Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa

Background. Limited research investigating treatment outcomes for HIV-positive orphans compared with non-orphans has shown mixed results, with several studies indicating that HIV-positive orphans are at greater risk of delayed access to HIV care and poor antiretroviral therapy (ART) adherence, while other data suggest that ART outcomes of orphans can be similar to those of non-orphans. Understanding the impact of orphan status on short-term ART outcomes could improve targeted intervention strategies, and subsequent long-term treatment and developmental outcomes, for HIV-positive infants, children and adolescents.Objectives. To evaluate the relationship between orphan status and ART outcomes among HIV-positive infants, children and adolescents initiating ART at two large public sector HIV clinics in Johannesburg, South Africa.Methods. This was a retrospective cohort study of HIV-positive children aged <18 years initiating standard first-line ART between June 2004 and May 2013. Using propensity scores, orphans and non-orphans were matched for age, sex, World Health Organization stage and ART regimen. The effect of orphanhood on attrition from care (all-cause mortality and loss to follow-up) was evaluated using Cox proportional hazards regression analysis, and its effect on having a detectable viral load (≥400 copies/mL) at 12 months on ART using binomial regression analysis with modified Poisson distribution.Results. A total of 251 (29.4%) orphans (maternal, paternal or both) and 603 (70.6%) non-orphans were included at ART initiation. Following multiple imputation for missing data and propensity score matching, 222 orphans and 222 non-orphans were included. Orphans had a median age of 8.0 years (interquartile range (IQR) 4.9 - 10.7) and non-orphans 7.4 years (IQR 4.2 - 10.2). A total of 12 (5.4%) orphans and 33 (14.9%) non-orphans experienced attrition from care during the first 12 months on ART (adjusted hazard ratio 0.32, 95% confidence interval (CI) 0.17 - 0.63). Among those alive and in care, with a viral load at 12 months on ART, 18.0% of orphans (33/183) and 14.8% of non-orphans (24/162) had a detectable viral load (adjusted risk ratio 1.15, 95% CI 1.04 - 1.28).Conclusions. Orphans were less likely than non-orphans to experience attrition, but among those in care at 12 months, orphans were more likely to have detectable viral loads. Lower attrition among orphans may be due to their being in institutional or foster care, ensuring that they make their visits; however, their higher rates of non-suppression may result from lack of psychosocial support or stigma resulting in struggles to adhere. Additional research investigating age-specific outcomes will be important to elucidate these effects further

Psycho-educational and social interventions provided for orphans and vulnerable children at a community-based organisation in Soweto, South Africa

This qualitative study explored the psycho-educational and social interventions provided for orphans and vulnerable children (OVC) in a community-based organisation (CBO) in Soweto, South Africa. The study involved 12 OVC (males = 40%, and females = 60%; aged 10 to 18 years). Data was collected using individual interviews, focus group discussions, and autobiographies. The thematically analysed data revealed that the OVC received psychological interventions through mentorship and peer-group support in the CBO. Educational interventions included the provision of school uniforms and educational materials, as well as sponsorship of tuition, sports and excursion fees. Academic track records presented a challenge, however, which was attributed to the enormous numbers of OVC under the care of the CBO. It was further established that social interventions were addressed by empowering the OVC with life skills and providing economic support for their families, specifically to pay rent and provide meals. The major contributions of this study are to note the importance of the CBO in addressing issues related to the lack of counselling, the stigmatisation of OVC by community members and the need for empowerment of their families by providing income-generating activities. The information obtained is useful in opening up avenues for interested parties to further explore the effectiveness of these psycho-educational and social interventions in improving the lives of OVC in society

