By Susan McCallister, Hesperian Staff

The room at Harvard Medical School was full of people who work on issues of children and HIV, from academics to service providers to activists and campaigners. Many are tireless workers among those suffering most directly, while others work in the halls of science and policy; but all are committed to improving the lots of children and families who struggle under the double burdens of HIV and poverty. Participants traveled from the US, Africa, Asia and Europe, including Noerine Kaleeba (pictured left), founder of The AIDS Support Organization (TASO) in Uganda.

I attended the September symposium for Hesperian in hopes of discussing: how to strengthen families, roles for community and civil society, and innovative models for providing services to children­— all focuses of the Joint Learning Initiative’s working groups, and content we are addressing in two Hesperian publications “Helping Vulnerable Children” and “HIV, Health and Your Community” while the presentations covered these topics, no time was allotted for discussion and the few questions addressed had to be submitted in advance, on index cards. Unfortunately, the meeting was not organized to take advantage of the amazing experience and perspective gathered in the room.

For instance, there was no chance to engage with Doug Webb who argued that orphans were a reliable “proxy” for measuring the impact of HIV, but not the best targets for support, suggesting that poverty rather than parental status was a more effective focus. He was one of several speakers arguing that we should be working to provide access to universal social protection to supplement community-based actions in support of poor and vulnerable households, and to move beyond charity driven responses to crisis.

The need for social welfare systems to include cash transfers to poor families was probably the most controversial topic addressed. Whether and how to organize and fund such systems in some of the poorest countries in Africa was the focus of an afternoon debate: “Can a developing country support the welfare needs of children affected by AIDS?” Economists heatedly argued both sides of this question from the podium, and activists spoke from the floor. Social protection programs are being considered very seriously, but there is a lot more work to do in imagining how they could be implemented­and implementing them!

I was glad to hear John Williamson, from the Displaced Children’s and Orphans Fund, discussing the different roles for a community in relation to three types of activities: agency-implemented activities, agency initiatives with community participation, and community-“owned” and -managed activities. One of his key ideas is that in community-owned activities, outside agencies must relinquish control of outcomes. Audience resistance to this definition of community ownership was fascinating; several questions objected to what people understood as his implied idea that poor communities should cope without outside funding, as if people thought it beyond question that providing financial resources determined who should control outcomes.

Perhaps this explains some of the barriers to trusting poor families with direct financial aid to meet needs as they see fit. Or scheduling sufficient time in a conference for participants to question, discuss, and generate debate and agreement.