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Mr. Chairman,
Honoured guests,
Ladies and gentlemen.

Thank you for inviting me to address you today about the greatest threat facing humankind's existence. Thank you also for the good work that you, your staff and your organization have been doing to help us to combat the HIV/AIDS pandemic.

Before I start with the main section of my speech, I want to read to you 7 very short statements taken from our Constitution. As you may know, the South Africa Constitution (Act 108 of 1996), places an obligation on government to ensure that the following needs of children are met.

1. Every child has the right to family care or parental care, or to appropriate alternative care when removed from the family environment (South African Constitution, Section 28.1(b)).

2. Every child has the right to basic nutrition (South African Constitution, Section 28.1(c)) and sufficient food and water (Section 27.1(b)).

3. Every child has the right to shelter (South African Constitution, Section 28.1(c)) and to adequate housing (Section 26.1).

4. Every child has the right to basic health care services (South African Constitution, Section 28.1(c)).

5. Every child has the right to social services (South African Constitution, Section 28.1(c)).

6. Everyone has the right to have access to social security (South African Constitution, Section 27.1(c)).

7. Every child has the right to be protected from maltreatment, neglect, abuse or degradation (South African Constitution, Section 28.1(d)).

Ladies and gentlemen, the subject of AIDS has been a very sensitive issue for the last decade or more, but it just seems that the issue is becoming more and more like one of those issues, which have a definite impact on every aspect of our day-to-day lives. This is on the one hand so, because of the prevalence of this problem in our South African community and the fact that statistics show that in South Africa as well as in Africa, compared to the rest of the world in a global sense, we have more infected people than other countries or communities.

On the other hand, though, Mr. Chairman, this pandemic disease currently has an enormous impact on Health and Social Services especially from the point of view of finances and manpower. But the effect and impact on Social Services will be present for even longer. As the social impact of the problem is one, which governments of the future will still have to contend with for a very long time even if they find a cure for HIV/AIDS in the near future.

The needs of sick children can only be met if the needs of families and communities are simultaneously addressed. The combined socio-economic consequences of HIV/AIDS on children in affected households and communities are far reaching, with reduced opportunity for growth and development creating a cycle of dependency, vulnerability and abuse.

In terms of the subject at hand, it is important to consider the current strategies and policies, which are being implemented.

CURRENT POLICIES AND STRATEGIES

The Department of Social Services in the Western Cape, as part of the National Integrated Plan on HIV/AIDS has been assigned the responsibility to focus on Children infected and affected by HIV/AIDS.

The National Plan has five strategic focuses namely:

1. To development of an appropriate policy in this respect;

2. To cause a decline in the prevalence of HIV/AIDS through targeted preventative interventions;

3. To manage the impact of HIV/AIDS on social security;

4. The development of affordable community based care and support models;

5. To formalise strategic alliances with the other role players, i.e. NGOs, business and other involved Departments.

However, we in the Western Cape a Provincial Strategic plan to combat HIV/AIDS, and this plan focuses on the following:

* Awareness and advocacy;

* Training and capacity building of both staff and civil society;

* Partnerships / inter-sectoral collaboration with other stakeholders;

* Accessible services and programmes for children infected and affected (they are not to be denied access to services/facilities); and

* Availability of disability grants to those who, by virtue of having HIV/AIDS, can no longer support themselves financially.

The Department of Social Services in the Western Cape is presently further involved in the following activities. We currently subsidise two children's homes focusing directly on HIV/AIDS babies and children at a unit cost of R1 000.00 per child per month.

Name of Children's Home: Beautiful Gate
Number of children approved for financing: 20
Monthly subsidy: R 20 000.00
Annual subsidy: R 240 000.00

Name of Children's Home: Nazareth House
Number of children approved for financing: 44
Monthly subsidy: R 44 000.00
Annual subsidy: R 528 000.00

Total subsidy: R 768 000.00

Other children's homes also admit children infected by HIV/AIDS. The policy which is encouraged, however is to integrate these children with other children, rather to isolate them to separate facilities, unless it is absolutely necessary.

It is further our distinct policy to support and strengthen the NGOs, particularly those who have a focus on children who are rendering services to people infected and affected by HIV/AIDS. Currently one NGO, namely Wolanani in Cape Town, receives funding for services to people living with HIV/AIDS. Two other NGOs namely: the Child Welfare Society, Cape Town and Khululeka Women's Organization, Beaufort-West, have applied for funding from the National Department of Social Development and the application is presently with the department for consideration.

Information sessions with regard to HIV/AIDS were also done at the De Novo Youth Centre; a state facility which renders services to young people addicted to drugs. The different places of safety within the province also have a focus on HIV/AIDS as part of their rehabilitation programmes. The Early Childhood Development facilities of which there are a large number in the province will also be included in programmes in order to ensure accessibility for the children to these facilities.

