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Last update: Mar 2011

Protect and support children affected by HIV and AIDS 


The challenge


Worldwide in 2009, there were an estimated 16.6 million children who had lost one or both parents to AIDS, including nearly 14.9 million children in sub-Saharan Africa. Many millions more were orphaned due to other causes. An analysis of recent household survey data in 47 countries shows that orphanhood from all causes exceeds 5 per cent in many countries and is over 20 per cent in Lesotho, Rwanda, Swaziland and Zimbabwe. Orphaning rates are lowest, in countries of Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS).  




The target set by the special session of the General Assembly on HIV/AIDS:

By 2005, implement policies and strategies to strengthen capacities to provide a supportive environment for orphans and children affected by AIDS and ensure that they have access to education and to health services on an equal basis with other children (UNGASS, 2001).

Orphans and vulnerable children are at higher risk of missing out on schooling, live in households with less food security, suffer anxiety and depression, and are in greater danger of exposure to HIV. Their experiences vary significantly across families, communities and countries, and are influenced by a complex mix of variables, including children’s relationships to their caregivers, the wealth of their household and community, HIV prevalence in the community and many other factors. In order to properly care for orphans and vulnerable children, the minimum package for them includes access to services like education, health care, social welfare and protection. Without laws, policies and services that support families and communities in caring for all orphans and vulnerable children, children in this situation face grave risks to their education, health and well-being, and support for them remains low.


Because a definition of vulnerability has not been standardized and a minimum package of services has yet to be determined, developing routine monitoring indicators and tools for collecting data on orphans and vulnerable children is difficult. Poor coordination of services means there is a strong possibility that children will receive multiple services and be counted more than once. Greater attention should be given to defining optimum services and beneficiaries, as well as strengthening coordination and reporting on the services provided to orphans and vulnerable children.



Millennium Development Goal Indicator
Ratio of school attendance of orphans to school attendance of non-orphans aged 10–14 years

Schools continue to be vital places where children affected by AIDS – and all children – can find protection and support, and schools often serve as entry points for children who need to receive health services and meals. The right to education is crucial, as access to schooling helps children affected by HIV and AIDS cope with their situation and regain a sense of normalcy and stability in their lives. The protective nature of schooling is, however, dependent on safeguarding rights within education and providing safe and inclusive learning environments at a reasonable distance from children’s homes and with access to safe water and sanitation.


Children who have lost both parents are generally less likely to be in school than children whose parents are both still alive. Thus, a key indicator of the situation of AIDS-affected children is the orphan school attendance ratio. This ratio compares school attendance of children aged 10–14 who have lost both parents with those children whose parents are both still alive and who live with one or both parents. Most countries in sub-Saharan Africa have made significant progress towards parity in school attendance for orphans and non-orphans 10–14 years old. In 27 out of 31 countries in sub-Saharan Africa that report data for at least two points in time, school attendance among children who have lost both parents has increased.


Trends in orphan and non-orphan school attendance ratios in selected sub-Saharan countries where the ratio has increased by at least 0.10 points, 1997–2008


Source: UNICEF, UNAIDS, WHO, UNFPA and UNESCO, Children and AIDS: Fifth stocktaking report, 2010.


UNGASS Indicator
Percentage of children whose households received external support

The overall situation of children’s vulnerability is complex and needs to be analysed within specific country and local contexts. An analysis of household surveys in 36 countries found, for example, that in many countries children who are orphaned are worse off than other children in relation to certain indicators of child development – nutritional status, school attendance, sexual debut – but in other countries they are equally well or better off. Some of this inconsistency can be explained by the situational context. In countries with high levels of overall school attendance nearly the same percentages of both orphans and non-orphans attended school, but in countries with lower levels of school attendance many countries showed large disparities between orphans and non-orphans.


In 25 countries where household surveys were conducted between 2005 and 2009, the proportion of orphans and vulnerable children whose households received basic external support ranged between 1 per cent in Sierra Leone and 41 per cent in Swaziland, with a median value of 11 per cent. Such support included education assistance, medical care, clothing, financial support and psychosocial services. The Unite for Children, Unite against AIDS goal is to reach 80 per cent of children most in need with services by 2010. 


Click to download the Percentage of orphans and vulnerable children whose household received basic external support.

The shift towards inclusive programming to help all vulnerable children, including those directly affected by AIDS, is having an impact. The growing call for a broader, more inclusive definition of vulnerability is reflected in many countries’ national plans of action (NPAs) in Eastern and Southern Africa. In Zimbabwe, for example, a new programme of support to the National Plan of Action for Orphans and Other Vulnerable Children accepts a wide definition of vulnerability beyond orphanhood and vulnerability due to AIDS.


National-level responses for orphans and other vulnerable children have been increasing since the 1990s, and as of 2008 nearly 50 countries globally were developing some type of AIDS-sensitive response. Also, about 32 countries had developed or finalized NPAs with benefits for orphans and vulnerable children. Countries of Eastern and Southern Africa have generally made the most progress in developing and implementing national responses, while programming for orphans and vulnerable children is relatively new in West and Central Africa. In the East Asia and Pacific region, Cambodia, Malaysia, Papua New Guinea and Viet Nam are in the process of drafting national plans. In South Asia, India was the first country to establish a national response to children affected by HIV and AIDS.


However, the process of developing NPAs has generally been slow, and implementation at scale is lacking. The often limited capacity of governments and implementing partners and lengthy periods for plan development – three to seven years or more – are major challenges. Insufficient resources for implementing NPAs are reflected in the levels of social assistance provided to vulnerable households. Efforts and investment should nonetheless be directed towards increasing access to basic services, ensuring appropriate alternative care, and providing social support and protection from abuse and neglect.



UNAIDS, Global Report: UNAIDS report on the global AIDS epidemic, 2010, UNAIDS, Geneva, 2010.

UNAIDS and WHO, AIDS Epidemic Update, UNAIDS, Geneva, 2009.

UNICEF, Progress Report for Children Affected by HIV/AIDS, UNICEF, New York, 2009.

UNICEF, UNAIDS, WHO, UNFPA and UNESCO, Children and AIDS: Fifth stocktaking report, 2010, UNICEF, New York, 2010.

UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Fourth stocktaking report, 2009, UNICEF, New York, 2009.

UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Third stocktaking report, 2008, UNICEF, New York, 2008.