Title: Saving lives for a lifetime: supporting orphans and vulnerable children impacted by HIV/AIDS
Authors: Beverly Nyberg, Dee Dee Yates, Ronie Lovich, Djeneba Coulibaly-Traore, Lorraine Sherr, Renee Tonya, Anita Sampson, Brian Howard
Abstract: President’s Emergency Plan for AIDS Relief (PEPFAR’s) response to the millions of children impacted by HIV/AIDS was to designate 10% of its budget to securing their futures, making it the leading supporter of programs reaching orphan and vulnerable children (OVC) programs globally. This article describes the evolution of PEPFAR’s OVC response based on programmatic lessons learned and an evergrowing understanding of the impacts of HIV/AIDS. In launching this international emergency effort and transitioning it toward sustainable local systems, PEPFAR helped establish both the technical content and the central importance of care and support for OVC as a necessary complement to biomedical efforts to end the HIV/AIDS epidemic. Critical services are reaching millions of HIV-affected children and families through vast networks of community-based responders and strengthened national systems of care. But rapid program scale-up has at times resulted in inconsistent responses, failure to match resources to properly assessed needs, and a dearth of rigorous program evaluations. Key investments should continue to be directed toward more sustainable and effective responses. These include greater attention to children’s most significant developmental stages, a focus on building the resilience of families and communities, a proper balance of government and civil society investments, and more rigorous evaluation and research to ensure evidence-based programming. Even as HIV prevalence declines and medical treatment improves and expands, the impacts of HIV/AIDS on children, families, communities, economies, and societies will continue to accumulate for generations. Protecting the full potential of children—and thus of societies—requires sustained and strategic global investments aligned with experience and science.
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Title: Building orphan competent communities: experiences from a community-based capital cash transfer initiative in Kenya
Authors: Morten Skovdal, Winnie Mwasiaji, Albert Webale, Andrew Tomkins
Abstract: As a result of the increasing number of orphans in sub-Saharan Africa, numerous programmes have been initiated to facilitate the care and support of orphaned and vulnerable children. This paper reports on a community-based capital cash transfer initiative in Kenya and explores its role in building orphan competent and supportive communities through its participatory project cycle. Using a mixture of individual and group interviews, 300 orphaned children and 110 adults involved in this initiative were interviewed using open-ended questions. A thematic analysis of the data revealed that many of the communities participating in this programme had become more united and active in the support of orphaned children following the mobilization of much needed economic, political and social support resources. Despite many difficulties, largely due to the complexity of communities, we conclude that community-based capital cash transfer initiatives can facilitate the building of orphan competent communities.
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Title: Building adherence-competent communities: factors promoting children’s adherence to anti-retroviral HIV/AIDS treatment in rural Zimbabwe
Authors: Catherine Campbell, Morten Skovdal, Zivai Mupambireyi, Claudius Madanhire, Constance Nyamukapa, Simon Gregson
Abstract: Given relatively high levels of adherence to HIV treatment in Africa, we explore factors facilitating children’s adherence, despite poverty, social disruption and limited health infrastructure. Using interviews with 25 nurses and 40 guardians in Zimbabwe, we develop our conceptualisation of an ‘adherence competent community’, showing how members of five networks (children, guardians, community members, health workers and NGOs) have taken advantage of the gradual public normalisation of HIV/AIDS and improved drug and service availability to construct new norms of solidarity with HIV and AIDS sufferers, recognition of HIV-infected children’s social worth, an ethic of care/assistance and a supporting atmosphere of enablement/empowerment.
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Title: From novice to expert: agroecological competences of children orphaned by AIDS compared to non-orphans in Benin
Author: Rose C Fagbemissi, Lisa L Price
Abstract: Background: AIDS has created new vulnerabilities for rural African households due to prime-age adult mortality and is assumed to lead to impairment of the intergenerational transfer of farming knowledge. There has been scant research to date, however, on the impacts of parental death on farming knowledge of children made orphans by AIDS. The question we investigate is if there is a difference in agricultural expertise between AIDS affected and non-affected adults and children. Methods: The research was carried out in rural Benin with 77 informants randomly selected according to their AIDS status: 13 affected and 13 non-affected adults; 13 paternal, 13 maternal and 13 double orphans; and 12 non-orphan children. Informants descriptions from pile sorting exercises of maize and cowpea pests were categorized and then aggregated into descriptions based form (morphology) and function (utility) and used to determine whether the moving from novice to expert is impaired by children orphaned by AIDS. Differences and similarities in responses were determined using the Fischer exact test and the Cochran-Mantzel-Haenszel test. Results: No significant differences were found between AIDS affected and non-affected adults. Results of the study do reveal differences in the use of form and function descriptors among the children. There is a statistically significant difference in the use of form descriptors between one-parent orphans and non-orphans and in descriptors of specific damages to maize. One-parent paternal orphans were exactly like non-affected adults in their 50/50 balanced expertise in the use of both form and function descriptors. One-parent orphans also had the highest number of descriptors used by children overall and these descriptors are spread across the various aspects of the knowledge domain relative to non-orphans. Conclusions: Rather than a knowledge loss for one-parent orphans, particularly paternal orphans, we believe we are witnessing acceleration into adult knowledge frames. This expertise of one-parent orphans may be a result of a combination of factors deserving further investigation including enhanced hands-on work experience with the food crops in the field and the expertise available from the surviving parent coupled with the value of the food resource to the household.