Mixed results: the protective role of schooling in the HIV epidemic in Swaziland

Swaziland has the highest HIV prevalence in the world. It is recognised that young women, especially adolescents, are particularly vulnerable to HIV infection and bear a disproportionate burden of HIV incidence. The HIV data from Swaziland show the location of the epidemic, which is particularly high among adolescent girls and young women. This paper is based on research in Swaziland, commissioned because of the perception that large numbers of children were dropping out of the school. It was assumed that these "dropouts" had increased risk of HIV exposure. This study carried out a detailed analysis using the Annual Education Census Reports from 2012 to 2014 produced by the Ministry of Education. In addition, this topic was explored, during fieldwork with key informants in the country. While HIV prevalence rises rapidly among young women in Swaziland, as is the case across most of Southern Africa, the data showed there were few dropouts. This was the case at all levels of education ­ primary, junior secondary and senior secondary. The major reason for dropping out of primary school was family reasons; and in junior and senior secondary, pregnancy was the leading cause. Swaziland is doing well in terms of getting its children into school, and, for the most part, keeping them there. This paper identifies the students who face increased vulnerability: the limited number of dropouts; repeaters who consequently were "out-of-age for grade"; and orphans and vulnerable children (OVC). The learners who were classified as repeaters and OVC greatly outnumbered the dropouts. We argue, on the basis of these data, for re-focussed attention and the need to develop a method for tracking children as they move across the vulnerable groups. We acknowledge schooling is protective in reducing children's vulnerability to HIV, and Swaziland is on the right track in education, although there are challenges

Assertiveness and attitudes of HIV/AIDS orphaned girls towards education in Kampala (Uganda)

Whereas HIV/AIDS prevalence has been declining in Uganda from 30 to less than 10 in the last 2 decades; the number of HIV/AIDS orphaned girls in secondary schools is still high and girl children have tended to carry the heaviest burdens of family responsibilities thereby adversely affecting their assertiveness and attitudes towards education. Assertiveness is a critical life skill that enables a person to state an opinion; claim a right; or establish authority and it is important to improve attitude towards education. This study examined the relationship between assertiveness and attitude towards education of HIV/AIDS orphaned and non-orphaned adolescent school girls in Kampala. The California Psychological Inventory (CPI) Dominance (Do) Assertiveness Scale and the Attitude Scale were administered to 225 students consecutively selected from 6 secondary schools in Kampala. HIV/AIDS Orphaned girls had lower levels of assertiveness and most had a negative attitude towards education compared to non-orphaned girls. Girls orphaned to HIV/AIDS were less assertive compared to those orphaned by other causes. There was a positive relationship between assertiveness and attitude towards education among orphaned adolescent secondary school girls in Kampala. Girls orphaned to HIV/AIDS were less assertive compared to other school girls and have a poor attitude towards education

The use of mobile phone technology as an assistive tool for emotional support of adolescents orphaned by AIDS in South Africa

The majority of adolescents in developing countries own and use cell phones. Given the number of adolescents orphaned by HIV and AIDS in South Africa; use of mobile phones to monitor their progress; and provide emotional support seems a feasible and cost effective option to provide support. The purpose of the study was to solicit caregivers' views on the use of mobile phone technology as an assistive tool in providing emotional support to adolescents. Three focus group interviews were conducted among caregivers working in an AIDS Awareness Centre which is visited regularly by adolescents orphaned by AIDS. Contrasting views on the use of mobile technology as an assistive tool in providing emotional support were raised by the caregivers. Two major themes emerged: Doubts about the efficacy of using mobile phones for counselling and providing emotional support were expressed based on the fact that there will be a lack of direct physical interaction and communication. The second theme; in direct contrast with the first theme illustrated that the majority of caregivers acknowledged the potential and positive application in supporting adolescents. If appropriately applied; mobile phone technology could be helpful as a supportive tool for adolescents in a primary health care context

Analyse de la prise en charge communautaire des orphelins et enfants rendus vulnerables (OEV) par le VIH/SIDA : experience de l'organisation communautaire de base (OCB) Jammixale yi Thies (Senegal)

