ANN PETERSON: Okay. Since you have to get passed – the card was passed to me, I am Dr. Ann Peterson, I am the Administrator for Youth Agency for International Development. I have a very strong panel with me -- Katherine Cann, (MS) many countries. Carol Bellamy from UNICEF is a very special guest today (MS?) But we’ll also look at – and we have three youth representatives from three different countries in the front row that you can talk to. (MS?) I’m here today to talk on an important publication, “Children on the Brink.” Three agencies – the U.S. Agency for International Development, UNICEF and AIDS have come together to (MS?) by AIDS.

Their collaboration on “Children on the Brink” has brought them increased world (MS?) the number of children affected by AIDS. “Children on the Brink” provides statistics on both (MS?) in Africa, Asia, Latin America. It provides a sobering projected estimate of the children that have lost one or both parents to AIDS in all of the continents. (MS?) 2.4 million orphans due to AIDS in this country, and yet this number is projected to grow to more than 25 million in 2010. Now, I know that the (MS?) there’s some confusion about how these numbers are different than previous numbers. So I will turn it over to Karen to explain what they actually mean, how we got them, and where we’re going with them.

KAREN CANN: Good afternoon. Previously – previously, UNAIDS, UNICEF and USAID have produced estimates of AIDS orphans, and USAID has produced estimates of all-cause orphans. These three groups have used slightly different methods and reported different estimates current – for example, current versus cumulative. But for these new estimates, the three groups have worked out, with the UNAIDS reference group, on estimates and projections to come up with a unified approach to making and reporting estimates of orphans. This UNAIDS reference group is the same group that worked with UNAIDS to produce the estimates of HIV prevalence that were released last week. And these are the same numbers that were used to estimate the number of AIDS orphans and orphans due to all causes.

I’ve been asked to define for you the different types of orphans that I described in the report. We have a number of maternal orphans. Maternal orphans are children who have lost their mother and perhaps their father. Paternal orphans are children who have lost their father and perhaps their mother. Double orphans are children who have lost both parents. And total orphans are children who have lost one or both parents. In addition, double-AIDS orphans mean both parents are dead, at least one of them – one of the parents have died of AIDS. We believe that the numbers that have been released today represent the best estimates of the current status in orphan issues and – and that’s all I want to say at this point.

ANN PETERSON: Thank you. So, with that best estimate, that is really the consensus document for all of these agencies. What we see is that the number of orphans is increasing dramatically. In Africa, 30 million children are orphans, one-third of them are due to AIDS. By 2010, 40 million children will be orphans, but half will be due to AIDS. And in addition, 1 in 16, or 6% of all children will be orphaned due to AIDS. In countries with high levels of HIV prevalence, this problem can become even worse. In 2010, in four African countries, one in five children will be orphans. Even if we could stop the spread of AIDS starting today, the number of orphans would continue to increase for the next decade. We have this example from Uganda, where HIV prevalence began to climb in the early 1990s, the number of orphans continued to grow for ten years, and it’s only now beginning to decline. In Asia, the total number of orphans is larger than in Africa, because the population is so much larger. However, the number of children orphaned due to AIDS is currently smaller. However, due to the large population again, even a very small increase in HIV prevalence could cause a massive leap in the new orphaned due to AIDS. As alarming as these trends are, they still do not include the millions of children whose lives are dramatically affected by AIDS. Countless children are living with and caring for parents who are sick and dying. With fewer healthy adults caring for the increasing number of children, the societal impact is beyond just the impact of those orphans themselves. The implications of this are unprecedented. Previous “Children on the Brink” reports have broken the silence on the issue on the large and growing of orphans due to AIDS. This reports brings a consensus on the incredible number, how massive the impact is likely to be, and that we must rapidly increase our global response. Our current efforts are significant. U.S. Agency for International Development currently has 75 projects in 22 countries. And we have a report at our booth that lists them country by country, so you can reference your people back to them. And we have successful models for reaching children. However, the efforts of USAID, UNICEF, UNAIDS and our many partners around the world have currently only reached a small fraction of the children affected by AIDS. Now the global community must respond together to this unprecedented problem in an unprecedented way. And I will now turn it over to my colleague, Mr. Peter Piot, to talk about UNAIDS.

