Marguerite Daniel

Resilience through participation and coping-enabling social environments: the case of HIV-affected children in sub-Saharan Africa.

Many children and youths living in low-resource and high-HIV-prevalence communities in sub-Saharan Africa are presented with daily hardships that few of us can even imagine. It is therefore no surprise that most research reporting on the experiences of HIV-affected children in resource-poor settings focuses on their poor health and development outcomes, casting them as victims. However, there is a growing trend to draw on more strengths-based conceptualisations in the study and support of HIV-affected children and youths. In this introduction to a special issue of The African Journal of AIDS Research, we cement this trend by providing a theoretical exposition and critique of the ‘coping’ and ‘resilience’ concepts and draw on the 11 empirical studies that make up this special issue to develop a framework that appropriates the concepts for a particular context and area of study: HIV-affected children in sub-Saharan Africa. The articles included here show, albeit in different ways and to different degrees, that the resilience of HIV-affected children in the region is an outcome of their agency and interactions with their social environment. Policy actors and practitioners working to support HIV-affected children in Africa should take heed of the proposed framework and draw on the research presented here to build coping-enabling social environments — presenting children and youths in Africa with greater opportunity to actively deal with hardship and work towards a more promising future.

Breaching cultural silence: enhancing resilience among Ugandan orphans.

Cultural silence is frequently the outcome of deep-seated taboos regarding adults talking to children about sex and death. This paper examines the impact of cultural silence on the resilience of children orphaned by AIDS in Uganda. Cultural silence is often linked with denial. This article explores the complexities of cultural silence in terms of its causes, justifications and impacts. The findings from two small, in-depth qualitative studies among orphans who were being supported by community-based organisations in Kampala illustrate the impacts of cultural silence and disclosure on the coping ability of orphaned children. The first study involved 11 children orphaned by AIDS (four boys and seven girls, aged 12 to 17 years) and four parents widowed by AIDS (two men and two women) who were themselves living with HIV. (None of the parents interviewed were related to the orphans in the study.) In the second study, 10 HIV-positive mothers (aged 25 to 40) and nine children (six boys and three girls, aged 11 to 18) with HIVpositive mothers were interviewed. The discussion examines the findings by using a model of resilience, centred on the concepts of closeness and competence as conditions for coping. Cultural silence emerges as a risk factor that increases childrens vulnerability through undermining both closeness and competence, while disclosure and openness — the breaching of cultural silence — are revealed as protective factors that may enhance resilience among children.

How disclosure and antiretroviral therapy help HIV-infected adolescents in sub-Saharan Africa cope with stigma.

HIV-related stigma has a major impact on the health and psychosocial wellbeing of HIV-infected children and youths. While there is some debate about the extent to which improved access to antiretroviral therapy (ART) contributes to a reduction in HIV stigma, we know little about how adolescents who know their HIV status and who are enrolled in ART experience and cope with stigma. The aim of the research was to understand and identify the pathways between HIV-status disclosure, ART, and childrens psychosocial wellbeing, including from the perspective of adolescents themselves. Two qualitative studies were carried out, in Botswana and Tanzania, in 2011: 16 adolescents and three healthcare workers were enrolled in Botswana, and 12 adolescents and two healthcare workers were enrolled in Tanzania. The data were collected through individual and group interviews as well as participant observation. The recorded interviews were transcribed and analysed using thematic network analysis. The findings indicate that HIV-status disclosure enabled adolescents to engage effectively with their ART treatment and support groups, which in turn provided them with a sense of confidence and control over their lives. Although the adolescents in the two studies were still experiencing stigma from peers and community members, most did not internalise these experiences in a negative way, but retained hope for the future and felt pity for those untested and uninformed of their own HIV status. We conclude that disclosure and good HIV-related services provide an important platform for HIV-infected adolescents to resist and cope with HIV stigma.