The development of community based care, support models also receive priority attention and is an important mechanism, depending on networking between the different role players and emphasising service rendering under circumstances where resources are limited.

The Department of Social Services is currently an important role-player in this field, together with the Departments of Health and Education and the NGO sector. The need for the further development of models of care targeted at children infected and affected still exists and further research is being done in this respect.

Children's homes should be encouraged to focus their programs on the child in totality. These programs should include a proposal for a support facility to foster placements of children infected and affected by HIV/AIDS.

The Department through the Directorate Social Security administers different social grants targeted at both adults and children infected and affected by HIV/AIDS. These various grants can be applied for at the district or respective service offices and falls mainly in the category of disability grants for the adults.

Mechanisms have also been put in place at these offices to deal more speedily with applications submitted as a result of HIV/AIDS, if the HIV/AIDS status of the applicant is known. The standard period of completion of any grant is thirty days.

The Department has also allocated funding to a number of programs from the Poverty Alleviation Fund. Revision and amendment of current legislation regarding children in need of care in order to deal more effectively with orphans. In this respect, it is important to note that child headed households are a new phenomena and affect the concept of guardianship as is provided for on our current law.

We therefore have to contribute and lead with the development of the capacity of the family and making appropriate resources, services and support accessible. This will enable communities to support their orphans.

Providing care and support for child headed households, train teachers, community workers, child and youth care workers, community leaders, volunteers and families is an important aspect of the how to intervene in these cases, but it is also essential to make them aware of the developmental needs of children, as well as their grief.

Children under normal circumstances today already have many needs, which need to be attended to, but children infected or affected by HIV/AIDS have amongst others the following additional needs and although it sounds like the regular needs for all the other children, some of these must be adapted for the specific situation of these infected or affected children:

* Housing/shelter;
* Health care;
* Nutrition;
* Social security;
* Social services;
* Basic services such as water, sanitation, electricity;
* Education;
* Prevention;
* Transport;
* Financial support for service providers and communities;
* Legal protection for children; and
* Communication and partnerships between local government and other sectors

A comprehensive HIV/AIDS prevention, treatment, care and support strategy is therefore essential and should target, among others:

* Children who are HIV positive;
* Children orphaned as a result of AIDS;
* Children who live in HIV infected households;
* Children at risk of infection such as child victims of rape, child sex workers;
* Families and caregivers caring for children infected / affected by HIV/AIDS;
* Affected communities; and
* Service providers.

Although children with HIV are not sick all the time and should lead as normal a life as possible, caring for children with HIV/AIDS infection can be a difficult and challenging task. Whilst the infection will not significantly be different for children who are not HIV infected, the stigma attached to HIV infection cannot be ignored. Care needs to be provided in the context of a confidential, non-discriminative and supportive environment.

HIV infected children should have:

* Good nutrition (including nutritional supplementation where necessary;
* Good hygiene, clean water and sanitation and protection from toxins;
* A balance between exercise and rest;
* Psychosocial support for the child and parent or caregiver;
* Comfort when in pain or in distress;
* Care and follow-up (growth and development monitoring);
* Early treatment of common childhood infections, including regular treatment for parasitic infections;
* Treatment of common opportunistic infections;
* Drugs (such as antibiotics);
* Complete immunization coverage.

As you can see, ladies and gentlemen, the needs and problems of this issue are very similar to the normal problems we have as far as children are concerned, but a number of adaptations needs to be made. A lot of these adaptations are made and are necessary as result of the stigma people still attach to infected individuals and the fear people still have, many times as result of ignorance as well as the perceptions we manufacture about the victims of HIV/AIDS. It has therefore been necessary to adopt certain guiding principles as far as children are concerned, for example:

* Infected children have the right to the benefit of family life.
* In the absence of family care infected, children have the right to alternative care.
* Infected children have the same rights to health care as uninfected children. Disclosure of a child's HIV status must be in the child's best interests.

The promotion of traditional models of care for children is of crucial importance. The family remains to be a fortress within which our children should be cared for and developed.

We must also assist communities to overcome poverty. Poverty is almost a buzzword today. (It is almost like with the Springbok rugby-team). Every one has something to say about it and every one has a solution ready for it. The fact is, that poverty today is the cause of many of our other problems in South Africa and if we can start making a difference by alleviating poverty by tackling it, community by community, with an integrated developmental approach, we can also address the problem tabled here today.

We should strengthen existing initiatives of women within communities who care for infected children. During my numerous visits to communities and care centres, I have seen that there are women who are taking initiatives and who are involved with a determined sincerity. We should support and motivate them to fuel their enthusiasm. A lot of work is currently being done voluntarily and it is right that civil society plays its responsible role, but we should explore ways to provide incentives for existing careers of sick children.