PETER PIOT: Is this working? Yes. Thank you, Ann. This is without doubt one of the most shocking reports that will – that has been released at this conference, because so many things have been said here. And it is in an area that illustrates how AIDS has moved into a truly family disease, affecting the most vulnerable groups in society, and in the first place also children. So I’m very pleased that in this way, we could collaborate with our very active co-sponsor, UNICEF, and with USAID, who is our major funder, also. And I’m very happy to share the podium with – oh, here. I see that we – I’m here for the gender balance, for once it’s not the other way around, like yesterday was.

AIDS has created really an orphan’s crisis. I think that the word is absolutely not an exaggeration. And it is an emergency. You heard some of the figures. And I couldn’t agree more with what Ann said, that even if today, by some miracle, all HIV transmission would stop, the number of orphans because of AIDS will continue to rise. And that’s one of the reasons that I’ve been saying for the last few weeks that we’re only at the beginning of the AIDS epidemic. Because we know for sure, because of all the others who are going to die from HIV that the number of orphans will increase.

Second point is that the global community, at the declaration of commitment that came out of the U.N. General Assembly, set some targets and goals to deal with the orphans – that each country should develop strategies and policies for development and for protection of orphans by 2003. We’re 2002. And for implementing them. So efforts are now under way – for example, 21 west and central African countries met in April 2002 to coordinate action. And there have been other efforts, as we heard from Ann.

But when we mention orphans, again, as Ann said, we should not forget that children as a whole are affected by HIV. The way I look at it and the way I was mostly – first confronted with it, is when I saw that children are now taking up the role of adults in many societies and communities that are affected by HIV, because there’s just a whole generation that has disappeared because of AIDS. And therefore, they can’t go through normal development. They have to work sometimes 40 hours a week, take on the roles of parents and son. And as a result, one could safely say that the very fabric of society is disappearing with family structures crumbling.

The last point I’d like to make is that, when you’re an orphan because your father or your mother died from AIDS, you carry with you the stigma and the discrimination that was associated with AIDS in your parents. If your father died in the war, he was a hero. If he died from AIDS, the shame is over the whole family. So in addition to all the problems that these children have, we have that, which shows not only viruses are transmitted, but also stigma and discrimination.

To me, the key is now that we move into implementation of the strategies that you see here. When I say that this is time to roll up our sleeves, this is an area where we have to do that. We will learn while we’re doing this, because this is unprecedented, except in times of war - where we’ve had this before, but then it’s usually the men who disappear, not both parents. And I hope that over the next year or so, that projects will start in as many countries as possible. Not only in Africa, because the orphan crisis, as you’ve seen the book, is also starting in the Caribbean and in some parts of Asia. Thank you.

ANN PETERSON: Thank you very much. Just a brief comment on Peter’s comment about the gender balance – actually the one thing I think it is reflecting, to some degree – while it doesn’t reflect the face of AIDS, which is a young face, it reflects the face of AIDS, which is a female face. And so I think that is something that one has to keep in mind.

This report is about children, so again, the young face. And it’s about estimates, and you’ve heard some of the numbers. But so that all of the reports don’t just stop with estimates or numbers, it’s also about strategy. And so I just wanted to make a couple of comments on the strategy issue. None of these will surprise you, but they are important to keep in mind, because the effort has to go forward, and therefore, these kinds of strategies that we are being reminded of and encouraged to participate in, must occur.

First and foremost is to strengthen and support the capacity of families to protect and care for their children. The fact is, the overwhelming majority of orphans and vulnerable children still either live with their immediate or extended family. And so, support to family is just crucial. And this is both immediate survival support as well it is more long-term support, both in economic support and psychosocial.

Second, the importance of mobilizing and strengthening community-based responses. The fact is, the community is the second safety net, if you will, for vulnerable children, vulnerable households. And we see, increasingly, a number of poor communities that have actually organized themselves to assist children. They could obviously be much more effective if more resources, both technical and financial resources, were available.

Third – in talking about these children having to be adults, is that we have to strengthen the capacity of children and young people to meet their own needs, because increasingly, that is something that is happening. And I could mention many things, but I’ll mention what we consider, at least, to be the key element here, and that is making sure that everything is done to keep vulnerable children in school. It’s the first line of defense. I’d like to make a special point on girls here, because when girls who are often the first to drop out – if that happens, it not only undermines their own health and well being, but virtually the next generation.

