Care and Support

What Works

Women and Girls
Orphans and Vulnerable Children

Care and support generally includes both care of people living with HIV and AIDS and of families and children affected by HIV and AIDS. UNAIDS includes in its definition home- and community-based care (HCBC), palliative care, psychological support, carer support, and nutrition support.  Among these, HCBC is meant to be the foundation on which national antiretroviral treatment programmes are built (UNAIDS, 2009c). Under PEPFAR, the term palliative care covers clinical services for opportunistic infections, social care (community mobilization, leadership development, legal services, linkages to food support and income-generating programs, among other activities to strengthen families and communities), psychological services, spiritual care, and positive prevention efforts (PEPFAR, 2009). A 2004 UNAIDS report estimated that in Africa, only 12% of HIV-positive people in need of home-based care actually received it (UNAIDS, 2004).

“Families and communities, particularly women, whose contributions to the HIV response often goes unrecognized and unsupported – meet most care and support responsibilities” (UNAIDS, 2010a: 109).The nature of care and support needed to meet the needs of people living with and affected by HIV and AIDS is changing as the epidemic evolves. A growing number of   people on antiretroviral therapy requires a growing need for lifetime care, including fighting opportunistic infections, providing palliative care and home-based care (UNAIDS, 2010c). While care and support continues to be highly “gendered” (Esplen, 2009), “there is limited evidence on what works in varied contexts to deliver quality long-term HIV treatment and care” and to scale up these programs (Atun and Bataringaya, 2011: S93). Given the evolving nature of care and the scale up in treatment, “current national HIV policies or strategies may not address many central aspects of care and support” (UNAIDS, 2010a: 109).

In 2008, about 17.5 million children were estimated to have had one or both parents die early of AIDS; 14.1 million of them lived in sub-Saharan Africa (UNICEF, 2010c). Some countries are particularly adversely affected: although the HIV prevalence in Zimbabwe declined from 23.7% to 14.3% between 2001 and 2009, an estimated one in four children is an orphan. It is among the countries with the highest number of orphans and vulnerable children per capita in the world, with a majority between the ages of 10 and 17 (Miller et al., 2011a). India also has a high number, estimated at four million children affected by HIV, with nearly 100,000 children orphaned (Ghanashyam, 2010). Despite the fact that “children who have lost parents to AIDS will need our attention long after rates of new infection go down” (UNICEF, 2010c: 27), “to date, there is an almost total lack of rigorously tested interventions for AIDS-affected children” (Cluver et al., 2012:133). Developing this body of evidence is critical to meet the needs of children affected by HIV. 

This section covers what is known about interventions that work in caring for and supporting women and girls in general, both with respect to their own needs in illness and the burden of caring for others who are ill. It also covers the care and support of orphans and vulnerable children, especially the particular vulnerabilities and needs of orphaned girls.