HIV Infected and Affected Children in Delhi A Status Report Delhi Commission for Protection of Child Rights Delhi Commission for Protection of Child Rights 5th Floor, IBST Building, Kashmere Gate, Delhi-110006 5th Floor, IBST Building, Kashmere Gate, Delhi-110006 Tel. ; 011-23862686, Fax: 011-23862684, E-mail: [email protected] Tel. ; 011-23862686, Fax: 011-23862684, E-mail: [email protected] HIV Infected and Affected CHILDREN IN DELHI A Status Report Delhi Commission for Protection of Child Rights November 2014 Foreword 5 CHAPTER I Definitions 7 CHAPTER II Introduction 9 CHAPTER III The Status of HIV in Delhi 14 Delhi State AIDS Control Society (DSACS) 21 Children Affected by AIDS (CABA) Pilot Scheme 24 < * ) Financial Assistance to PLHA in Delhi 25 CHAPTER IV National Policies and Guidelines 28 The National AIDS Control Organisation (NACO) 28 H HIV/AIDS Bill 2007 29 India's Commitment to Child Rights 30 Constitutional Provisions 30 z National Plan of Action for Children, 2005 31 w Policy Framework for Children and AIDS, July 2007 33 Integrated Child Protection Scheme (ICPS) 34 CHAPTER V Civil Society and NGO Initiatives 37 H CHAPTER VI Conclusion 41 Annexure 1 List of Abbreviations 43 Annexure 2 Global Perspective 46 z Annexure 3 Write up of the Plan Scheme for Financial Assistance to PLHAs 49 Annexure 4 Orphan & Vulnerable Children Infected or o Affected by HIV/AIDS in Delhi 53 Annexure 5 NACP I to IV 63 u Annexure 6 Operational Guidelines for Care & Support Centres, December 2013 68 Annexure 7 Government Schemes and Programmes 73 Annexure 8 Parliamentary Interventions 75 Annexure 9 Court Pronouncement and HIV 76 Annexure 10 Measures by International Organisations 81 Annexure 11 Media Reporting 84 FOREWORD HIV/AIDS has emerged as a major issue affecting children in our society. Children infected and affected by HIV face a lot of apathy and are one of the most vulnerable sections of our society. Children affected by HIV/AIDS include a relatively small number of children who are HIV-positive and a far larger number who are not infected but whose parents are living with, or have died of AIDS. In addition, there is an even larger group of adolescents who are at a heightened risk of HIV infection because they engage in unsafe behaviour or live in communities which are vulnerable to HIV. A 2012 Delhi State Aids Control Society (DSACS) study estimates that the total number of Orphan and Vulnerable Children (OVC) in Delhi was 1,908, of which 766 were infected with HIV and 1,142 were affected by HIV/AIDS. The data was gathered during the period April 2010-March 2012 from nine antiretroviral treatment centres, Children Affected by AIDS (CABA) pilot scheme, and two institutions providing residential care to CABA in Delhi. Being HIV positive, children face rejection within their own families, schools, medical care facilities and are ostracised by society at large. They are stigmatized and face a lot of discrimination as well as abuse. People are scared to come in contact with them and take care of their basic needs. Families refuse to share living spaces, utensils, clothes, toilets with HIV positive children in the household. Media has been constantly reporting on how children are forced to leave schools given their status. At times, other parents withdraw their children leading to pressure on these children to drop out of educational institutions. Even health care providers, despite their sensitisation, refuse to take care of HIV positive patients. Pregnant women are not attended to leading to transmission of the infection to the child. Surgeries are not performed on HIV positive individuals. Children are also pulled out of school to take care of their ailing parents. In the absence of parents, they are forced to become breadwinners of the family, having already suffered the trauma of the death of their near and dear ones. Malnourished, living with opportunistic infections, lack of access to treatment often leads to early death. Most often they lose their property and inheritance rights and are subjected to abuse and exploitation. In other words, HIV/AIDS compromises children's right to survival, protection, participation and development. It cuts short their childhood. Over the years, with improvement in testing facilities, medical intervention, free roll out of paediatric ART (antiretroviral therapy), and increase in awareness, their life span has enhanced and we need to ensure they have access to care and protection like any other child in this country. ART has transformed AIDS from a terminal illness to a treatable chronic condition. The objective of this study is to understand the status of HIV infected and affected children in the Capital city of Delhi which has been categorised as a "highly vulnerable but low prevalence" city. It also looks at the global and national context, the