December 16, 2008

VIII. Detailed Recommendations

To the Government of Kenya

To the Ministry of Public Health and the Ministry of Medical Services

·Ensure equal access to health care for all children and in particular to HIV testing and treatment.

·Integrate pediatric HIV testing and treatment into regular child health care-such as Maternal and Child Health clinics-by routinely offering voluntary counseling and testing (VCT) at all points of contact between children and the health system, including at dispensaries and health centers.

·Integrate pediatric HIV testing and treatment into facilities offering adult testing and treatment, to ensure that children are able to access treatment together with adult family members.

·Implement the current policy of routinely offering testing for infants at age 6 weeks, 12 months, and 18 months. In addition, instruct health facilities to offer testing for all children under the age of five who have not had a test yet, and for all children who have HIV-related symptoms.

·Change existing testing guidelines on parental consent to:

oGive children aged 15 and older the right to seek or refuse HIV testing or treatment, regardless of parental consent;

oGive children aged 12 and older the right to seek or refuse HIV testing or treatment, depending on their cognitive and emotional maturity; and

oAllow third parties such as community health workers to take children for testing if parents or guardians agree.

·Develop a policy on disclosure of HIV diagnosis to children, aiming for disclosure starting at age six, taking into account their cognitive and emotional maturity. Establish programs that provide guidance on disclosure to parents and caregivers.

·Strengthen the role of community-based health workers, social workers, and counselors in health facilities by expanding their numbers, introducing compensation fees to pay for their services, and providing additional training, in particular on pediatric HIV and child psychology.

·Reach out to families with HIV-positive children by:

oPublicizing information about pediatric HIV services available in each local area, including information about ART and cotrimoxazole as life-saving treatment for children;

oCreating treatment literacy courses for adults administering ART to children;

oEstablishing HIV support groups for caregivers of HIV-positive children and for children themselves; and

oMaking special efforts to involve fathers in family health issues.

·Carry out an awareness-raising campaign to inform the public about the availability of free HIV treatment, encourage sick people to seek care at local health facilities, and caution against reliance on non-medical AIDS cures.

·Develop and implement guidelines on palliative care for children.

·Ensure that children under the age of five do not have to pay user fees, in accordance with the current policy.

·Ensure that user fees for health services for children over the age of five do not constitute a barrier for HIV testing or treatment.

·Carry out an awareness-raising campaign to fight stigma and discrimination, including by:

oTraining health workers on HIV-related issues, including issues affecting mothers and children living with HIV;

oUsing radio and other media to sensitize the public to the rights of people living with HIV, with particular reference to the problem of stigma within families and communities;

oUsing radio and other media to show positive examples of women and men living with HIV and receiving antiretroviral treatment;

oIncluding the topic of protection from stigma and discrimination in school curricula.

To the Kenya Food Security Steering Group

·Take measures to address endemic food security problems. This should include specific measures for children, including free school meals.

·Help set up schemes to provide adults and children on ART with key nutrients through food supplements or with funds for income-generating activities.

·Help set up programs that provide infant formula for at least six months after birth to those HIV-positive mothers who are advised to feed their babies formula, in accordance with WHO guidelines for acceptable, feasible, affordable, sustainable, and safe infant feeding.

To the Ministry of Special Programs, including the National Aids Control Council (NACC)

·Ensure that existing donor funds for the fight against AIDS benefit the general health system.

·Verify that internally displaced people living in transit sites, including children, have access to health care, including HIV testing and treatment.

·Ensure that internally displaced people living in camps and transit sites have adequate nutrition, clothing, housing, and protection from violence.

·Develop an emergency preparedness strategy that addresses interruption of HIV treatment.

To the Ministry of Gender and Children Affairs

·Strengthen the current child protection system by significantly increasing the number of children officers throughout the country.

·Implement the recommendations of the UN Study on Violence against Children. As a first step, set up a task force to develop and implement a plan of action to end violence against children, including children living with HIV.

·Liaise with traditional leaders and communities in western Kenya with the aim of developing practices that provide alternatives to traditions such as widow inheritance.

·Provide access to HIV treatment for child-headed households through targeted programs to provide them with HIV-related services wherever possible.

·Provide access to HIV treatment for street children through outreach programs wherever possible.

To the Ministry of Justice and the Ministry for Gender and Children Affairs

·Ensure that cases of disinheritance, child neglect, and abuse are investigated and prosecuted in accordance with international legal standards.

·Ensure that sexual and gender-based violence against HIV-positive women are investigated and prosecuted in accordance with international legal standards.

·Take measures to improve access to justice for children suffering abuse or disinheritance. In particular:

oSet up schemes for free legal aid for vulnerable children;

oTrain legal professionals on children's rights, and employ them to represent children's interests, particularly in rural areas;

oDo outreach with traditional leaders on property rights issues of children;

oCarry out awareness-raising on children's rights, including on the child's right to health, protection from violence, and property;

oTrain judicial and law enforcement personnel on children's rights; and

oEnsure that inheritance cases of HIV-positive children are treated as priorities.

·Ensure that programs for orphans and vulnerable children include measures to improve access to health care and protection.

To the Attorney General

·Inform the public about the role of property rights of children and the role of the public trustee.

·Ensure public trustees proactively take up cases of orphans, as a priority.

To UNAIDS, the World Health Organization (WHO), the United States, and Other Donor Agencies Working on HIV/AIDS

·Assist the government, through technical and financial support, with the design and implementation of the public health measures outlined above.

·Strengthen the capacity of the health system by better integrating HIV/AIDS programs into existing health system structures.

To the United National Children's Fund (UNICEF) and Other Donor Agencies Working on Child Protection

·Offer the government technical and financial support with the design and implementation of child protection measures as outlined above.

To Donor Countries

·Fund research and development of drug formulations that are suitable for children in resource-poor settings, such as tablets in smaller sizes, tablets that can be divided easily, and tablets that can be sprinkled or dispersed.

·Fund research on new, more effective tuberculosis drugs that can be taken together with antiretroviral drugs, and on a test that can accurately diagnose tuberculosis in children.

To the African Union (AU) Commissioner for Social Affairs

·Ensure that efforts to implement the Abuja Call for Accelerated Action Towards Universal Access to HIV and AIDS, Tuberculosis and Malaria Services in Africa focus on treatment access for children.

·Urge the Kenyan government to allocate 15 percent of government expenditure to the health sector, in accordance with the Abuja Declaration of African governments.