Congress: Don’t Forget Orphans & Vulnerable Children
This post was written by Leila Nimatallah, Vice President, Advocacy & Mobilization, First Focus on Children/Campaign for Children
HIV is an insidious disease, particularly when it comes to children and babies. Its impacts extend well beyond the biomedical, often leaving society’s youngest without parents, without education, and even without food. When parents or caregivers become debilitated or die, children are at grave risk of falling into poverty, suffering abuse, and contracting HIV and dying themselves.
The Trump Administration’s dismantling of the U.S. Agency of International Development (USAID) and freezing of much of U.S. foreign assistance made this scenario far more likely.
These actions put the lives of millions of children in great jeopardy, even leading to some deaths. The services that specifically reach this most vulnerable of populations through the President’s Emergency Fund for AIDS Relief (PEPFAR) did not receive a waiver from Secretary of State Marco Rubio for “life-saving humanitarian assistance,” as other medical components did. Programs were abruptly cut off, and 6.6 million orphans, vulnerable children (OVC) and caregivers were completely abandoned. In addition, the thousands of layoffs and firings of USAID staff mean that the invaluable expertise and knowledge of those working on this issue for decades has been lost.
Now, the House Foreign Affairs Committee is putting together a wide-ranging State Department Reauthorization bill that will codify folding of what is left of USAID into the State Department. Though all signals point to most of PEPFAR being retained, at least in some capacity, OVC have fallen off the priority list. Again.
In the beginning of the AIDS epidemic, a bipartisan group of U.S. lawmakers understood the tragic impact the disease would have on children. They knew from practitioners that treating HIV alone wasn’t enough; the epidemic’s socio-economic consequences, especially on children, had to be addressed. That is why they very intentionally built protections into the AIDS, TB and Malaria authorization bill that created PEPFAR in 2003; these protections directed 10% of all HIV funding specifically to OVC in what is known as a “set aside”. These resources supported community-based programming, ensuring children were able to attend school, eat nutritious food, travel to clinics for testing and treatment, and receive psychosocial support to address the stigma and discrimination they experienced. The programs also trained OVC caregivers in positive parenting and provided livelihood support, enabling them to expand microbusinesses and better provide for their children.
One of the more complicated aspects of the OVC set aside is that, unlike most other aspects of PEPFAR’s policy framework, it expires. The OVC set aside requires that Congress preserve it, adding it back each time the program is reauthorized. Although it has historically enjoyed bipartisan support, and has been included in each reauthorization, recent political attacks on foreign assistance have cast doubt on its future. But there should be no question as to how essential and life-saving these resources are.
PEPFAR’s OVC programs have played a key role in identifying HIV positive children, getting them tested, and ensuring adherence to treatment regimens. These functions are still urgently needed as children continue to be left behind in the global HIV response. Just over half of all children living with HIV (57%) are on life-saving treatment versus roughly 77% of adults. And, while children make up only 3% of people living with HIV, they account for 12% of AIDS-related deaths.
The OVC set aside was a remarkable achievement, representing the first time that the holistic needs of children were addressed in one program. It did much more, which was not anticipated at the time, by providing an antidote to child labor and sex trafficking — evils that perennially thrive in conditions of marginalization and poverty.
Over the past two decades, PEPFAR has supported over 13 million orphans and vulnerable children and their caregivers with holistic interventions addressing the social and economic devastation of AIDS. OVC programs succeeded by strengthening the family and caregivers around the child. These programs prevented 8.2 million children from becoming orphaned and its parenting programs have been shown to reduce physical, verbal, and sexual abuse of children by up to 57%. For example, PEPFAR’s OVC work on behalf of adolescent girls reduced their experiences of sexual violence by 65% in Malawi and 68% in Kenya.
When children remain in school, especially girls, they can generate income, support their families, and contribute to the economy as adults. These types of activities are time- and labor-intensive, but they change behavior of communities over the long term and are critical in ensuring global HIV goals. They also produce a strong return on investment. PEPFAR’s OVC programs have produced a $4 return on economic productivity gains for every $1 spent on programming.
But these OVC programs are all gone as of January 2025.
Right now, in countries that were receiving PEPFAR’s OVC support, children are not getting food or being connected to medical care. Because education is not free in many countries, when a family is not able pay school fees (something the OVC set aside did), children are often forced to work, many times on the street. In some places, when conditions are dire, it is not uncommon for children to be trafficked — “sold” into domestic servitude or married off as young children, where they are without protection from physical and sexual abuse.
But we know how to prevent this.
We have the tools, the experience, and the evidence to protect vulnerable children from the devastating ripple effects of HIV. But we need the political will. As Congress moves forward with the State Department Reauthorization bill, it must not only preserve PEPFAR but also make the 10% OVC set-aside permanent. Rebuilding and fully funding these programs is not optional—it’s a moral imperative. If we do nothing, millions of children will be exposed to hunger, illness, exploitation, and abuse. But if we act, we can uphold a legacy of compassion, stability, and progress that PEPFAR was built upon. The lives of millions of children hang in the balance. We cannot turn our backs now.