Introduction: le VIH/SIDA ne cesse de provoquer de multiples difficultes avec l'accroissement du nombre d'orphelins et enfants vulnerables (OEV). Au Senegal; 3193 OEV etaient recenses en 2008. L'objectif etait d' analyser la prise en charge communautaire des OEV par l'organisation communautaire de base (OCB) JammiXale Yi (JXY) de Thies afin de mieux apprecier les effets psychologiques du VIH sur les enfants; les parents. Population et methode: Il s'agissait d'une etude transversale faite en 2009 aupres des agents de sante; des OEV et de leurs parents. Des entretiens individuels et des focus groups ont permis de recueillir des donnees. Selon la source et la cible; une triangulation des informations avait ete faite Resultats : 61 OEV etaient suivis. L'age moyen etait de 9;82 ans; variant entre 2 mois et 17 ans. Le sex- ratio etait de 1;08 (filles = 48).Dans cet OCB; 99 des enfants etaient a l'ecole publique; 20 avaient une bourse scolaire ; 92 n'etaient pas depistes. Parmi ceux depistes; 8 etaient seropositifs.Selon la cible; les principaux effets psychosociaux du VIH/SIDA etaient pour les enfants: l'utilisation de l'alcool; de la drogue; la prostitution. Pour les parents venaient au premier rang : la discrimination; le non depistage des enfants; les difficultes d'acces aux soins de qualite; l'attitude d'indiscretion du personnel de la sante. Les agents de sante avaient surtout souligne le manque de formation sur la prise en charge psychologique des OEV. Conclusion : on note l'importance des effets psychosociaux du VIH/SIDA sur les enfants; leurs parents et la difficulte de la prise en charge communautaire de cette maladie dans les pays a ressources limitees

Expanding vulnerability; dwindling resources:implications for orphaned futures in Uganda

"The recent government and donor response to the ""orphan crisis"" in Africa has expanded beyond orphans to incorporate children in a number of difficult circumstances by employing the concept of OVC; orphans and The recent government and donor response to the ""orphan crisis"" in Africa has expanded beyond orphans to incorporate children in a number of difficult circumstances by employing the concept of OVC; orphans and vulnerable children."" While the general concept of vulnerability helps acknowledge the needs of children beyond orphanhood; its expanding definition under policy development in Uganda has inflated the numbers of children that fall under its purview to about half the child population. This expanded definition of OVC also creates a hierarchy of vulnerability that affects which OVC will receive assistance in the midst of ever-dwindling aid resources.This paper explores the dynamics of childhood vulnerability in the Ugandan context from policy to practice. While Ugandans' growing acknowledgement of child vulnerability is in itself seen as an achievement by policymakers; it creates an untenable demand for OVC services and potentially reifies vulnerability as an ironically privileged and empowered identity. ."

A Community Based Approaches to Assist Orphans and Vulnerable Children in Luwero; Uganda-Strategies for Implementation

16.2of children in Uganda are orphans; mainly due to AIDS and civil war. The magnitude of the problem makes institutional solutions unfeasible; and methods of assisting orphans and their guardians in the community are being tested. In 2 sub-counties in Luwero district; 5;360 orphans have been identified in a total population of about 39;000. A needs assessment identified schooling; feeding; bedding; clothing; health care; and housing as highest priorities. Rather then directly paying school fees; admission of orphans to school in exchange for material assistance to the school was negotiated. This has allowed 1;200 orphans to enter school; eliminates the problem of direct cash payments; improves the quality of education for all in the school; and requires community involvement in negotiating assistance; choosing those to be assisted; and in establishing school projects to sustain0 assistance in the future. Guardian groups and individual guardians are also provided material assistance to increase the potential for income in the guardian households; rather than giving direct payments to guardians. Guardian committees and local leaders identify and certify those needing assistance most. The method requires considerable time in negotiating agreements with schools and guardians committees and in monitoring implementation of activities; but it does foster a sense of community resaponsibility from the onset