1. Introduction

1. A. Orphans and Other Vulnerable Children (OVCs) and the HIV/AIDS Pandemic

Because HIV/AIDS predominantly attacks people of childbearing age, the impact this is having on children, extended families, and communities is devastating. If a parent dies of AIDS, the child is three times more likely to die, even though he or she is HIV negative.¹ Besides increased risk of death, children whose parents have died due to HIV/AIDS also face stigmatization and rejection, and often suffer from emotional distress, malnutrition, a lack of health care, poor or no access to education, and most importantly, a lack of love and care. They are also at high risk for labor exploitation, sex trafficking, homelessness, and exposure to HIV. Extended families and communities in highly affected areas are often hard-pressed to care for all the children. In communities hard hit by the double hammer of HIV/AIDS and poverty, there are millions of children who are not orphans, but who have been made more vulnerable by HIV/AIDS. For example, children whose parents are infected with HIV/AIDS might not receive the care and support they require, and may instead become their parents' caregivers, often dropping out of school and becoming the breadwinner. Research indicates that these children, caring for sick and dying parents, are the most vulnerable of all. ², ³

The most fundamental way to meet the needs of vulnerable children is to keep their parents alive and prevent them from becoming orphans. Treatment and palliative care, made possible through the President?s Emergency Plan for AIDS Relief (PEPFAR/Emergency Plan), often enable the parents to resume their role as caretakers, allow the children to reclaim their childhood, and protect the families. Yet even with treatment and a reduction in HIV prevalence, the number of orphans will continue to rise in many countries. By 2010, the number of children orphaned by HIV/AIDS is projected to exceed 25 million, and the number of other vulnerable children will greatly surpass that number. ⁴, ⁵

PEPFAR recognizes the urgency of addressing the growing needs of children orphaned or made vulnerable by HIV/AIDS with compassionate care. PEPFAR is committed to the development of evidence-based policy and the implementation of sound practices in the care and support of orphans and other children made vulnerable by HIV/AIDS. Our goal is to help these children and adolescents grow and develop into healthy, stable and productive members of society.

1. B. Scope and Purpose of Guidance

This document offers practical guidance for programs aimed at addressing the needs of children made vulnerable by HIV/AIDS. It provides key definitions, guiding principles, and important considerations for programming decisions. The guidance clarifies Emergency Plan priorities and the activities that it will fund related to OVCs. It builds on the principles outlined in the U.S. Five-Year Global HIV/AIDS Strategy, and extends the vision and guidance of the President's Emergency Plan. With new experiences over time, the OVC Guidance will evolve and incorporate new practices and lessons learned.

1. C. Foundation for OVC Guidance

This document affirms the agenda for responding to the OVC challenge detailed in The Framework for the Protection, Care and Support of Orphans and Vulnerable Children, Living in a World with HIV/AIDS, 2004.⁶ It also adapts key concepts and principles from other internationally developed documents, such as the International Protection of Children, Family and Property Relations, Hague 1996⁷, and Children on the Brink, 2004⁸, applying them to the particular requirements of PEPFAR. These and other references appear in Appendix II.

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