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Lessons learned: Coping strategies in children and communities, Kenya and Uganda

The CCATH project in Kenya and Uganda aimed to develop and help strengthen 'community coping strategies' for supporting children and young people in communities affected by HIV/AIDS.

The project partners worked with community-based organisations (CBOs) to learn from their experiences and to support them in assessing needs and in identifying, developing and evaluating practical responses to help children and their families cope with the impact of HIV and AIDS. These strategies focused on five main areas:

• Enabling older children to strengthen their coping skills and resilience for their own survival and continued development through the illness or loss of a parent
• Supporting older children and parents/guardians in providing appropriate care for their younger siblings and at the same time providing them with emotional support and enjoyment through activities which are creative and rewarding for both older and younger children
• Addressing the ‘culture of silence’ surrounding HIV and AIDS, especially how the subject of HIV and AIDS is discussed with, and by, children and young people
• Promoting the social inclusion of children affected and infected by HIV and AIDS and tackling discrimination
• Enabling families to develop coping strategies for managing the severe economic impact of HIV and AIDS, including issues surrounding planning for the future after the death of a parent, inheritance, sexual or labour exploitation, income generation and continuing access to education.

Impact of HIV/AIDS on children
The process began with an assessment of the needs of children, their families and CBOs in communities affected by HIV and AIDS. This research was conducted in Kenya and Uganda, introducing child-centred participatory research methods to help adult researchers to listen to and learn from children. The research revealed a range of risks to children’s development in these communities. It showed how deeply children are affected – psychologically, economically and socially – by the impact of HIV and AIDS on their lives.

Children’s resilience
Yet CCATH’s research also showed areas of resilience – what it is that enables some children to cope better than others with the impact of HIV and AIDS in their families? A number of factors were identified which promote children’s resilience:

• Open communication between children and their parents and/or guardians, including preparing for life after the parents' death
• Children's ability and opportunity to express their emotions and fears
• Developing a positive goal to live for
• Memories and records of their own past and of good, loving relationships, usually with their parents
• Spirituality, expressed through different faiths
• An opportunity to help others and thereby gain a sense of resourcefulness and self-esteem
• And, most significantly, a supportive environment for children.

A supportive environment
It is vital that programmes that seek to strengthen children’s resilience also address the issue of their environment. This includes the emotional, social and practical support they receive in their immediate environment from family, peer groups and neighbours. It also includes support from community-based organisations, faith-based organisations, schools and health services, which need to be accessible and welcoming to children (what people sometimes call ‘child-friendly’). Children also need a supportive environment at the national level to ensure that policies, legislation and structural support are in place to support and protect children.

Helping children and communities to cope
The CCATH partners each have organisational strengths that they have developed to support children and communities to cope with the impact of HIV and AIDS.

• ACET promotes life skills-based education to develop children's communication and coping skills.
• ACET also facilitates seminars for children and parents to promote open communication and mutual understanding.
• Child-to-Child Uganda works in primary schools promoting the principle of children helping and supporting each other. Children have formed clubs where they share problems and work together to find solutions. They also learn to communicate their emotions and fears and to develop empathy for each other. Child-to-Child gives children a sense of self-esteem because they are able to contribute to others’ well-being. In some cases, children are ‘twinned’, that is, they are paired up for mutual support.
• NACWOLA has pioneered work in supporting women and children to cope with illness and bereavement in the family. They have introduced the idea of a Memory Book, in which parents living with HIV record their own and their children's past lives, celebrating good, loving memories. The Memory Book also helps parents and children to prepare for bereavement and make concrete plans for the future.
• NACWOLA has also established children’s clubs where they learn about health, child development and basic survival. Children can share their emotional and psychological problems with adults at these clubs. They can also get access to training and small grants for income generating activities, such as the rearing of goats.
• KANCO supports community-based organisations (CBOs) to develop their capacities for working effectively with children through participatory processes. KANCO also operates at the national and international level, influencing policy development in relation to children and HIV and AIDS. The organisation has been instrumental in the drafting of a children’s bill in Kenya.

Lessons learned
The CCATH work has affirmed the importance of working not only with children but with the community as a whole. Adults play an important role in communicating with children, learning to listen to and respond to children’s concerns and to respect their need for honest answers. CCATH’s work has also underlined how the impact of HIV and AIDS in fact affects all children in a community, whether through illness and death within the family or of neighbours, teachers, health workers or friends. Interventions need to therefore include all children, not just those most obviously or directly affected by HIV and AIDS.

The main challenge faced by community-based organisations has been in finding an appropriate balance between addressing children’s survival and addressing their development needs. While children benefit from counselling and psycho-social support, their basic need for food, shelter, health care and school fees must be met. It is a need that is indeed overwhelming and growing and can only be met through effective collective response at community level and effective support at government levels. Another area that cannot be ignored is the need for anti-retroviral drug treatments in these communities to enable parents to survive their children’s childhoods. Further advocacy, policy commitments and structural support are urgently needed at national and international levels to make this a reality.

CCATH has sought to identify not just children’s needs and vulnerabilities but also positive coping skills. Such skills will enable them to help not only themselves but also other children to survive and find a positive future. A literature review has indicated that little has been documented about research on children’s resilience in the context of HIV and AIDS. CCATH aims to contribute to this area with a particular focus on the role of Child-to-Child approaches in the development of children’s resilience.

The CCATH project has demonstrated the value of NGOs working in partnership. The work of each of the organisations involved in the project complements the work of the others and has led to enriched, shared learning. Project partners have relied on each other for support in training, based on areas of expertise, and for mutual monitoring and evaluation. It has created a trusting and effective learning partnership.