Providing nutrition programmes for children is one of the ways to ensure that children remain immune and strong enough to fight disease and sickness. The following can be done:

* Strategies should be developed to keep siblings together.
* The pool of foster and adoptive parents should be increased and the process of adoption streamlined.
* More training and support for community careers should be provided.
* We should develop monitoring mechanisms for the protection of both infected and affected children.
* Social services for these children should be improved.
* Physical and emotional support for the grieving process should be increased.
* Home/community-based care and support to extended families and communities should be improved.

Housing and shelter is needed for the large numbers of children who are being orphaned by HIV/AIDS and for affected families who have lost their homes. These may take the form of cluster foster care settings or low cost housing. Child headed households are unable to access the housing subsidy and many lose their homes and property after the death of a parent. Housing subsidies should be made available for these children as well as assistance with home maintenance.

The following are some of the health care interventions, which should be implemented:

* Integrated family clinics, which deal with the needs of the whole family (these facilities need to be child and adolescent friendly);

* Trained and supported home based careers to assist with caring for the sick and dying and for the children of caregivers who are dying;

* Family counselling at health care facilities;

* Pre and post test counselling for young children;

* Training of primary health care staff on the care of HIV positive children including psychosocial support, nutrition, medication;

* More clinic staff in heavily affected areas;

* Health education through schools, libraries and clinics (particularly in the rural areas);

* Subsidized volunteers for home based care services;

* Extension of mother to child transmission interventions to all health care facilities;

* Free health care for all children up to the age of 17 years;

* Hospice facilities for terminally ill children and families-together; and

* Ongoing capacity building around HIV/AIDS with staff

The importance of good nutrition under these circumstances cannot be underestimated and the following proposals in this regard are:

* Food parcels for affected families;

* Micro-nutrient supplementation, such as Vitamin A which slows HIV disease progression; and

* HIV infected families should be linked to the PEM scheme where children's growth is monitored and food supplements are provided if necessary

The impact of HIV/AIDS on children is exacerbated by the fact that HIV usually strikes more than 1 member of an infected household and this usually includes the primary caregiver and/or breadwinner. Once an HIV positive diagnosis is made within a family, the family is often thrown into financial and emotional turmoil. Social security is therefore essential in:

* Fast tracking of birth registration to enable caregivers to apply for the child support grant;

* Alternative forms of social security such as food parcels, transport vouchers, free health care and free education for vulnerable children;

* A clear policy on who is eligible for the various grants;

* Recourse for families who wait for longer than 30 days for a grant application to be processed;

* Emergency relief funds should be made available to desperate families with no income, while they wait for their grant to be processed.

* Local government should put pressure on National government for the extension of the child support grant to all children (0-17 years);

* Structures are needed to ensure that child headed households have access to social assistance;

* Awareness raising within communities around who is eligible for grants and how to apply for grants; and

* Extension of care dependency grant to young children who are HIV positive Satellite birth registration facilities in rural areas.

HIV/AIDS places additional pressure on the already highly loaded plate of social services, but the following are some of the actions needed to alleviate the problem:

* Facilities for vulnerable children which allow mothers and children to stay together;
* Financial support for volunteers;
* Community based placement and supervision programs for children;
* Community based programs which identify children who are at risk and protect children from abuse and neglect;
* Additional community social workers in heavily affected areas;
* Training of service providers to enable them to move towards community empowerment and self-help programs;
* Training of social workers and other services providers on succession planning with children of HIV infected parents;
* Support for older siblings caring for younger children;
* Counselling for children who witness the dying or death of a parent;
* Support groups for HIV positive mothers and their children;
* Skills development programs for income generation in HIV infected households;
* Training at children's homes on how to care for HIV+ children; and
* Care and support for service providers working with families affected by HIV/AIDS.

In order to combat the many effects of the HIV/AIDS pandemic on children, it is also crucial that our interventions effectively capacitate and mobilise families, communities, children and young people themselves. The accessibility of integrated services for both infected and affected children are therefore essential.

Mr. Chairman, it is my experience that so many of the social problems we have in the Western Cape and I believe in the country as well, has a solution, which lies on many fronts. A number of the solutions or remedies offered here today flows into the areas of health, housing, economic development and education. Some of these can be tackled on a provincial level, but others must be lobbied on a national level.

I strongly and sincerely believe that one can only win this battle if all the role players collectively pool their resources and work together to rid us and our children of this dreaded disease. All the role players, which includes members of the community, NGOs, CBOs, Government (at all levels), Church leaders, the medical fraternity, youth organisations and others, strive to achieve the exact same goals on an integrated co-operative basis.

I want to again thank the Joan Cousins HIV/Aids Mission for inviting me here today. Events such as these promote the awareness about this pandemic, and helps to present a platform for debate on this matter. It is at events like these, that those who attend can obtain and access more information about what is happening on the battlefront against HIV/AIDS.

I thank you all.

Issued by: Office of the MEC of Social Services and Poverty Relief, Western Cape, 7 June 2001