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Title: Exploring the relationship between caregiving and health: perceptions among orphaned and non-orphaned adolescents in Tanzania
Authors: Kristin Mmari
Abstract: The objectives of this study were to (1) explore the nature of caregiving for orphaned and non-orphaned adolescents; and (2), examine how changes in the caretaking roles, as a result of a parental loss, impact on an orphan’s sexual behaviors. A total of 52 in-depth interviews and 11 focus group discussions (n = 83) were conducted among adolescent orphans and non-orphans, as well as among 17 caregivers of orphans in Tanzania. Findings revealed three important caregiving roles that contributed to adolescent health: the provision of basic needs, advising and monitoring adolescent behaviors, and assigning household chores. Adolescent participants believed that when these roles are compromised, female orphans’ sexual behaviors are impacted. Consequently, they are perceived to be at greatest risk for HIV. Comprehensive programs are needed for orphans to ensure their basic needs are being met, and to assist caregivers find extra support to carry out their caregiving responsibilities.
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Title: The influence of orphan care and other household shocks on health status over time: a longitudinal study in rural Malawi
Author: Megan Littrell, Neil W Boris, Lisanne Brown, Michael Hill, Kate Macintyre
Abstract: In the context of rising rates of orphanhood in AIDS-affected settings, very little is understood about implications for caregiver well-being given increasing and intensifying responsibilities for the care of orphaned children. Emotional distress and self-reported health status as well as shifts in household orphan care, wealth, food security and recent illness and death among household members were measured among a panel of 1219 caregivers in rural Malawi between 2007 and 2009. Logistic regression was used to identify predictors of improved and diminished caregiver health and emotional distress. Results suggest that becoming an orphan caregiver is associated with a shift from good to poor health status (adjusted odds ratio AOR=2.29, 95% confidence interval CI=1.16-4.54), and that elevated levels of distress and poor health both persist over time in comparison with care for non-orphans only. Once engaged in orphan care, taking on additional orphans is associated with increased emotional distress in relation to not caring for orphans (AOR=3.16, 95% CI=1.30-7.73) as well as in relation to maintaining the same number of orphans in care over time (AOR=2.84, 95% CI=1.04-7.70). In addition, findings illustrate the strong influence of household wealth and food security on caregiver well-being. Food insecurity and poverty that persist or develop over time are associated with increasing distress. Conversely, maintenance or improvement in food security and household wealth are associated with decreases in distress. Providing all aspects of household maintenance and care for children, primary caregivers are key to the extended family solution for orphaned and vulnerable children. Bolstering the foundation of rural African families to ensure care and protection of these children involves targeting support to orphan caregivers but must also include addressing the issues of poverty and food insecurity that pose a wider threat to caregiving capacity.
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Title: The motor development of children with and without HIV: pilot exploration of foster care and residential placement
Authors: Jennifer Jelsma, Naliah Davids, Gillian Ferguson
Abstract: Background: The AIDS epidemic has lead to an increase in orphaned children who need residential care. It is known that HIV leads to delayed motor development. However, the impact of place of residence on motor function has not been investigated in the South African context. The aim of the study was therefore to establish if children in institutionalised settings performed better or worse in terms of gross motor function than their counterparts in foster care. A secondary objective was to compare the performance of children with HIV in these two settings with those of children who were HIV negative. Methods: Forty-four children both with and without HIV, were recruited from institutions and foster care families in Cape Town. The Peabody Development Motor Scale (PDMS II) was used to calculate the total motor quotient (TMQ) at baseline and six months later. Comparisons of TMQ were made between residential settings and between children with and without HIV. Results: Twenty-one children were infected with HIV and were significantly delayed compared to their healthy counterparts. Antiretroviral therapy was well managed among the group but did not appear to result in restoration of TMQ to normal over the study period. HIV status and place of residence emerged as a predictor of TMQ with children in residential care performing better than their counterparts in foster care. All children showed improvement over the six months of study. Conclusions: Foster parents were well supported administratively in the community by social welfare services but their children might have lacked stimulation in comparison to those in institutional settings. This could have been due to a lack of resources and knowledge regarding child development. The assumption that foster homes provide a better alternative to institutions may not be correct in a resource poor community and needs to be examined further.