Fourth – and there are five of these – the fourth is to insure that governments develop appropriate policies – and this includes legal and programmatic frameworks, as well as essential services for vulnerable children. I think we forget this sometimes. It isn’t just the government response, but clearly there are government policies and procedures that are very crucial, whether it is assuring the kids go to school, whether it is providing economic support, whether it is support for community-based institutions.

Fifth is to raise the awareness within societies, to try and create and environment that enables support for children. Too often these children, whether – whatever their status may be, are assumed to be infected, if not affected. They become outcasts in their community. The kind of advocacy and awareness that understands that these are children - they are vulnerable, but they are also strong, they need to be supported, it has to occur.

Finally, just to remind you, as Peter said, these are reflected in many ways in the goals that were adopted at the HIV-AIDS (MS?) but to remind you and bring it back to this book, which is on children, they were reconfirmed by those very same governments, all of them, at the special session on children that was just held a couple of months ago. So these are commitments that have binding obligations to them. They need to be acted on. Thank you.

FEMALE SPEAKER: Thank you very much. (MS?) from Zimbabwe.

Thank you. I’m just here to highlight from one of the passages that we saw on new participation. This has, to a long extent, helped to address the impact of HIV and AIDS, because through the involvement of young people, HIV and AIDS becomes more of a reality for them. And youth are now coming to assist in addressing the effects of HIV and AIDS.

So through the program I work for, which is the Foundation – I mean the (MS?) we have helped establish support groups for young people. And those young people in the support groups are touching up income-generating projects to assist other children who have been affected by AIDS. And they’re also participating in psychosocial support in the community. Thank you.

ANN PETERSON: And I’m so glad that today we could have a youth come and speak on these issues. And having lived in Zimbabwe and worked with the youth there, I know that there are many model programs. I will just add one other piece, and that is, I worked with children in the schools, doing AIDS education. And when I talked with them, the greatest issue for these kids in (MS?) Zimbabwe was their fear that their parents might get sick and die of AIDS. It wasn’t their own risk; it wasn’t learning about this disease, it was, “What will happen to me and my family if my parents get sick?” So even for those not yet touched by the epidemic, that in these hard-hit countries, this is an area of overriding fear and concern for the children of those countries.

Now we will open it up to questions. Yes.

EMMA RAWSON: Emma Rawson, Associated Press. Are the local communities equipped to absorb this high number of AIDS orphans, or is there any suggestion of large-scale foreign adoption programs?

ANN PETERSON: I think each of us probably can say something about this. There are communities that are already so hard-hit that the community capacity is already used up. And we are seeing children moved from extended family, grandparent head of household to community-based support to children heading households and now living in the streets. Thee are some that are already overwhelmed. There are some that are not yet overwhelmed, and especially as I’ve traveled to the Caribbean, that it’s on the beginning end of this epidemic. Not seeing as many deaths yet. They are saying, “Please show us now how to be prepared for the upcoming orphan issue, so that our family and community know how to be able to absorb, so we will not be overwhelmed,” as has happened in many African communities already.

MALE SPEAKER: I would just say that I don’t think we’re at that point yet. The fact is the kinds of support for communities and even for the extended family that needs to be there, hasn’t fully been there. We all know that the best environment for a child to grow up in is in the family – at least in a familiar environment. And so, really, these really extreme alternatives should only be thought of at some point when we are convinced that all the efforts to support the community and support the family have been put in place, and they have not.

ANN PETERSON: And orphanages and foreign adoptions can only do small numbers, at best. They’re very wonderful options, but it can’t take care of the large numbers.

MALE SPEAKER: Thank you. You can get it from (MS?)

PETER PIOT: First of all, in the vigorous teaching some people have even larger, down to 29 million (MS?) to the world. They’re talking about 100 million. Even three times larger, because they say that they’ve estimated (MS?)

Anyway, those figures are incredible, incredible highs. (MS?) the person who’s right. (MS?) And the second question would be?

MALE SPEAKER: What could be the destiny of these children, if they don’t (MS?) What’s going to happen with their lives? How are they going to survive, or what (MS?) are you going to convert?

Thank you.

ANN PETERSON: I will address the first part of your question. I think that what we have here is the best set of estimates that have been produced today.

MALE SPEAKER: Can you hear?

ANN PETERSON: I believe that these numbers that are released in this report are the best estimates that have been produced to date. It’s based on most recently released HIV prevalence numbers that were in the UNAID document just last week. It’s a collaboration between statisticians and demographers from the U.N. pop office, as well as the U.S. Census Bureau, as well as (MS?)

