Address by the Deputy Minister of Social Development, Dr Jean Swanson-Jacobs at the International AIDS Conference, Mexico City

Programme director
Dr Olive Shisana, Chief Executive Officer of the Human Science Research Council
Your Excellencies
Distinguished panellists
Ladies and gentlemen

I am grateful for this opportunity to address the International Symposium on Children and HIV/AIDS. As the Minister of Social Development, the issues of children are the competency of my Department and very close to my heart. I am particularly moved to have this chance to contribute to the discussions about the impact of the epidemic on children - a discussion which has always been on the periphery of AIDS discussions.

In 2006 I had the opportunity to participate in the International AIDS Conference in Toronto, Canada, and I was disappointed by the little attention the conference gave to this subject. Symposiums such as this one are commendable because they provide a platform for concerted effort for sharing strategies and best practices that strengthens the protection of vulnerable children.

This symposium comes at an interesting time in the history of the epidemic. The year 2008 marks the 27th year since the first reported case of HIV infection in the world, yet the infection and prevalence rate still remain unacceptably high.

The symposium also follows on the heels of the United Nations General Assembly High-Level meeting on HIV/AIDS that took place in New York in May 2008. The meeting noted that despite progress made by countries, both individually and collectively, to address the problem of HIV/AIDS, much more work still need to be done in areas of political leadership, policy making and funding of interventions. The meeting further noted with concern the slow pace of providing treatment, care and support to multitudes of orphans and vulnerable children.

Global outlook

Today, 33,2 million people are living with HIV worldwide. Globally, children under 15 years of age accounted for 2,1 million of the estimated 33,2 million people living with HIV in 2007. Seven thousand people are newly infected every day. More disturbing is the fact that half of them are women, mostly young adults in what should be the prime of their lives.

The World Health Organisation (WHO) ranks AIDS as the sixth cause of death worldwide. The epidemic has orphaned almost 15 million children. Its impact on individuals, families, communities around the globe is beyond comparison. In just a quarter of a century, AIDS is one of the defining challenges of modern times. A true product of our increasingly globalised society, AIDS is now present in every region, in every country. In Africa, the epidemic has caused untold misery and created a "generation of orphans".

Regional context

The HIV/AIDS epidemic has drastically changed our world. No where, more so than in Africa. Let us be frank, our silence in the early days of the epidemic has been a major factor in contributing to the current state of affairs. We are already paying the hefty price of not taking decisive actions earlier on at the onset of the epidemic.

According to UNAIDS Update 2007, sub-Saharan Africa is regarded as the epicentre of the epidemic and accounts for 64 percent of the global population of people living with AIDS. An estimated half of all adults who acquire HIV become infected before they reach 25 years. This emphasises the particular vulnerability to infection amongst young people and calls for the intensification of prevention programmes.

Impact on children

Often the first person to fall sick is the main breadwinner. The entire family will be turned upside down as it has to come to terms with what's happening, and work out how to cope with the physical and economic repercussions. The damage to children is particularly severe. When a parent becomes sick and dies, it affects every aspect of a child's life: emotional wellbeing, physical security, mental development and overall health. Women are hit hard too. It is mostly wives, mothers, daughters and grandparents who bear the brunt and the burden of care and support.

The fact that women constitute a majority (55% of HIV positive people) in South Africa is a worrying factor as this has huge implications for the welfare and well being of children. Amongst the greatest needs of children is to have families that love and protect them. This becomes impossible as primary caregivers succumb to the disease and exacerbates the children's vulnerability by depleting the pool of traditional caregivers and breadwinners. To add to that, the psychological needs of these children are often neglected because of the absence of the primary caregiver.

As it was noted during the recent 118th Assembly of the Inter-Parliamentary Union in Cape Town, HIV/AIDS remains one of the leading causes of mortality, especially among children under the age of five as well as the 25 to 44 age groups for both males and females. One relatively straightforward area where we have made little progress is in preventing transmission of HIV to women, and from parent to child. It is estimated that of the 5,4 million people living with HIV in South Africa, 294 000 are children from 0 to 14 years.

We should work harder to prevent women from being infected in the first place. If infected, access to drugs to prevent mothers from infecting their babies with HIV and access to treatment is essential. Countries like Kenya and Zambia have taken the lead in this area and have shown us that this is possible. Increasing prevention of mother to child transmission is critical to achieving two Millennium Development Goals - those relating to both AIDS and maternal and child health.

Comprehensive legislation

Since the advent of democracy, South Africa has passed a number of pieces of progressive legislation to address the situation of orphans and vulnerable children. Key among these is the Constitution and notably the Children's Act 38 of 2005 and the Children's Amendment Act No. 41 of 2007. Of significance is the recognition of and provision for child-headed households as an official category of vulnerable children. The implementation of these pieces of legislation relies on community-based services that support children and their families. Hence our strong focus on Early Childhood Development.

The Growth Report

Strategies for Sustained Growth and Inclusive Development 2008 revealed that sustained growth is attainable for developing countries with the "right mix of ingredients." The report goes further to say that adequate nutrition among infants and children is crucial to the equalisation of opportunities thus enabling them to benefit appropriately from educational systems and bring this capacity to the workplace.

