Broad, Ongoing Support Needed for Children Affected by HIV.
Children in sub-Saharan Africa who are infected with HIV, orphaned or otherwise affected by the virus, need “broad, society-wide interventions,” including economic and social supports, according to a team of global health researchers from the School of Public Health.
In an article in the journal Pediatric Clinics of North America, Malcolm Bryant, clinical associate professor of global health, and Jennifer Beard, assistant professor of global health, say that while international investments have been successful in helping to prevent mother-to-child transmission of HIV and ensuring medical care for infected children, the social, emotional, and developmental health of children orphaned or otherwise affected by HIV remain more difficult to target.
In addition, they say, given that 47 percent of all Africans live on less than $1.25 a day, strategies directed at HIV must address the underlying challenges faced by all children living in extreme poverty.
“The differential vulnerability between children affected by HIV and those who are not is largely determined by global donor assistance,” the report says. Children infected with HIV represent “a tiny minority of those orphaned or made vulnerable by HIV. These children are . . . often pushed into extreme poverty by the presence of HIV in the household.”
Beard and Bryant note that care and support programs for children affected by HIV are funded almost entirely by international donors, with the President’s Emergency Plan for AIDS Relief (PEPFAR) a strong leader. They say that, while some donor-funded programs have had documented success, those projects are temporary and vulnerable to changes in donor priorities.
In order to maintain the positive outcomes yielded by donor support, they emphasize that “the global community must continue to place high priority on mitigating the impacts of HIV on children for many years to come.”
They say that new approaches are needed that address barriers such as access to education, stigma, and discrimination, to ensure that “the neediest [are not] passed over for services and support.”
The 920 million people who live in sub-Saharan Africa represent only 12 percent of the world’s population, yet they carry 75 percent of the total HIV burden. That burden falls disproportionately on children: 90 percent of the world’s HIV-positive children under the age of 15, and 84 percent of AIDS-orphaned children live in the region. Overall, more than 15 million children in sub-Saharan Africa have lost one or both parents to HIV.
Beard and Bryant note that much progress has been made in improving access to antiretroviral treatment for adults and children. But affected children also face high rates of poverty, homelessness, neglect, and psychological distress, they say. Adolescent children need specialized supports that include counseling about sex, educational supports, and vocational training.
African countries, as well as donor organizations, have begun to invest in social welfare and protection programs aimed at reducing poverty, including so-called “cash transfer” programs that dispense cash to families in extreme poverty. But more research is needed to determine whether those programs are effective in high-HIV populations, Bryant and Beard say.
“Even if HIV were eliminated in the near future, the devastating social and emotional impacts will continue to affect multiple generations of children,” they write. “Caretakers, service providers, governments, and donors must use the current focus on children orphaned and made vulnerable by HIV to strengthen the societal mechanisms that will address the needs of all vulnerable children.”