Families and communities: young children affected by HIV and AIDS

Despite massive increases in orphan numbers, surprisingly small numbers of children have slipped through the safety net of extended families. A major impact of HIV and AIDS is that caregivers of young children, whether they are parents, grandparents or extended family members, are pushed to financial and practical limits. Community-based care should reflect the culture and values of the families and communities and support existing coping mechanisms. Working with families and communities in a way that respects cultural values and builds local capacity to cope is challenging. There is no one definition of family and no one model of family support. The Key list includes practical guidance on what to consider when supporting community and family-based interventions.

We welcome your feedback: please send comments or suggested additions to sourceassistant@hi-uk.org.

Selected resources

Books, reports, etc

A description of the selected interventions for the care of orphans and vulnerable children in Botswana, South Africa and Zimbabwe

DLAMINI, Phetsile K
2004

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This report contributes to phase one of a research programme which explores the social, political, economic and systemic determinants that affect vulnerability to HIV. This report documents existing interventions to gain more in-depth knowledge of interventions at grassroots level, identify their strengths and weaknesses, and consider opportunities and threats; analyse and assess the outcomes of such interventions and whether objectives were met, including the impact on vulnerable children, their families and communities, considering nutritional and education status, and psychosocial well-being; ascertain the level of awareness around HIV and AIDS, and especially of prevention strategies and care

A family is for a lifetime

WILLIAMSON, Jan
December 2003

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A discussion on the need for family care for children living in HIV/AIDS affected communities followed by an annotated bibliography. This pulls together the best research and experience from practice to provide important guidance to responses at family levels. Community based responses are difficult to define and this identifies the need to find a consensus so as to provide a way forward for action. The discussion in the paper is a review of 80 documents about the provision of care for children lacking family care in countries affected by HIV/AIDS

Child needs assessment tool kit : a tool kit for collecting information your organization needs for designing programs to help young children in areas heavily impacted by the HIV/AIDS epidemic

TASK FORCE FOR CHILD SURVIVAL AND DEVELOPMENT
December 2001

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The Task Force for Child Survival and Development was commissioned by the Early Child Development Team of the World Bank to develop an assessment tool to help programmes address issues and needs of young families and their children. The tool kit was designed to access the needs of young children (under 8 years old) in communities heavily affected by the HIV/AIDS pandemic. The assessment provides information about the household, family, the main caregiver of young children, each child under 8 years of age, their basic needs (housing, food, clothing, bedding, daily activities, health, education and childcare), and unmet needs. The information from the assessment is intended to be used to design service programmes targeted to the needs of young children and their families
The needs assessment is carried out through the use of a survey of households in the area serviced by the organisation. If a survey of all households is not possible, simple random sampling or cluster survey methodology is used

Children in residential care and alternatives

MILES, Glenn
STEPHENSON, Paul
January 2001

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Residential Care and Alternatives is based on child development and protection principles. Tearfund is a Christian organisation and the document makes a number of references to Christian scripture and values. It could be a useful tool for helping Christian organisations that provide, or that are considering providing, residential care to explore better care alternatives or improving the quality of residential care

Community care, change and hope : local responses to HIV in Zambia

LUCAS, Sue
2004

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This case study documents a successful model for facilitating a strong community response to HIV and AIDS. The Salvation Army Change Programme in Ndola and Choma Districts in Zambia illustrates the facilitation process stimulating an appropriate local response to HIV and AIDS and essential component of human capacity development. The model builds on local strengths and resources, stimulating ordinary people to address the barriers that prevent them from using HIV and AIDS information and services to prevent new infections, compassionately care for those who are infected and mitigate the effects of the epidemic on families and the community. Only by addressing personal risk, stigma and the potential for personal and societal change will the demand for and use of voluntary counselling and testing, prevention of mother to child transmission and antiretroviral therapy services increase

Defining orphaned and vulnerable children

SKINNER, D
et al
2004

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This research forms part of a broader project aimed at development and evaluation of interventions for orphaned and vulnerable children. The paper aims to provide a definitional framework and an understanding of orphans and vulnerability