Accordingly, our Early Childhood Development (ECD) programme aims to ensure that the care of infants and children is paramount and we thus aim to equalise the subsidy at a minimum of R9 per child, per day in each province. Our target is to subsidise 600 000 children in the current financial year. In the long-term, this will provide the foundation to break the intergenerational and vicious cycles of poverty.

Policy responses

Significant progress has been made by government at both policy and programmatic levels to assist through many anti-child poverty initiatives. The interventions provided include access to treatment, food, skills training and psycho-social support. It also involves access to social grants, education and health as well as statutory services such as alternative care, urgent assistance in cases of child abuse, neglect and exploitation.

The National Strategic Plan for HIV/AIDS and Sexually Transmitted Infections 2007/11 serve as South Africa's primary HIV/AIDS policy document. Recognising the growing need to combat the further spread of the epidemic, the plan hinges on four key priorities, namely:

* prevention
* treatment, care and support
* monitoring, research and surveillance
* human rights and access to justice

The sustained national response is beginning to pay some dividends as data indicates that the infection rate among women younger than 20 years has decreased significantly whilst the average national HIV prevalence among pregnant women has shown signs of stabilisation in the past three years to 2006. However, these little milestones should not induce in us a feeling of complacency as there is still much more to be done to build a better life for our people.

Central to the national response is social protection, including family and child support programmes to mitigate the social and economic impact of the epidemic and build social cohesion. Consequently, South Africa has a large social assistance programme which offers social protection to many vulnerable individuals and households. The provision of social security is a lifeline to many people trapped in poverty. The number of beneficiaries has increased from about 3, 5 million in 1999 to 12 million today.

Over eight million children now have access to social assistance. These include 7, 9 million children benefiting from the child support grant, close to 412 000 benefiting from foster care grant and over 98 000 benefiting from the care dependency grant. More than 2, 1 million older persons receive the old age grant and 1,4 million people receive the disability grant. Expenditure on social security increased from R36,9 billion in 2003/04, that was 2,9 percent of Gross Domestic Product (GDP) to a projected R73 billion in 2009/10, constituting 3,1 percent of GDP).

Home-Community Based Care

Our intention is to keep orphans and vulnerable children within their extended families and communities of origin where possible. Communities have been at the forefront of the fight against HIV/AIDS and most services to orphans and vulnerable children are rendered through the Home-Community Based Care programme. This programme is implemented by my Department and the Department of Health. The programme enables children and their families to have access to services nearest to their homes.

The provision of Home-Community Based Care has grown rapidly in the last five years. Last year alone, there were 1 700 organisations rendering Home-Community Based Care services. This constitutes 70% of sub-districts in the country with up to 35 000 community caregivers trained and some receiving stipends. Services provided through the home community based programmes include the early identification of vulnerable children, support groups, provision of food parcels and clothing, psychosocial support, provision of day and after school care, and referrals for alternative placement in the form of adoption, foster care or residential care.

South Africa, like other countries in the continent such as Malawi and Kenya, has a critical shortage of health and social service professionals. To address this problem, the government introduced the Expanded Public Works Programme (EPWP) in the social sector. The training of community caregivers and Child and Youth Care Workers will not only ensure the provision of quality services to children and their families, but will also alleviate the critical shortage of health and social service professionals, and complement the current government strategies such as the Recruitment and Retention Strategy for Social Workers as well as implementation of the Occupation Specific Dispensation in both sectors.

Partnerships

Government is fully aware that it cannot win the fight against the epidemic alone. To this end, the government of South has responded to the calls made at the Abuja Special Summit of the African Union (2006) on HIV/AIDS, and at the recent United Nations High-level meeting on HIV/AIDS by strengthening partnerships with civil society, business sector, donor community and most importantly, with the affected communities through public-private partnerships.

Over the past years there has been a significant increase in funding for health and social development activities by the corporate sector. One such pioneering and innovative partnership which has received international recognition, is the community project run by Mercedes-Benz South Africa in the rural province of the Eastern Cape. The project has improved testing rates and uptake of antiretroviral treatment thus keeping HIV employees strong and economically active to provide for their children. Of significance is that collaboration between the government and community-based organisations is well established, with many receiving funding from government and other donors, some of which work closely with government.

In particular, we appreciate the support of Presidential Emergency Plan for AIDS Relief (PEPFAR), United Nations International Children's Emergency Fund (UNICEF) and many other organisations we have partnered with on issues of orphans and vulnerable children.

The shift from policy to action

Various forums such as this one, have presented evidence from research and lessons from the field on the devastating impact of HIV/IDS on children. Our collective task as community leaders and as researchers is to translate policy into actions that will impact on positively on the lives of children in affected communities.

In this regard, let me express my gratitude to the Human Sciences Research Council, under the leadership of Dr Olive Shisana, for generating research that has immensely contributed to the improvement of our interventions targeting orphans and vulnerable children.

We are at a turning point in the global response against HIV/AIDS. South Africa and Africa in particular, remains on the frontline of that response. More than ever before, this symposium presents us with the opportunity to advance our endeavour of creating a better life for our children.

Thank you.