It’s a process by which we used the best information available to come up with the best estimate of the orphans. In terms of numbers, what we have now is the best estimate we can come to date, in terms of the situation. And remember that AIDS data is always difficult, and if something dramatically changes in the epidemic itself, it will dramatically change the number of orphans.

And crisis areas – areas of conflict – change the orphaning overall as well. So there are some factors that we can’t know and predict, but these really are a unified best estimate.

PETER PIOT: Well, what will happen to their lives? I think that will depend in the first place whether the strategies that you find in the book, and that Carol summarized, whether they will be implemented at a scale large enough or not. If not, I mean, the most catastrophic scenarios may be (MS?) I mean, certainly a lot of street kids, children who will not go to school, children who grow up in an environment which is not one that will empower them to – to make them ready for life. And you know, this is – this is speculation at the moment, but we should not let it go that way, that’s the key.

ANN PETERSON: I would like to also say that we do have data that shows the AIDS orphans in general, and children affected by AIDS grows in a community. What you see often first is the number of girls decreasing in school, so that is a very early indicator of some of the harm that is long-term harm. And then certainly you see the social and economic indicators how much money and food they have coming into the household, that then has long-term effects as well.

There is concern that we’re also setting up a population who have not had parents to guide them through the principles of life, to grow up in a stable environment, where you set up a place for children to be pulled into prostitution, to become child warriors. They become very vulnerable children; completely separate from the orphan issue themselves. They are vulnerable to all of the externalities and harm that can come to unprotected children.

MALE SPEAKER: Hi, my name is (MS?) I’m from (MS?) My question is to Ann Peterson. Months ago, (MS?) that the adjustor – the health adjustors for AIDS intervention is physical and has – and is supposed to be able to turn back an epidemic. (MS?) that if these interventions are going to be implemented, this would require 10 billion additional dollars to - for implementation. And later on at the press conference, (MS?) have an institute and that the American – that the youth had to contribute to this effort against AIDS. If these people (MS?) AIDS, malaria and tuberculosis.

What is your – what can you tell us about prospects of your considerable efforts, and also – you don’t have to answer, but (MS?)

ANN PETERSON: Let me first say that I can’t promise anything for my President and the Congress, where a democracy of many people are involved in these decisions. You asked who is the biggest contributor to the global fund.

We are currently giving 44% of the foreign aid that is going to AIDS internationally already. So we are a large contributor. Is the need greater? Absolutely. My role – and I try very hard to make sure that this goes very well – is to use every dollar that we get. And I have the largest amount of foreign aid for international HIV/AIDS work. Make sure every dollar works well, that we show that it worked. I can go back to my President and to Congress and say, “look, this is money well spent. We are making a difference and the need is greater out there.” So I can give you my promise that that will be my role in advocating for more resources, that we will use what we have well, and that we will go forward to make sure the programs make a difference. Thank you.

PETER PIOT: Oh, in the back there.

ANN PETERSON: I think there’s one in the back.

MALE SPEAKER: I’d like to ask a question of the young lady from Zimbabwe. Dr. Piot has told the most shocking report of the conference and that AIDS has created an orphan’s crisis and that children are taking up the role of adults and that stigma’s carried in this disease much like the virus is.

I’d like to know from your experience with orphans who have been orphaned by AIDS in Zimbabwe, just tell us what it’s like there, and in fact, have you been orphaned by AIDS?

FEMALE SPEAKER: Okay, for starters, I haven’t been orphaned by AIDS, but I’ve been affected by AIDS one way or the other. And, yes, there are a lot of children in Zimbabwe who are actually heading households, because they have lost one parent or both parents due to HIV and AIDS. And it has impacted a lot on our economic status and just general bringing up of the child has been affected because of the loss of the parent. So it has affected, and there are a lot of children who are heading household. Mm-hmm.

MALE SPEAKER: In your experience, have you seen the stigma transmitted much like the virus is?

FEMALE SPEAKER: Yes. To a large extent, because – at the moment, quite – very few people who talk openly about HIV and AIDS, because they are afraid of the stigma. And we have seen it in health care and also in the communities. That’s why maybe there’s still a lot of silence.