Family and community interventions for children affected by AIDS

RICHTER, Linda
MANEGOLD, Julie
PATHER, Riashnee
2004

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This report, based on over 400 documents, reviews the available scientific and programmatic information on interventions aimed at children, families, households and communities. Specifically, the report considers: home-based child-centred development programmes focussing on health and nutrition; psychosocial care and management of inherited assets; interventions directed at supporting families and households to cope with the HIV/AIDS problem and interventions directed at building the capacities of communities to provide long-term care and support for children and households. It also contains an annotated bibliography of available literature in this area in Section 2. The main emphasis of the report is on intervention principles rather than on actual program implementation details as it is widely understood that interventions need to be tailored for each particular situation. There is no specific focus on very young children but interventions to support children, families and communities run into each other with inevitable overlaps

Helping children in the time of HIV and AIDS

CHLDREN'S INSTITUTE
2004

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The information and recommendations in this clear, accessible publication come from an in-depth multi-site qualitative research study conducted by the Children’s Institute between 2001 and 2003. The research explored the life experiences of children in communities heavily affected by HIV and AIDS. It also looked at the experiences of their caregivers and service providers. This brief publication is aimed at individuals and organisations and considers which children to help, who should help, how to strengthen community responses, and related fundamental questions about starting to take action to help children

HIV/AIDS : what about very young children?

DUNN, Alison
March 2005

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This paper presents the results of research into the question of how to include very young children in programming and policy responses in HIV/AIDS affected communities. The third in a dedicated sub-series of working papers devoted to young children and HIV/AIDS, it shows how young children impacted by HIV/AIDS often seem to be almost invisible in the wider HIV/AIDS field, although no affected group is more vulnerable, more deserving or has greater potential to benefit from proper programming

HIV/AIDS : what about very young children?

DUNN, Alison
July 2004

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This short paper reflects findings from research carried out to identify current responses to meet the needs of children age 0-8 living in HIV/AIDS affected communities. The overall results show that at local, national and international levels there are gaps in programming and policy to engage ideas and mobilise resources to address the needs and experiences of very young children both infected and affected by HIV/AIDS. The question is then raised: What can we actually do to include very young children in programming and policy responses in HIV/AIDS affected communities? Supporting existing family and community networks and current efforts that are being made by people confronting HIV/AIDS on a daily basis are important strategies. Conclusions are drawn indicating that services are required urgently to support very young children both directly and through the families and communities in which they live. Ways of listening to and including very young children in these processes need to be developed and used. Partnerships need to be developed between parents, families, NGOs, CBOs and government to ensure the holistic development of the child. At policy levels, very young children need to be included in programmes that address children, HIV/AIDS and community development. All government ministries can participate in meeting the needs of very young children in HIV/AIDS affected communities

Matrix of five types of ECD HIV/AIDS interventions, suggested outcome indicators, and comments

WORLD BANK
2004

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This is a matrix of the five recommended types of Early Childhood Development (ECD) and HIV and AIDS interventions. It includes suggestions of delivery services to young children, education and support for families and caregivers, training and support of care providers, sensitisation through the mass media and community mobilisation. It provides indicators and comments for each of these categories and is a useful overview of the key interventions which could take place in this field

The spillover impacts of Africa's orphan crisis

EVANS, David
2005

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This is a study using a collection of 41 demographic and health surveys from 26 African countries. The households that provide care for orphans are characterised, and the impact of taking in orphans on outcomes for other household residents, including children's health and education, is estimated. A key finding is that orphan care is concentrated in households with fewer other childcare responsibilities, especially elderly households. The researcher found no evidence that having an orphan join the household significantly affected the household, contrary to popular views that orphans generate negative spillovers

Understanding community responses to the situation of children affected by AIDS : lessons for external agencies. Draft paper prepared for the UNRISD project HIV/AIDS and Development

FOSTER, Geoff
March 2002

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This is a key report that documents community responses and coping mechanisms towards the HIV/AIDS pandemic in relation to children affected by AIDS (CABA) and orphans and vulnerable children (OVC). Fostering families are under enormous strain and local initiatives at the community level have been little studied or documented, and few organisations have sought to encourage their development. The paper analyses some of these initiatives and encourages external agencies to support them through building the capacity of local responses rather than imposing external solutions

