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Children on the brink 2004: A joint report of new orphan estimates and framework for action
United Nations Children's Fund (UNICEF)
July 2004

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Introduction
HIV/AIDS is recognized worldwide as a threat to children and their families. AIDS is the leading cause of death worldwide for people ages 15 to 49. In 2003, 2.9 million people (estimate range, 2.6-3.3 million) died of AIDS and 4.8 million people (4.2-6.3 million) were infected with HIV. While most of the estimated 37.8 million people (34.6-42.3 million) living with HIV/ AIDS in the world are adults, the pandemic's devastating effects on families and communities reach down to the most vulnerable among us - our children.

Millions of children have been orphaned or made vulnerable by HIV/AIDS. The most affected region is subSaharan Africa, where an estimated 12.3 million children have been orphaned by AIDS. This orphan¹population will increase in the next decade as HIV-positive parents become ill and die from AIDS. While sub-Saharan Africa has the highest proportion of children who are orphans, the absolute numbers of orphans are much higher in Asia, which had 87.6 million orphans (due to all causes) in 2003, twice the 43.4 million orphans from all causes in subSaharan Africa.

As was reported in the 2002 Children on the Brinkreport, the data in this report reconfirm that:

• Sub-Saharan Africa has the greatest proportion of children who are orphans.
• While the proportion of orphans in Asia is much less than in subSaharan Africa, the absolute number of orphans in Asia is much larger.
• The number of children orphaned by AIDS will continue to rise for at least the next decade.

Orphaning is not the only way that children may be affected by HIV/AIDS. Other children made vulnerable by HIV/AIDS include those who have an ill parent, are in poor households that have taken in orphans, are discriminated against because of a family member's HIV status, or who have HIV themselves. Consequently, programs should not single out children orphaned by AIDS but should direct their efforts toward communities where HIV/AIDS is making children and adolescents more vulnerable. Generally, the people who live in these communities are in the best position to determine which children are at greatest risk and what factors should be used to assess vulnerability and set priorities for local action.

HIV/AIDS has joined a host of other factors - including extreme poverty, conflict, and exploitation - to impose additional burdens on society's youngest, most vulnerable members. To the children and households in communities affected by HIV/AIDS, addressing only AIDS-related problems and ignoring other causes of children's vulnerability does not make sense. Programs should target geographic areas seriously affected by HIV/AIDS and then support the residents of these communities in organizing to identify and assist the most vulnerable children and households, regardless of the specific causes of vulnerability.

If programs need to target the much broader vulnerable children population and not just orphans, why then does the Children on the Brinkseries present estimates of orphaning? While not all orphaning is due to HIV/AIDS, orphaning remains the most visible, extensive, and measurable impact of AIDS on children. To date, no methodology is available for estimating the number of other children made vulnerable by AIDS. Orphans are not only of great concern, their presence reflects a much larger set of problems faced by children.

The large majority of orphans and other children made vulnerable by HIV/AIDS live with a surviving parent and siblings or within their extended family, and the overwhelming thrust of an effective response must be to give direct substantial support to the millions of families who continue to absorb children who have lost parents. After losing parents and caregivers, children have an even greater need for stability, care, and protection. Family capacity - whether the head of household is a widowed parent, an elderly grandparent, or a young person - represents the single most important factor in building a protective environment for children who have lost their parents to AIDS and other causes. There is also an urgent need to develop and scale up family- and community-based care opportunities for the small but highly vulnerable proportion of boys and girls who are living outside of family care.

Children on the brink 2004
This report contains the most current and comprehensive statistics on children orphaned by AIDS and other causes (appendix 1). Unlike previous editions of Children on the Brink, which included data for children under age 15, this edition provides data for children under age 18. This change brings the statistics in line with the international definition of childhood. It also recognizes that orphans and vulnerable children are not necessarily young children and that problems caused by orphaning extend well beyond age 15. The available data in fact suggest that adolescents make up the majority of orphans in all countries. As another new feature, this report also includes estimates of the number of children who became orphans in the last year. The methodology explaining how all estimates are calculated is described in appendix 2.

This edition of Children on the Brink also examines the changing developmental needs of orphans and other children made vulnerable by HIV/AIDS as they progress through childhood. From infancy through age 17, a child passes through a number of life-cycle stages. HIV starts to affect a child early in a parent's illness, and its impact continues through the course of the illness and throughout the child's development after the parent's death. Children who are deprived of the guidance and protection of their primary caregivers are more vulnerable to health risks, violence, exploitation, and discrimination. Policymakers, leaders and practitioners in public health and other development sectors, and communities and families need to provide care and support to orphans (from all causes) and children made vulnerable by HIV/AIDS with an understanding of their stages of development and changing needs.

The report also provides an overview of the Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS. TheFrameworkrepresents the best hope for pulling orphans and other vulnerable children back from the brink. It is now recognized as the normative basis for responding with increased urgency to the needs of the growing numbers of orphans and vulnerable children and for protecting their rights. It has been endorsed by all United Nations agencies that are cosponsors of UNAIDS and welcomed by many of the international partners working to address the complex and far-reaching impacts of HIV/AIDS on millions of children and adolescents. The Frameworkis a key outcome of the first Global Partners' Forum convened by UNICEF, with support from UNAIDS, in October 2003. The Frameworkis structured around the goals set for orphans and other children made vulnerable by HIV/AIDS at the 2001 United Nations General Assembly Special Session on HIV/AIDS. Implementation of the Framework will also bring significant progress toward the Millennium Development Goals and other global commitments such as Education for All and the Elimination of the Worst Forms of Child Labor.

The five key strategies of the Framework (summarized in the body of this report) are:

• Strengthening the capacity of familiesto protect and care for orphans and vulnerable children by prolonging the lives of parents and providing economic, psychosocial, and other support
• Mobilizing and supporting community-based responsesto provide both immediate and longterm assistance to vulnerable households
• Ensuring access for orphans and vulnerable children to essential services, including education, health care, birth registration, and others
• Ensuring that governments protect the most vulnerable children through improved policy and legislationand by channeling resources to communities
• Raising awareness at all levels through advocacy and social mobilization to create a supportive environmentfor children affected by HIV/AIDS

Summaries of the Framework's monitoring and evaluation indicators (appendix 3), programming principles (appendix 4), and recommendations for national action (appendix 5) are also included in this report.

With new funding commitments from the 2004 start-up of the President's Emergency Plan for AIDS Relief of the United States government, the World Bank, UNICEF, UNAIDS, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, resources for providing support to orphans and other children made vulnerable by HIV/AIDS have increased in recent years. While these additional resources represent an outstanding commitment, funding in general for programs for orphans and vulnerable children nonetheless remains small compared with other HIV/AIDS funding.

More importantly, an enormous gap remains between what has been done and what needs to be done to protect the rights and address the needs of orphans and vulnerable children. At the end of 2003, only 17 countries with generalized epidemics reported having a national policy for orphans and vulnerable children to guide strategic decisionmaking and resource allocation. Closing the gap is possible, but it will require the combined efforts of all those able to respond - governments, donors, nongovernmental organizations, faith-based organizations, the private sector, and the thousands of community groups already struggling on the front line of response. Through committed partnerships and collaboration, millions of children and adolescents will have a chance of a better future. 5

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