MALE SPEAKER: I’m Chris (MS?) from BBC. Peter here mentioned street children. A lot of these countries that we’re talking about that are the worst affected, don’t have a very good record when it comes to looking after the most vulnerable children (MS?) before AIDS even came along.

Is this issue different? Do you really think there will be a political will in these countries to address this issue?

PETER PIOT: It’s directed to me. I would say that I – what I’ve seen in other areas is that often with AIDS, there are pre-existing problems, because actually, I fully agree with you, in that street children are an enormous problem in many parts of the world and a very neglected one. But let’s hope that, because of AIDS, finally this will not only benefit so-called orphans of AIDS, but also other children and street children. But that’s speculation. I think this is what this conference can do.

KATHY CANN: You know, if I might say, some of the governments have actually had reasonably decent records in some of the goals that have been set for children in the past, but some have not. But they’ve made commitments at these global meetings in the area of street children, and clearly we’ve seen growth in street children due to HIV/AIDS.

But maybe a way of getting to the street children where the program wouldn’t have been directly on street children has been come at the other way in terms of AIDS. So I have a little bit more optimism on getting the governments to be responding – from the approach of dealing with some of these or other ways of dealing with AIDS than perhaps the street children program in the first place.

ANN PETERSON: And I would add to that, we’re talking about AIDS here today and the increase in orphans due to AIDS. But our programs are focused on orphans and vulnerable children from whatever cause they are orphans or vulnerable. So we are trying to address it, and the strategy very much includes appropriate government policies. And there have been some in the past that had been harmful to reaching out and being about to do programs, either for kids still in communities or those already living on the street.

As the problem gets very large that it impacts the government in many different ways, where some of them are finally – just like we’re seeing in the AIDS epidemic overall – it gets big enough that finally they realize they must do something about it. It would be wonderful if we could get to governments in countries where it isn’t that big and get the policies changed in advance of it as well.

MALE SPEAKER: I wonder if you can – I realize this is not the focus of your report, but I wonder whether anyone has looked -

(Audio drops out)

ANN PETERSON: The UNAIDS report that was released last week does have a total for AIDS orphans for the world, and it does include estimates for those countries that are not included in this report. But that’s just for current number of AIDS orphans, so that number is reflective of the global total.

CHARLENE PORTER: Charlene Porter with “The Washington File.” Following up on the question over here about the compassion that can be generated by children and helpless children - earlier today, some of us saw a film that is going to be the crux of an advertising campaign to run – it’s to raise – for fund-raising for this issue. A couple of years ago, people were saying that the prospect of orphaned children, their difficulty – one of the issues that was turning it around in the U.S. Congress in terms of generating kind of political will and the compassion.

Would you elaborate on that a little bit more? Is this the population that makes the world wake up and open their hearts?

KAREN CANN: Maybe this will – first of all, I would like to just suggest – and I’m sorry, it’s just words, but I don’t think we should call these “helpless” children. If you meet many of them, you will see they are far from helpless. They may be vulnerable, but they aren’t helpless, and many of them are doing extraordinary things that we would perhaps be hard-put to do. So, sorry – I don’t mean just to be silly on words, but that’s really a big difference.

It may be a way to get some of the rest of the world – or the north, if I might call it that – to understand the scale of the AIDS pandemic. I don’t think that that is something generally that has still to be understood in the south. The action is still not fully there in the south, but the scale of it. But perhaps – on the other hand, the problem is too often, people talk much more about children than they do. And so what we’re looking for is action here.

But I think the point – and again it’s been made – even if today, the AIDS – the pandemic started to level out, the growth in orphans would continue for another ten years. And by the report from UNAIDS, clearly the pandemic isn’t leveling out. But if it were today, this issue would continue to grow. So this may at least – may have some possibility of grabbing attention in those parts of the world that think that they are somewhat removed from the problem.

FEMALE SPEAKER: Jennifer (MS?) from “The Guardian” newspaper. Two things – one is, can you give us any sort of sense of the incremental progress of these orphans? I can’t remember the previous figures that we’ve had for numbers of orphans, so is it going up by a few percent a year, doubling each time, or anything of that sort?

And the second issue is, shouldn’t we be paying a lot more attention to the treatment of the mothers who are given MTCT, because clearly, you know, you have babies preserved from HIV infections, and then they’re made orphans once they’re toddlers.