Challenges and coping strategies of orphaned children in Tanzania who are not adequately cared for by adults

Orphaned children in poor rural communities sometimes have no adult who is able to care for them or else the adult caregiver is not able to provide adequate care. Tanzania remains one of the poorest countries in the world, and poverty frequently constrains foster care. Although HIV prevalence is declining, AIDS is still a major cause of orphaning. This article explores the challenges and coping strategies accompanying two possible life trajectories for orphaned children without adequate adult care: 1) that they remain in rural areas in child-headed households, or 2) that they are trafficked to an urban area. Antonovskys salutogenic model is used as the theoretical framework. The data come from two separate phenomenological studies with vulnerable children. In the first study, in-depth interviews were held with 12 orphaned children in a poor rural area; data concerning three child heads of households are included here. In the second study, 15 girls who were trafficked from rural areas to Dar es Salaam gave extended life-history narrations; data are included for nine of the girls who were orphaned. Loss of parents, a lack of cash, and the need to balance school attendance with food production were chronic stressors for the children heading households, while resources included income-generation strategies and the ability to negotiate with teachers for time to cultivate. For the trafficked girls chronic stressors included exploitation, long working hours, little or no pay, isolation and rape. Resources for them, although limited, included faith networks and neighbours; escape from the exploitative situation frequently involved external help. We conclude that given physical and social assets the child-headed households were able to cope with the challenges of caring for themselves and a younger child, but isolation and dependency on employers made it difficult for the trafficked girls to cope with this exploitation. The salutogenic model proved a useful tool in analysing the coping strategies of children living without adequate adult care.

“It can save you if you just forget”: Closeness and Competence as Conditions for Coping among Ugandan Orphans

This article explores the coping strategies of orphaned children and their caregivers supported by a community-based organization in a Ugandan slum area. In-depth qualitative interviews were conducted with eight orphans (aged 12 to 16 years) and their caregivers selected by the community-based organization. The children had experienced several co-occurring risk factors such as loss and separation, poverty, disease, and an unsafe environment. Most caregivers were extended family members. One caregiver was an unrelated foster carer. Three of the households were child-headed. Data were analysed using an adapted approach of Giorgios (Hafting, 1995; Malterud, 2001) psychological-phenomenological method. Participating children from child-headed households lacked protective factors associated with closeness (i.e., supportive dyadic relationships). All the children in the study experienced competence in the arenas of school and household chores. Cultural advice on handling adversity, including ‘forgetting’, ‘accepting’ and ‘adjusting’, appears to contradict Western theories of coping. Sommerschilds theoretical model on the conditions for coping was effective in identifying conditions in childrens lives that may impair their coping, self-worth, and resilience.

Safe male circumcision in Botswana: tension between traditional practices and biomedical marketing.

Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswanas Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance.

Growing up in an era of AIDS

During the past two decades the upbringing and livelihood of children in sub-Saharan Africa has gained immense attention in the realms of social science international aid and the media. While there is no doubt about the devastating impact of HIV/AIDS on the lives of young Africans attention is rarely cast on connections between the epidemic and contemporary knowledge and theoretical developments in research on childhood in Africa. This special issue of the African Journal of AIDS Research contains a selection of articles that are primarily concerned with what growing up in the era of AIDS entails. Several factors have contributed in rather different ways to the emergence of this separate field of research among scholars who work with development issues in contemporary Africa. First of all across much of Africa children and young people constitute over 50% of local populations (International Labour Organization 2005) and this proportion is likely to further increase in the current century. Secondly African children are living in a time when the AIDS pandemic wars and poverty challenge the values and organisational forms of society. The epidemic began to fully emerge just at the time the Convention on the Rights of the Child (United Nations 1989) which recognises the particular circumstances needs and entitlements of people under the age of 18 years was ratified and adopted into international law. Thus concurrent international recognition of the rights of children (sometimes accompanied by substantial research funding) and of the socio-economic consequences of HIV/AIDS has shaped an emerging field of research concerning childhood advocacy in Africa with advanced concepts of orphans orphanhood vulnerable children and child-headed households. (excerpt)

Keeping the secret: how HIV-positive children in Iringa, Tanzania, respond to the perceived need for silence and secrecy

