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A NETWORK OF UNITED METHODISTS AND OTHERS WHO CARE ABOUT THE GLOBAL HIV/AIDS PANDEMIC AND THOSE WHOSE LIVES HAVE BEEN TOUCHED

Contents

• Introduction
• Children Living With HIV and AIDS
• Children in the Shadow of HIV Risk
• HIV and Child Sexual Abuse
• HIV and Consensual Sex with Peers
• HIV and Drug Use
• Refugee and Displaced Children
• Children in Detention and HIV
• Children with HIV/AIDS in Developing Countries
• School Education on HIV/AIDS
• Strengthening Development to Strengthen Coping
• Facts and Figures
• Datos y cifras

Additional Resources (Religious)

• Annotated Bibilography
• Worship Resources

(adapted from UNAIDS World AIDS Day 1997 material)

From the sick and neglected infants dying of AIDS in the orphanages of Romania to the young people watching over their dying parents in East Africa, images of the children of the AIDS epidemic are among the most compelling reminders of the reach of this global crisis.

Today's children - defined by the United Nations Convention on the Rights of the Child as people under the age of 18 years old - are growing up in a world with AIDS. They must cope not only with issues and problems that have long existed and are now being revealed by the HIV/AIDS epidemic, but also with those that result directly from the epidemic.

HIV/AIDS is a disease of the young. Last year 400,000 children under the age of 15 years became infected with HIV worldwide, bringing the total number of children living with the virus at the end of 1996 to 830,000. Hundreds of thousands of HIV-infected babies are born every year to HIV-positive mothers. By the end of 1997, UNAIDS estimates that 1 million children worldwide will be living with HIV. Well over 90% of these children live in developing countries.

More children are contracting HIV than ever before. There is no sign that the infection rate is slowing. Children are vulnerable to infection through mother-to-child transmission, unsafe blood and injection practices, sex-- including sexual abuse, coercion and commercial exploitation-- and injecting drug use.

In sub-Saharan Africa, the region most severely affected by AIDS so far, the US Bureau of the Census has predicted that AIDS will offset improvements in infant and child mortality achieved in the past decade. By the year 2010, if the spread of HIV is not contained, AIDS may increase infant mortality by as much as 75% and under-five child mortality by more than 100% in those regions most affected by the disease.

Children are not only infected by HIV, they are also affected. While the number of those infected by HIV continues to grow, the epidemic is also having a direct and devastating effect on millions of other children whose lives have been permanently altered by the intrusion of HIV/AIDS into their households or communities. Children living in hard-hit communities feel the impact as they lose parents, teachers and caregivers to AIDS, as health systems are stretched beyond their limits, and as their families take in other children who have been orphaned by the epidemic.

Individual households struck by AIDS often suffer disproportionately from stigma, isolation and impoverishment. The emotional toll on the children is heavier still. As the number of children orphaned or otherwise affected by AIDS rises, social security systems, already underfunded and overburdened where they exist, are at breaking point. The impact is most acute on girls and boys already facing hardship or neglect-- children in institutional care, children in poor neighborhoods or slum areas, refugee children-- and even more so for young girls who have unequal opportunities for schooling and employment.

In countries such as Uganda, where the epidemic already took hold over a decade ago, the impact of AIDS on the socioeconomic fabric of communities is becoming increasingly visible. As one UNICEF/WHO report puts it, "the effects of the epidemic are starkly obvious from the banana plantations going fallow, the houses closed or abandoned, the funeral processions on the roads and the recent graves near homes where grand-parents care for children whose parents have died. " AIDS sets back development and changes patterns of life. To a child, this translates into a world turned upside down.

The shadow of the epidemic extends far beyond even these millions of infected and affected children. In the final analysis, all children of the world henceforth face a life-time of risk from HIV. They are exposed to the risk of HIV infection at different life stages as they grow into adulthood, because of circumstances such as sexual exploitation and abuse, or simply due to violation of their rights to information, to education and services. There must be greater recognition of the specific needs of girls and especially vulnerable children, both boys and girls, such as refugees, street kids, and children exposed to drug use.