ANN PETERSON: In terms of reports that were released before, it’s difficult to compare these numbers with those numbers. Two years ago, in the UNAIDS global report, the estimate of orphans was a cumulative number from the beginning of the epidemic, and it was only reflective of maternal orphans. This report looks at both the total number of orphans, including both maternal, paternal and doubles. I would refer you to the annex that shows the trends of orphan numbers over time, starting from 1990 through 2010 to look at the rate of increase of orphans over time.

KATHY CANN: Let me add that we need to remember that most of the orphans that – and vulnerable children – are not infants. They are not, the mother has just delivered the baby and then the mother dies and the child is either HIV-positive or negative. Most of these are in school-age kids, most of them are not HIV-positive, and that is the bulk of the orphan population.

If we were able to preserve the life of parents, yes, we would slow down the orphaning. But we do know that even with full treatment, can we extend life sufficiently so that all of the children can grow up, that’s a very long time. And it – we have all of the complications with current treatment. Anything we can do obviously improves it. Our programs also – we’re doing some of the treatment, but we’re also working with nutritional supplementation to families, both people living with AIDS, families who have taken in orphans, the income generation – all the other aspects that can make living with AIDS less bad, that can extend life and that can protect the children who have already been orphaned by AIDS. So we need to attack this from many, many directions so no, it isn’t just the babies and the MTCT issues.

ANN PETERSON: I’m sorry, just add one – I don’t mean to drag it out, one small thing – as you know, there have been programs in a number of countries, and it is increasing, dealing with mother-to-child transmission. And that, as you pointed out, is Nevirapine for the child. There is now an increasing effort, and certainly the U.S. has been one of the strong supporters, with a number of private foundations to mother to MTCT-plus, PMCT for plus – mother-to-child transmission plus. And the plus basically is – a package of services, so that HIV-infected women could be offered a more comprehensive package of services, with the hope that perhaps – as was pointed out here – along with nutritional supplements and others, and including, where possible, antiretroviral drugs. It would allow the mother, certainly we would hope, who has been infected, but certainly to prolong her life.

Again, that brings us back to one, prolonging life, but recognizing that the majority of these young people are still living with families or extended families.

PETER PIOT: And what I would like to add to what Carol has said is that, the fact that this orphan crisis is an additional and a major reason for introducing treatments for adults on a wider scale.

I’ve never seen that in some of these simplistic cost-effectiveness analysis, and saying that treatment is not cost-effective. They just haven’t even thought it, that there are orphans left behind after an adult dies. And I think that, as Carol said, this MCTC or PMCTC-plus – and that’s we’ve got to start somewhere. It’s clear that treatment for everybody overnight is not possible. But this is a nice and very productive and good entry point to start. Also because in these programs, women will know whether they’re infected or not. And therefore, we have here a group that is identified as being infected, and so this is, I think, a very good entry point for these programs.

EMMA RAWSON: Emma Rawson from the AP again. Does the $10 billion annual projected need, does that include care for orphans, or would that be a separate cost?

PETER PIOT: Yes, in the paper that was published in “Science” magazine a year ago, care for orphans is in there, but I think that in view of the new statistics, that that was probably on the conservative side. This is probably not in here. The problem is that when you look at the strategies, these are not strategies that deal with orphans because of AIDS in a very narrow sense. You need quite a supportive environment and other interventions.

EMMA RAWSON: Does that mean you’re now going to rethink the $10 billion, based on these results?

PETER PIOT: No, what it means is that we have to constantly – here, what they’re doing, as I explained, I think yesterday at the press conference, is that we’re now investing in regional estimates and country-by-country costing of what are the needs to be financed. So – and obviously, the orphan crisis is part of that.

But I’d like to say that, you know, we have to think a bit outside just a simple, the AIDS box when it comes to resources. The same dollar, for example, that will keep a girl in school will do not only a lot of good for AIDS, for – for 20 other things. And we have to be careful that we’re not ending up with estimates for every single problem in the world, and that they’re independent estimates. And then we get to the needs that are far greater than the gross domestic product of the whole world. Because as I said, with one type of intervention, particularly when it comes to education and some infrastructure, really, you can deal with a lot of issues.

JOHN DONNELLY: John Donnelly, “The Boston Globe.” Can you tell me the number of double orphans, and can you also give the justification for describing paternal and maternal orphans as “orphans”? Do you run the risk of exaggerating something that’s already a crisis?