Children who live with HIV may experience two aspects of disclosure: receiving disclosure and disclosing their status to others. The objective of this paper is to explore how HIV-positive children respond to: (1) the disclosure process; and (2) the perceived need for secrecy and silence concerning living with HIV. Thirteen HIV-positive children between the ages of 10 and 15 years were recruited through a HIV treatment centre in Iringa, Tanzania. Data were collected through in-depth interviews with the children and staff members. The children received disclosure about their status from healthcare workers rather than caregivers. Several children were asked by their caregivers to keep their status secret, some chose to do so themselves, largely to avoid experienced or perceived stigma from the community. Secrecy had an impact on potentially supportive relationships. Children tend to mimic adult responses, including partial disclosure and lying to others.

Growing Up in the Era of AIDS: The Well-Being of Children Affected and Infected by HIV/AIDS in Sub-Saharan Africa

Children may be affected by HIV/AIDS in numerous ways. When parents fall ill from HIVrelated infections, household income falls or is diverted to medical expenses, food insecurity increases and children may have to drop out of school to take on care responsibilities. When parents die, children are orphaned and, besides coping with grief at the loss of their mother or father, they face new care arrangements which may involve separation from siblings and migration to a new location. Most of the children who are orphaned and made vulnerable by HIV/AIDS live in sub-Saharan Africa. UNAIDS (2010, p. 180) estimates that 67.6 percent of people living with HIV globally are found in sub-Saharan Africa, but nearly 90 percent of all children orphaned by AIDS 12.1 million children live in sub-Saharan Africa (UNAIDS, 2010, p. 186). Children may be infected with HIV through mother to child transmission (MTCT) during pregnancy, at birth or through breast milk. Such paediatric AIDS is increasingly being discovered and treated through programmes to prevent MTCT (PMTCT). Adolescents may be living with HIV: they may have been infected by MTCT and survived through childhood or they may have been infected through sexual intercourse, sadly often through being raped. UNICEF et al. (2010, p. 15) call this a “hidden epidemic” because many adolescents living with HIV do not know they are infected, they have never been tested and do not access treatment. UNICEF et al. (2010, p. 41) estimate that in 2009 92 percent of children (under the age of 15) who were living with HIV were in sub-Saharan Africa (nearly 2 million children) and 70 percent of these were found in East and southern Africa. In sub-Saharan Africa in 2009 only 26 percent of children deemed to require antiretroviral treatment (ART) were estimated to receive it (UNICEF, et al., 2010, p. 41). Sub-Saharan Africa clearly bears a disproportionate burden when it comes to the effects of HIV/AIDS, particularly on children. This chapter gives an overview of the impact of HIV/AIDS on the well-being of affected and infected children, and reviews the responses at community, national and international levels.

Iatrogenic Violence? Lived Experiences of Recipients of Aid that Targets Vulnerable Children in Makete, Tanzania

Humanitarian aid does not always achieve its intended outcomes but may have unintended side-effects which harm rather than help recipient communities in the long run. In the context of aid, iatrogenic violence refers to circumstances where aid intended to benefit recipients instead causes social disruption. The relations between donor and recipient contribute significantly to the outcomes of aid. This article aims to explore the recipient side of donor–recipient relationships in humanitarian aid targeting children affected by HIV/AIDS in Makete, Tanzania. Specific objectives include exploring (i) the lived experiences of the children who are targeted by the aid, (ii) the lived experiences of related caregivers and community members and (iii) the responses of local leaders, both non-governmental organisation (NGO) officers and local government leaders. Forty-one orphaned children aged 9–18 were involved in 3 one-hour-long participatory activities. From these, 12 were selected for in-depth interviews. Four caregivers of orphaned children and 15 key informants (community leaders and NGO officers) were interviewed. Findings show that the type of aid and method of distribution are determined by the donors and do not fit well with local conditions. Examples of iatrogenic violence include conflict and division between those in the community who receive aid and those who do not, increasing dependency with a corresponding reduction in self-reliance, criteria that exclude the most vulnerable children from aid and passivity and non-participation. Donor-controlled humanitarian aid is causing unintended harm in the recipient communities.