suggestions as to how these gaps could be addressed were also given and are summarised below.

Widescale Prevention Education and Skills Training
1. Most participants pointed to the need for widescale prevention education and skills training at community level. Not only should this result in less people contracting HIV infection, but they felt that this would result in less fear, and potentially more offers of help when someone is sick. They felt that a better understanding of HIV transmission would mean more offers of care for AIDS orphans, and possibly a better standard of care from relatives and friends.

2. Participants felt that community leaders, monks and particularly teachers should be targeted for HIV/AIDS education since they are in a good position to influence both behaviour change for prevention and positive attitudes for care.

Mainstreaming HIV/AIDS Prevention and Care
3. The need to mainstream HIV/AIDS prevention and care with all NGO and government activity at community level was also highlighted. This would mean integrating HIV/AIDS work with for example, credit and savings activities, water, sanitation, agriculture and community health programmes.

Role Modeling Prevention and Care
4. Participants said there was a need for more on HIV/AIDS on the radio and television, but that role modeling contact and care for people with HIV in the community was the most important strategy.

5. Similarly, it was felt that influential people in the country and in the communities should promote a more positive attitude towards people with HIV/AIDS.

HIV Counselling and Testing - Pre, Post Test and Ongoing
6. Participants also overwhelmingly pointed to the need for access to specialised HIV counselling and testing so that parents with HIV would know not to waste resources on inappropriate treatment and could be helped to plan for their children's future.

7. This planning was seen to be part of on-going HIV counselling which would also serve to reduce family stress and isolation.

8. Children could also receive counselling, which would help to reduce guilt and anxiety and enable them to grieve.

9. Some participants felt that it was important for all couples to be able to access counselling and testing before marriage and before having children.

10. Counselling a terminally ill child and their parents or carers is a special skill. Specialist training is needed in this type of counselling, and very few people in Cambodia have yet had experience of counselling in this situation.

11. Preventing transmission from mother to child should be promoted, but drug treatment should only be available as part of a wider care package for families. In particular, greater availability of counselling and testing would allow couples affected by AIDS to make informed decisions about having children.

Scaling Up Existing Interventions
12. This need for counselling and for role modeling care, was linked to the suggestion that home-based care be scaled up to the provinces and include community volunteers trained as counsellors.

13. Participants wanted to see projects for street children scaled up in provincial towns, with drop in centres and vocational training.

14. Some suggested more mobile/outreach health teams who could provide a range of services to children who are abandoned or who choose to look after themselves.

15. Where they exist, it was also recommended that skills in play therapy, and related techniques which can help children make sense of their situation, should be cascaded through extensive training programmes.

Self-Help and Support
16. Special support groups for children affected by AIDS to be able to meet and socialise with each other were also proposed. HIV/AIDS materials specific to young children would need to be developed to help them make sense of their situation and equip them with prevention skills.

17. Another suggestion was to increase support to formal and informal support and self-help groups including those formed by people and families affected by AIDS.

18. These support groups could also prove invaluable in helping PLWHA plan for death and for the future of their children.

19. Bolstering the psychosocial status of individuals and families was seen as crucial in influencing coping processes and subsequent behaviour. The behaviour of parents was in turn seen to influence the coping capacity or resilience of children.

Advocacy Advocacy
20. Participants felt that a strong NGO specialising in the needs of children affected by AIDS would help in advocacy, and persuade others - including relatively wealthy business people - to provide direct and indirect services which may assist these children.

Government and Legal Reform
21. To generally reduce the vulnerability of families affected by AIDS, participants urged faster reforms in government health care, better access to specific drugs and better transport/roads to health centres, schools and hospitals in rural areas.

22. They also wanted to hasten widespread training of government health (and other sector) workers on HIV/AIDS.

23. Participants suggested that government social workers and child case workers should be trained and that provincial strategies for child protection should be drafted and most importantly, implemented.

24. Participants wanted government to clamp down on fraudulent inheritance claims and draft clear laws for land ownership.

25. Participants wanted legal protection implemented for children with regard to labour exploitation, sexual abuse and trafficking.

26. Some felt that vulnerable children should be enumerated and targeted for protection by local authorities and that all orphans should be given free education subsidised by the government.

27. Education for the police on child protection was seen as a priority.

28. It was also suggested that orphanages should be improved and that they should only take the most vulnerable children.

Community Mobilisation
29. Some suggested that communities form committees which hold land in trust for orphaned children until they reach majority.

30. Some also mentioned replicating community savings schemes by involving community members in assessing schemes that work.

31. They also suggested supporting Village Development Committees (which are widespread) to look after the interests of vulnerable children and those affected by AIDS and to mobilise the community to do the same.

32. Some participants mentioned that the role of traditional healers could be enhanced by forming local networks and providing training. These healers could then be formally linked with providers of home-based care.

Economic Strengthening of Children and Carers
33. Participants felt that NGOs could provide start up materials and training for small businesses to people with HIV, widows, grandparents caring for orphans or to children affected by AIDS themselves.

34. Others felt that vocational training was a waste of time unless the economy was significantly improved so that there were markets for these children's and their carer's skills.

35. Many participants mentioned that low interest loans should be targeted without security at people with HIV, widows, grandparents caring for orphans or to children affected by AIDS themselves.

36. Others felt that savings schemes could be more effective if communities started these before they began to feel the impact of AIDS.

37. Participants also suggested direct support to grandparents or relatives who take on the care of a child orphaned by AIDS. Suggestions included business people or those relatively well-off to 'adopting' a grandparent; food aid being given to families by NGOs; school fees being subsidised by government or by INGOs; food for work programmes; donations of household materials and school books; providing free medical care to vulnerable children and their carers.

38. Some preferred to see carers of all vulnerable children supported - not just those affected by AIDS.

39. A few participants suggested supporting orphaned children to stay in their own homes and communities and help them to look after themselves.

Drugs for Opportunistic Infections
40. Participants mentioned significant gaps in addressing the needs of children with HIV. The drugs needed to treat complications associated with late stage paediatric AIDS are not available in Cambodia, or only at great expense. In addition most hospitals do not have the capacity to accurately diagnose these conditions.

Skills for NGOs
41. It was suggested that NGOs be assisted to build skills in working with children in distress and to research strategies for promoting the psychological and emotional welfare of children.

42. Further, it was suggested that the NGO sector generally be strengthened in terms of organisation and technical capacity, both to access available funding and also to integrate appropriate services for children affected by AIDS into on-going HIV/AIDS work.