The global epidemic continues to accelerate. We have no vaccine or no cure for HIV. For all the welcome recent advances in scientific treatments, much of the medicinal drugs may never be accessible to the vast majority of people living with HIV who are in the developing world.

The epidemic casts a big shadow on the hundreds of millions of children who live in risk of HIV infection because because their personal circumstances make them especially vulnerable to sexual abuse. Sexual abuse during childhood and adolescence is a pervasive problem affecting all societies.

Sexual abuse of children takes two main forms - commercial sexual exploitation, a multi-billion dollar world industry; and sexual abuse in the home or community by relatives, "friends" or associates of the child's family, or others with easy access to the child such as schoolteachers or employers.

No one knows how many child sex workers there are in the world. Figures reported to the first World Congress Against Commercial Sexual Exploitation of Children, which took place in Stockholm in August 1996, suggested that worldwide, more than a million children enter the sex trade every year. What research has been done suggests that such exploitation is growing, and the age of the children involved is falling.

Most children in the sex industry are girls aged between 13 and 18, although there are instances of much younger children being sold. Many such children spend most of their lives on the street, often because they are escaping violence or sexual abuse at home. Other children live in brothels, having been drawn into prostitution by procurers. For example, female children are often purchased from their parents or lured to the city with promises of jobs, education or money, only to be sold to a pimp.

Girls are at greater risk than boys. Those who have been abused or forced into prostitution are often stigmatized and marginalized, which further undermines their status, and reduces their opportunities for accessing education, formal employment and, in many societies, marriage.

The HIV/AIDS epidemic has made child sexual abuse and child prostitution more dangerous than ever before. Studies indicate that rates of HIV infection among child sex workers and street children are often very high. Surveys of Kenyan girls living on the street indicated that as many as 30% were HIV-positive.

The belief that children are less likely to be infected has raised the demand for younger sex workers. The vulnerability of children to sexual exploitation may well result in their becoming infected with other sexually transmitted diseases (STDs) and increasing the child's susceptibility to HIV.

Steps are being taken at national levels to target not only commercial sexual exploitation at home but also abroad. New extraterritorial laws in some countries, including Australia, Germany, Japan, the Netherlands, Sweden, the United States and the United Kingdom, now permit countries to prosecute nationals guilty of sex offences against children overseas. The World Trade Organization recently

established a new Task Force to target tour operators and hotels that knowingly cater to sex tourists. Enforcing these new sanctions and laws will require international cooperation from a variety of actors including government entities such as the police and judicial systems. While sex tourism is a major problem, commercial sexual exploitation of children is predominantly a local issue, with both clients and agents coming from the local community.

An unknown number of children in developing and industrialized countries alike are at risk of sexual abuse by relatives, other members of the child's community or strangers. Sexual abuse in the home is also a significant factor in pushing children to leave home, thereby perpetuating a cycle of vulnerability.

A study in Zimbabwe found that most cases of child sexual abuse probably go unreported. Some are detected when the child develops a sexually transmitted disease - proof that abuse took the form of actual sexual intercourse. In 1990, 907 children under 12 were treated for a sexually transmitted disease at the Genito-Urinary Centre in Harare. Most of the offenders responsible for passing these infections to the child were either neighbors or close relatives.

Child abuse ranges from enticement to coercion. "Sugar daddies" are older men who seek out young girls (often, because they believe they are at less HIV risk from children) and entice them into sex with offers of meals, clothes, luxuries and cash, including money for school fees. The age disparity between the girls and the older and sexually experienced men, creates a particularly great HIV risk for the children. Girls employed as domestics are vulnerable to another type of abuser-- the male head of household, or his sons. Occupational exposure to sexual coercion is, of course, not restricted to household employees, but live-in domestics run a greater risk because they are accessible around the clock.

