This is a working paper for discussion within the Regional Inter-Agency Task Team on Children Affected by HIV AIDS in the West and Central African Region (RIATT/CABA-WCAR). It was designed as a programming and advocacy tool and is part of the wider process of formulation of a regional strategic framework for OVC programming for West and Central Africa, a region commonly labelled as low HIV prevalence region. This document tries to show that OVC issue, including children affected by HIV and AIDS is relevant even for low HIV prevalence countries and should be an opportunity for response for the most vulnerable children in West and Central Africa. The document also reports on efforts made in OVC programming in WCAR, at countries and regional levels. It raises some issues and provides food for thoughts on the contexts and the different key aspects of OVC programming in low prevalence countries. Finally, the document calls on the international community to intensify their efforts in order to help countries in the region for the development of more appropriate tools for OVC programming and to ensure that programmes are sustainable and beneficial to the most vulnerable children, including those affected by HIV and AIDS.