ANN PETERSON: If you turn to page 24 of your document, the total number of double orphans is estimated at this year – the end of 2001 is approximately 9.5 million. For the three regions. The reason why we break it down by maternal and paternal and double is that there are various issues that – different issues that have to be dealt with, in terms of whether or not a child has lost his mother, whether a child has lost his father, or whether the child has lost both parents. And they have impact one way or the other in terms of the lives of the children, and there are various programs that try to deal with the issues. And in different countries, the issues are different. And we have to gear these toward the problems that arise whether or not a child has lost a mother, father or both of their parents.

KATHY CANN: We also know, really, from antidotal evidence in many ways that certainly a child in poorest communities who loses a mother, virtually the whole structure of whatever existed just really disappears. That’s not to suggest that the father doesn’t contribute, but in the poorest communities in Africa, the loss of the mother is virtually the disintegration of the family.

FEMALE SPEAKER: Liz (MS?) from Internews. I just wondered if we could hear a couple positive examples of where communities are responding to this issue, even if it’s on a small scale so we understand what needs to be scaled up.

KATHY CANN: Sure. We have our whole project profiles, with all of these different projects in many different countries. I will just speak to one example that I know from Zimbabwe, which started out of a community hospital and began doing outreach into the community, doing home visits. It started with documentation of grandparent-headed households, then more and more child-headed households, and said, “We must do something.” And as a community, they began to set up ways for volunteers to check on kids who were heading their own households, bringing food, making sure school fees were paid, uniforms were bought. Some of the other programs that I mentioned earlier, where we’re going micro enterprise, either for families – parents who are infected with AIDS but still alive, either – so you’ve got one or the other parent- to be able to have them at home, but still sustain income and care for their kids better.

Some wonderful programs for parents to be able to prepare their children on the psychosocial aspect for when they are no longer there – memory books that have made a big difference on the individual level, on how does the child go through the grieving, how does the child prepare to be the head of the household, or know where to go once the parents actually do die. So we’re doing a number of different things. There are a lot of NGOs, community-based groups, faith-based groups that are becoming very active in this area and have some very successful projects that then other communities are saying, “Show us how to do this. This would help us as well.” And we’re trying to facilitate that transfer of expertise through some very, very hard experiences.

FEMALE SPEAKER: Yeah, we’ve had also, quite a number of successes where we have seen a lot of people in the community coming up to help. For example, we have been studying (MS?) which are owned by the community – these are owned by the young people in the community. And they’re monitored and evaluated by them. So we have seen a lot of young people coming to assist and also – not only the young people, but the adults are also coming to compliment the young people and encourage them, and so we’ve really seen a lot of community action and a lot of community effort there.

ANN PETERSON: Last question? Yes.

FEMALE SPEAKER: Can you comment on why the figures are missing for India if the number of children here have been orphaned as a result of AIDS, please.

KATHY CANN: Yeah. My only comment is we weren’t able to get the data, quite frankly. Sometimes it’s difficult to get information, and we’re trying to include at least as close a guesstimate as possible, and we weren’t able to get the information.

ANN PETERSON: We have included some data on India in the young people with HIV/AIDS. But it’s a separate issue. It’s not on orphans; it’s the young face of AIDS. But we just haven’t been able to get better data in terms of the orphans.

KATHY CANN: I know we said it before, but I’m not sure still, and I just wanted to say one more time, this is just a correction. There is one correction in the press release that was –

ANN PETERSON: We can take one question over here, while Carol looks for it.

FEMALE SPEAKER: (MS?) I wanted to know from you, which countries are going to benefit from the PMTCT – mother-to-child transmission, prevention of mother-to-child transmission-plus program.

ANN PETERSON: The U.S. government has an ongoing problem already. We have been working in both mother-to-child transmission. Also the PMCT-plus. We currently have programs in ten countries, and that is just my agency – the US Agency for International Development. CDC has additional. The new presidential initiative will begin in ten countries, and Uganda will be one of them. And that includes mainly African countries, but also Caribbean, with plans very quickly to expand to four or five others.

And obviously, as soon as we can – and all of us in our regular programming are trying to enhance this capacity overall.

I think we’re out of time. If we can follow up with questions, remember, we have youth in the front who would love to talk with you. And I have a last announcement that the International Association of Physicians in AIDS Care is going to do a repeat press conference at the back table. Thank you all.