various interventions and initiatives at CHAPTER different levels and the schemes and programmes which can be accessed by these children in difficult circumstances. This status report on HIV and children began with a desk review of the available material on HIV Definitions as well as children's rights in the context of their positive status. This included policy documents, various guidelines laid down by the Government of India, reports related to children and their rights and laws, and reports of various donor agencies.Reports by experts in this field as well as of NGOs working in different parts of the country were studied to understand the programmes, Child: The Juvenile Justice (Care and Protection) Act 2000 defines children as persons below 18 schemes and initiatives and their impact on the children infected and affected by HIV. Media years of age. The UN Convention on Child Rights defines children as human beings below the age reports related to HIV and children were scanned to understand the debate and discussion on the of 18 years. issue within the media. Vulnerable children: As per the Sub Group Report on Child Protection for the Eleventh Five Year Govt departments working at the national (NACO) and Delhi level (DSACS) as well as NGOs Plan by the MWCD, some children are more vulnerable in terms of the harm/ danger/ risk to working in Delhi were contacted for their perspective on this issue. DCPCR appreciates the their survival/ development and participation than others. These children in difficult support from the Delhi State AIDS Control Society in providing relevant data and information. circumstances fall into the following groups: We are grateful to the various organisations - CHELSEA, Nai Umang, NIPCCD, who contributed a. Homeless children (pavement dwellers, displaced/ evicted etc) to the study and provided relevant data and reports. The Commission acknowledges the Refugee and migrant children contribution of Members Mr. Shashank Shekhar and Mr. M. M. Vidyarthi as well as b. Ms. Anuradha Mukherjee, Consultant, for putting together all inputs for this status report. c. Orphaned or abandoned and destitute children d. Children whose parents cannot or are not able to take care of them e. Street and working children f. Child beggars II g. Victims of child marriage (Aran Mathur) h. Trafficked children Chairperson i. Child sex workers DCPCR j. Children of sex workers November 2014 k. Children of prisoners l. Children affected by conflict/civil strife m. Children affected by disasters both natural and manmade n. Children affected by substance abuse, HIV/AIDS and other terminal illness o. Disabled children p. Children belonging to ethnic, religious minorities and other socially marginalised groups q. Girl child r. Children in conflict with law and s. Children who are victims of crime. In the context of HIV/AIDS, vulnerable children are those children who are in such circumstances that their risk of HIV infection is high. For instance children on the streets, orphans, children of sex workers, child labour, child sex workers and trafficked children. 7 HIV affected child: A child who a. Has a family member living with HIV/AIDS CHAPTER b. One or both parents living with HIV/AIDS c. Has lost a parent or significant guardian or care provider due to AIDS Introduction d. Is orphaned by HIV/AIDS e. Is living with HIV/AIDS An HIV infected child is defined as a child living with HIV/AIDS. It is a sub-set under affected child. In India, the first case of HIV or Human Immuno-deficiency Virus was reported in 1986 in Orphan: A child under the age of 18 years who has lost one or both parents Chennai, in the Southern state of Tamil Nadu, among commercial sex workers. The second case was reported among intravenous drug users in the Eastern state of Manipur. Once perceived as an infection restricted to high risk groups (HRG) like truck drivers, commercial sex workers, homosexual men and intravenous drug users, it has percolated to the general population and from the urban to the rural areas. Despite various efforts at the national and state level, the disease continues to be a cause for concern in the country. There are four modes of transmission of HIV 1. Through contaminated blood 2. Through unprotected sexual contact with an infected person 3. Use of contaminated needles and syringes 4. From infected parent to child In the Indian context, most of the people have been infected through heterosexual contact, i.e. 87.4 percent of the cases, as indicated in the graph below. Parent to child transmission contributed to 5.4 percent of the cases in the country. This is quite high considering that interventions at the appropriate time can significantly bring down the chances of transmission of the virus from parent to child. Children born to HIV positive women can be infected with the virus during a.