The role of schools in supporting HIV-affected children in sub-Saharan Africa: a systematic review

Aim: To establish an overview of school-based interventions carried out to support the health and well-being of vulnerable children in Zimbabwe and similar socio-economic contexts in sub-Saharan Africa. Methods: A literature search was carried out in Web of Knowledge using combinations of the following search terms: support, intervention, school, child, Zimbabwe, sub-Saharan Africa, health, well-being, inclusion and enrolment. A total of 12 articles were identified as relevant to the research question and included in this review. Findings: Interventions in sub-Saharan Africa have been successful in implementing health knowledge at schools. Whereas a few studies have acknowledged the potential of schools to go beyond knowledge and facilitate a supportive and caring environment for vulnerable children, they tend to refer to studies reporting on externally implemented and resourced interventions. Limited attention has been given to the psychosocial well-being of children and children’s own experiences of school environments. Conclusion: Existing literature needs to be supplemented with research exploring pathways through which schools in challenging socio-economic contexts manage to support HIV-affected children by drawing on already available resources and by involving local communities. Furthermore, more in-depth qualitative research from children’ is needed in order to understand the needs of HIV-affected children and how they themselves experience ways in which schools support them to cope with adversity in their everyday lives

Children’s representations of school support for HIV-affected peers in rural Zimbabwe

HIV has left many African children caring for sick relatives, orphaned or themselves HIV-positive, often facing immense challenges in the absence of significant support from adults. With reductions in development funding, public sector budgetary constraints, and a growing emphasis on the importance of indigenous resources in the HIV response, international policy allocates schools a key role in 'substituting for families' (Ansell, 2008) in supporting child health and well-being. We explore children's own accounts of the challenges facing their HIV-affected peers and the role of schools in providing such support. Methods. Contextualised within a multi-method study of school support for HIV-affected children in rural Zimbabwe, and regarding children's views as a key resource for child-relevant intervention and policy, 128 school children (10-14) wrote a story about an HIV-affected peer and how school assisted them in tackling their problems. Results: Children presented harrowing accounts of negative impacts of HIV on the social, physical and mental well-being of peers, and how these manifested in the school setting. Whilst relationships with fellow learners and teachers were said to provide a degree of support, this was patchy and minimal, generally limited to small-scale and often one-off acts of material help or kindness (e.g. teachers giving children pens and exercise books or peers sharing school lunches), with little potential to impact significantly on the wider social drivers of children's daily challenges. Despite having respect for the enormity of the challenges many HIV-affected peers were coping with, children tended to keep a distance from them. School was depicted as a source of the very bullying, stigma and social exclusion that undermined children's opportunities for well-being in their lives more generally. Conclusions: Our findings challenge glib assumptions that schools can serve as a significant 'indigenous' supports of the health and well-being of HIV-affected children in the absence of a very significant increase in outside training, support and additional resources. Schools are an extension of communities, with members of school communities subject to many of the same deprivations, anxieties and prejudices that drive the health-limiting exclusion, impoverishment and stigmatisation of HIV-affected children in their households and wider communities

Children's caregiving of HIV-infected parents accessing treatment in western Kenya: challenges and coping strategies

This article describes qualitative research carried out in rural western Kenya in a setting characterised by poverty and high HIV prevalence. It discusses the responsibilities and challenges that children face when becoming the primary caregiver to an HIV-infected parent enrolled in an antiretroviral therapy (ART) programme, and the coping strategies these children adopt to deal with hardship. The research draws attention to the difficulties and opportunities of strengthening home-based care services to facilitate better conditions for children to cope as caregivers. Ethnographic data was collected through a variety of qualitative research methods (in-depth interviews, focus group discussions, drama, diaries and participant observation) during five months of fieldwork in 2009. Informants included caregiving children (ages 6-16 years), HIV-infected parents, community members, school teachers, community health workers, NGO representatives, and other home-based-care stakeholders. The findings reveal that children may play a significant role in the daily healthcare of an HIV-infected parent enrolled in an ART programme. The main responsibilities of the children caring for parents on ART were intimate care and nursing, household duties, and income-generating activities. A number of social factors determine children's ability to cope with these responsibilities, including the caregiving children's access to nutritious food, social and emotional support, assistance from community health workers, and adequate healthcare knowledge. The level and consequences of the children's caregiving activities as well as their ability to cope were heavily influenced by: 1) the dynamics of their parent's health condition while on antiretroviral (ARV) medication, and 2) the context in which the child sought social and economic resources. There is an urgent need for home-based care services to look holistically at people's needs and resources at the household level, and, in particular, to consider the hardships and coping strategies of children who live with a parent on AR