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Title: Health of adults caring for orphaned children in an HIV-endemic community in South Africa
Authors: Caroline Kuo, Don Operario
Abstract: Abstract In South Africa, an estimated 2.5 million children have been orphaned by AIDS and other causes of adult mortality. Although there is a growing body of research on the well-being of South African orphaned children, few research studies have examined the health of adult individuals caring for children in HIV-endemic communities. The cross-sectional survey assessed prevalence of general health and functioning (based on Short-Form 36 version 2 scale), depression (based on Center for Epidemiologic Studies-Depression scale), anxiety (using Kessler-10 scale), and post-traumatic stress (using the Harvard Trauma Questionnaire) among a representative community sample of adults caring for children in Umlazi Township, an HIV-endemic community in South Africa. Of 1599 respondents, 33% (n=530) were carers of orphaned children. Results showed that, overall, carers reported poor general health and functioning and elevated levels of depression, anxiety, and post-traumatic stress. Carers of orphaned children reported significantly poorer general health and functioning and higher rates of depression and post-traumatic stress compared with carers of non-orphaned children. In multivariate analyses, orphan carer and non-orphan carer differences in general health were accounted for by age, gender, education, economic assets, and source of income, but differences in depression were independent of these cofactors. Interventions are needed to address physical and mental health of carers in general. Greater health problems among orphan carers appeared to be fully explained by socioeconomic characteristics, which offer opportunities for targeting of programs. More research is needed to understand determinants of mental health disparities among orphan carers, which were not explained by socioeconomic characteristics.
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Title: Depression among carers of AIDS-orphaned and other-orphaned children in Umlazi Township, South Africa
Authors: Kuo Caroline, Operario Don, Cluver Lucie
Abstract: South Africa faces the challenge of supporting the well-being of adults caring for growing numbers of AIDS-orphaned children. These adults play a critical role in responses to the epidemic, but little information exists in regard to their mental health needs. This paper reports on findings from n=1599 adults, recruited through representative household sampling, who serve as primary carers for children in Umlazi Township, an HIV-endemic community. Overall, 22% of participants were carers of AIDS-orphaned children, 11% were carers of other-orphaned children and 67% were carers of non-orphaned children. Prevalence of depression was 30.3%. Orphan carers, regardless of whether they cared for AIDS-orphaned or other-orphaned children, were significantly more likely than carers of non-orphaned children to meet the clinical threshold for depression (35.2% vs. 27.9%, p < 0.01). In multivariate logistic regressions, food insecurity and being a female carer were identified as additional risk factors for greater depression. In contrast, households with access to running water and households dependent on salaries as the main source of income were identified as protective factors for disparities in depression. Mental health interventions are urgently needed to address an increased risk for depression among all orphan carers, not just those caring for AIDS-orphaned children. 2012 Copyright Taylor and Francis Group, LLC.
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The U.S. President’s Emergency Program for AIDS Relief, more commonly refereed to as PEPFAR, released its new Guidance for Orphans and Vulnerable Children Programming on its website on Wednesday, July 26, 2012.
PEPFAR hosted a session entitled PEPFAR’s Orphans and Vulnerable Children Program: Taking Programming to the Next Level for an AIDS-Free Generationat the International AIDS Conference on Wednesday, July 25th. An array of policy makers and representatives from USAID, the Office of the U.S. Global AIDS Coordinator, and other groups spoke at this session about PEPFAR and OVC programming.
PEPFAR highlights a number of self-identified “key points” amongst the new guidelines:
- “There is no ‘minimum package of services.’ Program planners and implementers should ensure prioritized and focused interventions that address children’s most critical care needs through family strengthening. While programs must continue to improve child outcomes, the primary strategy for achieving this is strengthening parents and caregivers so they can provide for their children’s basic needs. The seven core areas have been reinterpreted to better reflect this shift.
- Child‐focused, family‐centered interventions at the household level take precedence over handing out materials only to children identified as ‘OVC.’
- Sustainability through capacity building and transfer of program responsibility to promote country ownership are imperative and must be balanced with careful planning and monitoring to ensure children’s immediate needs are also met.
- A young person who turns 18 while receiving OVC services should not automatically be terminated from receiving assistance. Programs should plan for appropriate transition strategies and be prepared to cover a buffer period for a seamless transition to adulthood.
- There is a growing evidence base for OVC programming reflected in this document . Programs should build interventions on evidence‐based practice. This guidance includes summaries of the evidence for the efficacy of a range of child and family support interventions.
- Programs should allocate at least 10 percent of project funding to monitoring and evaluation (M&E) to ensure that the evidence base continues to grow and to inform better practice.
- Experienced and specialized technical expertise is required for many types of interventions included in this guidance. Country teams and implementing partners should call upon individuals and resources with this expertise when designing programs and country strategies.”