HIV and AIDS - Background reading
Working with children - The Child-to-Child Approach (CCATH)
Initial programmes on HIV and AIDS and children were focused primarily
on prevention.
However, the growing crisis in many countries now sees millions of children enduring the impact of HIV and AIDS in their families and communities. It has been estimated that one in every eight children in Africa is and orphan, having lost one or both parents. However, many children, not just orphans, are vulnerable, because of HIV and AIDS and other causes. These children may have terminally sick parents, they may be living with HIV themselves, they may have lost close friends, neighbours or teachers, or they may be street children. HIV and AIDS programmes working with children at community level, therefore, should not focus only on children who are orphaned, but on all children who are vulnerable.
In addition, when considering the needs of children affected by HIV and AIDS, it is vital to recognise the importance of a supportive environment for a child’s survival and development. Effective child-centred interventions do not focus on children alone, but consider the social context of their communities, as well as the structures and services which support children. National policies and legislation affecting children are also key factors in the creation of a supportive environment for children affected by HIV and AIDS.
Impact of HIV and AIDS on children
HIV and AIDS can affect children in a range of ways, such as:
- Having to cope with sick parents or guardians, which brings both practical and psychological pressures
- Having to cope with the death of parents and other loved ones
- Having to deal with the trauma and grief of bereavement and resulting psychological problems, such as depression, guilt, anger and fear – often with a lack of support
- Having to deal with neglect and loss of parental care, love and attention - leading to developmental problems
- Having to adjust to life with guardians/foster parents
- separation from siblings
- Facing life unsupported in a child-headed household
- Losing inheritance and home
- Being forced into survival as street children
- Facing stigma, discrimination and social exclusion
- Experiencing a cycle of illness and malnutrition
- Becoming infected and living with HIV
- Inability to thrive or continue in school
- Severe economic hardship and lack of livelihood opportunities
- Gender discrimination
- Sexual abuse and exploitation
- Exploitation for labour.
Child-centred approaches to HIV and AIDS
Governments, international agencies, and non-governmental organisations
(NGOs), faith-based organisations (FBOs) and community-based organisations
(CBOs) make use of a range of approaches to support children in communities
affected by HIV and AIDS. They engage with children to find ways to meet
their practical needs and/or to provide other forms of psychological
and social support. Effective child-centred approaches are underpinned
by a set of principles that view the child as a whole person, rather
than as a set of separately defined needs. Effective interventions seek
to listen to children and their families. They work to strengthen the
capacities of children, families and communities to respond effectively.
Child-centred approaches to HIV and AIDS include:
- Listening to children and young people to learn about the situation from their perspective, to understand their needs, and to find out about their coping strategies and their aspirations
- Supporting children to help themselves and others, so that children’s potential is recognised and they become active participants in community activities, in an environment where they feel safe and supported
- Supporting extended families and communities to care for children, rather than placing them in institutions. This includes providing material support and economic opportunities, where appropriate, at family and community level. Grandparents, in particular, often need support to cope with adopting their orphaned grandchildren, and with meeting their practical and emotional needs
- Responding to the psychological needs of children by helping parents/guardians and other community members to understand and respond to children’s needs. This can help to prevent long-term emotional, social, and psychological problems, including reducing children’s own vulnerability to HIV infection
- Being sensitive to gender issues recognising that girls and women are particularly vulnerable to the impact of HIV and AIDS. Girls are socially and biologically at greater risk of HIV infection than boys
- Reducing children’s vulnerability to HIV infection through effective prevention programmes, including life-skills-based education, open access to health services, alternative income-raising activities, voluntary and confidential counselling, and HIV and AIDS testing
- Providing children with opportunities for education such as programmes that enable vulnerable children to continue to attend school or the provision of non-formal education alternatives, with flexible timings for children who are unable to attend full-time education
- Providing young people with opportunities for vocational training, income generation, and access to savings and loan schemes. NGOs and CBOs should identify technical support to help them to plan these economic interventions, since it is a specialised area.
- Strengthening community-based responses and local networks such as groups of people living with HIV and AIDS, women’s groups and faith-based groups. These groups are key to identifying vulnerable children and are central to enabling effective, sustained support, rather than one-off handouts, to orphans and vulnerable children
- Promoting cooperation between different sectors at community level who are involved with supporting children. It is therefore important to link the activities of schools, health centres, CBOs, faith-based organisations and other groups, so that the needs of children are met holistically. Ideally, a committee could be set up at community level to coordinate work with children. This committee should include child participants. Similar multi-sectoral cooperation should also exist at district and national levels
- Creating links between different interventions for children in health, education, social services, etc. It is also important to establish links between interventions that address different aspects of the HIV and AIDS pandemic, such as HIV prevention, support to orphans and vulnerable children, and health care for children and adults living with HIV
- Using outside support to reinforce – not undermine – community initiatives and motivation, recognising that external programmes should avoid creating dependency. Communities may need support, for example, in accessing resources and using them in a way that is effective and transparent to the whole community
- Ensuring continuous monitoring and evaluation of the changing impact of HIV and AIDS on communities and of the effectiveness of ongoing interventions. Children can actively participate in this research
- Promoting the experience of children through advocacy on policy reform at national and international level to ensure that governments protect the rights of their child citizens and provide essential support and services, including access to anti-retro viral drugs to enable parents to survive their children’s childhood.
How Healthlink Worldwide uses Child Centred Approaches to HIV and AIDS;
International Memory Project (Africa and Asia)
Strengthening support for orphans and vulnerable children affected by HIV and AIDS (Nigeria)
Resources on Child-to-Child Approaches to HIV and AIDS and other HIV and AIDS issues can be found on the Source website;
This article was written by Rachel Carnegie, Advisor to the Child-to-Child Trust in 2003 for Healthlink Worldwide. Individuals and organisations are welcome to adapt or reproduce the article for non-profit uses, provided that Healthlink Worldwide and the individual author are clearly credited.