USAID project profiles : children affected by HIV/AIDS

UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)
January 2005

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This document presents profiles of 114 projects (90 country-specific, 12 regional, and 12 global) funded by USAID. It includes a section on USAID projects that support access to education in Africa. The project profiles include the names of implementing organisations, funding periods and amounts, objectives, strategies, key accomplishments, priority activities for the year ahead, and materials and tools available to other projects that can help meet the needs of children and youth affected by HIV and AIDS. The diversity of these projects demonstrates the US government's efforts to meet the wide variety of needs of children and youth affected by HIV and AIDS. Approaches vary in both strategy and scale. The vast majority of projects work with communities to identify opportunities that strengthen existing resources without undermining local ownership. In many places, communities are already mobilised and have systems in place to identify, protect, and provide basic necessities to the most vulnerable children. USAID supports the strengthening and monitoring of these existing activities

Journal articles

ChildrenFIRST : a journal on issues affecting children and their carers [whole issue]

DESMOND, Cosmas
Ed
August 2001

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This issue of ChildrenFIRST is devoted to a workshop on family support that was held in Cape Town in June 2001. The workshop intended to share knowledge and experiences of working with families in different social and cultural contexts. It contains articles on the importance of male involvement in Early Childhood Development (ECD) and a useful list of ECD suppliers and family support resources

Orphans and schooling in Africa : a longitudinal analysis

EVANS, David
MIGUEL, Edward
2005

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This paper looks at the impact of parent death on primary school participation using an unusual five-year panel data set of over 20,000 children in rural Kenya. There was a focus on children who began the study period as non-orphans and compare children who subsequently lost a parent to those who did not. There is a substantial decrease in school participation following a parent death as well as evidence of a drop before the death. Effects are largest for children whose mothers died, for young girls (under age 12) and for children with low base line academic performance. The authors then discuss implications for the design of programmes to assist orphans and vulnerable children

Multimedia

ECD and HIV/AIDS in Rwanda

WORLD BANK

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This PowerPoint presentation takes a specific look at Early Childhood Development (ECD) and HIV/AIDS in Rwanda. It initially considers the statistics around HIV infection of babies and infants and the number of children orphaned by AIDS. There are a high number of child headed households and street children. There are few interventions that comprehensively target the ECD section. The major problems are presented as high levels of stigma and discrimination, the lack of adult care and provision of basic needs to child headed households, limited technical skills in counselling, medical care and home care of children affected by AIDS. Existing interventions are fragmented and coordination and M&E is weak. Existing interventions are usefully listed and finally future perspectives are given

HIV/AIDS : issues affecting the young child

EDWARDS, Morris
2002

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This PowerPoint presentation looks at the impact and scale of HIV/AIDS on the young, and the health and social aspects of HIV/AIDS. The focus on very young chldren focuses on the prevention of mother-to-child transmission. The presentation also makes recommendations for advocacy to ensure the non-discrimination of children living with HIV/AIDS and their access to health care, education and social services and benefits

Integrating food and nutrition into HIV and AIDS strategies

MCDERMOTT, Peter
2005

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This is a slide presentation which considers the role of food and nutrition in the context of HIV and AIDS. It notes the vicious cycle of malnutrition, HIV and poverty and the effects of HIV and AIDS on nutrition, household food security and food production. HIV and AIDS also have an impact on the agricultural sector and examples are shown from Kenya, Zambia and Malawi. Increased malnutrition can lead to adults needing more access to quality health care but not getting it, increased caring for sick adults means less time for childcare, and children drop out of school to help with household labour. Finally, UNICEF support to nutrition and HIV and AIDS is shown along with their current operational approach. The Food and Agriculture Organization (FAO) and World Food Program (WFP) approach is also considered

Websites

ECD and HIV/AIDS

WORLD BANK

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This website is updated with current initiatives on ECD and HIV/AIDS. It includes details of the important workshop on ECD and HIV/AIDS held in Dar es Salaam in April 2004. The site provides links to resources on HIV and AIDS and links to organisations taking action in this area

Orphans and other vulnerable children support toolkit

INTERNATIONAL HIV/AIDS ALLIANCE
FAMILY HEALTH INTERNATIONAL
December 2005

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This is a collection of information, tools and guidance on supporting orphans and other vulnerable children living in a world with HIV/AIDS. It covers a wide range of subject areas, including running a programme, health and nutrition, education, psychosocial support, economic strengthening, living environments and children's rights. It contains a wide range of useful resources on the different topic areas. It also contains a section on early childhood development