Sanctions and laws are only a first step in stopping child sexual abuse. In the shorter term, they may raise awareness of this terrible affliction. Increased attention will in turn help change the culture of silence surrounding abuse and make societies more sensitive to abused and exploited children. But while laws forbidding sexual exploitation of children exist in nearly every nation on earth, they are notoriously hard to enforce.

Children are not only at risk of HIV infection when they are sexually exploited or abused, but also when they engage in consenting sex. Many children have their first sexual relationships when they are under the age of 18. A major source of

vulnerability is their lack of knowledge about HIV transmission and their lack of skills in recognizing situations that may turn risky, such as alcohol consumption, standing up to pressure for sex (and drugs), and negotiating condom use and other forms of safer sex.

Love and trust also make children vulnerable. The rate of partner turnover is often greater during adolescence and the early twenties than in later years. This applies not only to casual partners but to regular relationships which occur one after the other. Although these relationships may not last long, in the minds of young people they are often considered to be "safe" in terms of HIV transmission because they are "monogamous." Thus intercourse without a condom occurs with a series of partners. Unwanted pregnancies and high rates of STDs among young people show that the consequences can be severe and even lethal.

The injection of illicit drugs, always a risky behavior, now carries an additional danger-- HIV infection. Drugs do not have to be injected to carry an HIV risk. Alcohol, smoking drugs or glue-sniffing make people forgetful or careless about safer sex or abstaining from sex. While some adolescents inject drugs, many more engage in non-injecting use of substances that can increase their vulnerability to HIV infection.

Many factors influence drug use. However, the association between drug use and HIV infection appears to be particularly dangerous for females involved in commercial sex and for both girls and boys on the street. The environmental factors involved include poverty, discrimination and lack of access to education and health services. "When surveyed, young people in developed or developing countries often indicate that boredom, curiosity and wanting to feel good are perceived as the main reasons for use. Other functions served by substance abuse are to relieve hunger, to adopt a rebellious stance, to acquire courage to beg or be involved in commercial sex, to keep awake or get to sleep, and to dream," says a WHO report.

Children in difficult circumstances are more liable to maintain and escalate substance abuse. For girls living or working on the street, the risks are particularly great as they often have to cope with violence, HIV and other STDs, unplanned pregnancies and unsafe abortions. If they carry their pregnancies to term, they are often left to their own devices to support themselves and provide for their children.

As civil conflict, political persecution, and natural disasters plague many countries, millions of people are forced to live outside of their countries of origin. The majority of the world's refugees are children and women. In conditions ranging from large rural encampments with limited infrastructure to intensely crowded urban shanty towns, young refugees are vulnerable to nonconsensual sex. Even if there is consent, availability of condoms is often quite limited.

The same is true for many displaced children living within the borders of their country, but not in their homes. They survive in very unstable, often threatening environments where risks are high and rights are rarely protected.

To make matters worse, refugee and displaced children are known to be targeted for rape and sexual abuse by adult tormentors from within their own communities, and from external exploiters taking advantage of these environments in which children's rights are often violated.

Similar to the saga of their adult counterparts in prisons, children who are in detention are often exposed to violence, abuse, and unwanted sex. Drug abuse is also a compounding factor for HIV transmission, along with the prohibition of condoms, and body piercing, and unsanitary/unsafe tattooing. Young people in reformatories and other such facilities often have few, if any, options for preventing HIV and other sexually transmitted diseases. Without radical reform in juvenile justice and social welfare institutions, these children will remain with their rights violated-- and their risks increased.

Children with HIV/AIDS in Developing Countries

HIV infection in children runs a faster course to AIDS and death than in adults. Pediatric AIDS kills especially fast in developing countries. Sick children in developing countries are generally at greater risk of death than children in industrialized countries; this is no less true of children with HIV. In Europe, 80% of HIV-infected children survive until their third birthday; more than 20% reach the age of 10. In Zambia, however, nearly half of HIV-infected children in one study had died by the age of two. In another study in Uganda, 66% were dead by the age of three.