For decades, local organizations and communities have worked to bring us closer to the end of the AIDS epidemic. Together we’ve made great progress toward creating a resilient, AIDS-free generation. Yet there is much work left to do. Globally, there are 1.7 million children under 15 living with HIV, and of these, only 54% have access to treatment.
Adolescence is also the only age group in which AIDS-related deaths are increasing. An estimated 7,000 adolescent girls and young women, or AGYW, become newly infected each week. Due to a variety of interpersonal and social issues, they are among the most vulnerable populations when it comes to contracting HIV and other sexually transmitted diseases that increase their vulnerability to HIV. Getting to epidemic control will require a focus on children, adolescents, and their families.
AGYW will open up and make themselves available to receive support if it is provided in a confidential manner and in a nonjudgmental way.—
New modeling has also shown a potentially high cost of COVID-19 on new HIV infections among children. Disruptions to HIV services because of the COVID-19 response, particularly services for mothers and children, could reverse the gains that have been made in reducing new HIV infections in children in sub-Saharan Africa, leading to a spike in new infections.
At Pact, much of our HIV work has focused on children and adolescents. In partnership with local organizations, we currently serve these groups across Africa and beyond. In specifically targeting young people with our interventions, there are certain lessons we have uncovered about what strategies see the most engagement and have a greater impact on reducing the HIV burden.
1. Reach children and adolescents where they live and learn
Reaching vulnerable children at home is critical, as is keeping them in school. In Tanzania, we assign community caseworkers — lay social welfare volunteers — to households with children living with HIV. These adults provide a consistent source of social support in the child’s community over time.
For children living with HIV, these volunteers can support caregivers by disclosing the HIV status of the child in a sensitive and supportive manner, openly discuss the importance of staying on HIV treatment with the family, and listen to and address their concerns about living with HIV. For children who are not infected but are vulnerable to HIV, these caseworkers can play a key role in identifying specific vulnerabilities and risk factors and helping children and families overcome them.
This includes supporting households to keep children in school. Evidence has also shown that education can protect youth from a HIV infection. Children and youth who stay in school are more likely to be aware of their risks and to engage in safer sexual behaviors. Education can also help reduce stigma and discrimination against HIV-positive children and adolescents that result from them dropping out of school.
Promoting access to education can help keep children in school, as can the provision of education grants and complementary education services such as homework clubs. This helps children and adolescents who are affected by HIV not only to attend school but also to perform and progress to the next grade level, particularly through the transition from primary to secondary school.
2. Reach children and adolescents where they play and socialize
Effectively engaging with children is key to helping them build knowledge and skills for facing challenges and rejecting risky behavior. In South Africa, evidence-based social behavior change programs You Only Live Once — which reaches adolescents between the ages of 14 and 24 — and the ChommY program — for children 10 to 14 — reinforce social assets, such as positive role models and peer networks, through culturally relevant and gender-sensitive material.
Building Resilience Among HIV-infected and Affected Children and Adolescents
On Monday, July 6, 2 p.m. ET (11 a.m. PT) Pact is hosting an AIDS 2020 satellite session on building resilience among HIV-infected and affected children and adolescents.
The session will focus on the latest information, actions, and evidence-based approaches for getting to epidemic control among children and adolescents with speakers from the office of the Global AIDS coordinator, the USAID Bureau of Global Health, Jhpiego, and Pact.
ChommY’s content, for example, has been adapted for the South African context, incorporating traditional games and cultural symbols. The program helps children form positive friendships to build their resilience in the face of peer pressure to engage in risky behavior.
In Eswatini and Zambia, Pact reaches AGYW in their communities through safe spaces facilitated by trained DREAMS mentors — older young women from local communities who serve as role models for AGYW — play a supportive role in their lives and help them access HIV and other health services. Through DREAMS, AGYW gain knowledge, skills, confidence, assertiveness, determination, and empowerment — all in a safe space where they are surrounded by peers facing the same challenges as they are.
We have seen time and again that AGYW will open up and make themselves available to receive support if it is provided in a confidential manner and in a nonjudgmental way, backed by education and information.
3. Support parents and caregivers
Immediate caregivers profoundly influence a range of outcomes for children, including HIV vulnerability. This is why providing age-appropriate parenting skills to caregivers — starting with early childhood education to develop attachment and to support nonviolent discipline — is critical. Opportunities for parenting development should continue over the child’s life, including joint caregiver-adolescent classes to build open communication. In Tanzania, the Furaha Caring Families Program strengthens the ability of caregivers to provide a protective environment and ensure the health and well-being of children through positive parenting techniques and relationship-building.
In Eswatini, our programming uses curricula adapted to the local context to help caregivers learn positive parenting strategies and then practice those skills. Lessons empower parents to prioritize their children’s health. Caregivers of babies and younger children receive home-based early childhood development education and mentorship. A six-month comparison among HIV-positive children and adolescents whose caregivers completed the training revealed an increase in treatment linkages, honored clinic appointments, status disclosure, and successful linkages to peer support groups.
4. Address underlying factors
Building resilience among HIV-affected children means giving them and their families tools to overcome many potential vulnerabilities. By providing parents of children living with HIV with economic opportunities — such as savings and lending groups — we promote an economically stable household and also provide caregivers with a social group for psychosocial support.
Pact builds such interventions into our programming in Tanzania and Eswatini, and we have seen that when households aren’t struggling to make ends meet, children are far more likely to remain in school and have nutritious food and access to health care, further building resilience.
In Zambia, our programming provides economic strengthening for older adolescents. Reducing socio-economic vulnerability among AGYW decreases high-risk sexual behavior and helps them gain resources to be independent. Our work in Zambia also includes community-wide interventions to stem gender-based violence, such as training and supporting volunteers to serve as anti-GBV champions.
5. Mobilize communities and partners
As the African proverb says, “it takes a village to raise a child.” Through our work, we have found that partnerships and communities are critical to helping vulnerable children and adolescents stay healthy and thrive. Working together helps to expand reach, prevent duplication of services, and facilitate effective referrals. This includes working with clinics and hospitals, schools, youth groups, and more.
In Eswatini, our programming is bridging the gap between health facilities and households with children and adolescents living with HIV by bringing partners together, including health care workers, caregivers, social workers, and children. We co-monitor appointment attendance and medication refills, for example, to identify early those who default on treatment and hold group care conferences to address barriers to care and psychosocial issues for children struggling with treatment. This reminds us that while HIV is a health issue, it requires integrated solutions that address its health, social, economic, and structural impacts.
This article includes contributions from Pact teams in Eswatini, South Africa, Tanzania, Zambia, and the U.S.