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Transitions to adulthood. Opportunities and Challenges for Children with HIV 6 August 2008 By Mutsa F Bwakura-Dangarembizi. Outline. HIV Epidemic in Zimbabwe Adolescence Challenges faced Models of care Opportunities Conclusion. Zimbabwe. Population ≈12 million
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Transitions to adulthood Opportunities and Challenges for Children with HIV 6 August 2008 By Mutsa F Bwakura-Dangarembizi
Outline • HIV Epidemic in Zimbabwe • Adolescence • Challenges faced • Models of care • Opportunities • Conclusion
Zimbabwe • Population ≈12 million • 22% aged between 10-19 years • Early and severe adult HIV epidemic • Peak HIV prevalence 1997 (29%) • Current prevalence 15.6 % • 1,265,473 orphans (77.1% are HIV/AIDS) • 54% are adolescents (10-18yr) • Life expectancy 33 years HIV prevalence among 15-49 yr olds in Africa in 1990 (UNAIDS) Ministry of Health and Child Welfare. Zimbabwe National HIV and AIDS Estimates 2007, final draft report
Trends in the number of Children Living with HIV and AIDS Source: Ministry of Health and Child Welfare. Zimbabwe National HIV and AIDS Estimates 2007, final draft report
Orphan-hood trends Source: Ministry of Health and Child Welfare. Zimbabwe National HIV and AIDS Estimates 2007, final draft report
The HIV-infected adolescent • …has walked a journey from childhood • … survived the more than 50% early mortality associated with vertical HIV transmission • … survived recurrent opportunistic infections • … survived years of under-nutrition • …is likely to have survived parental loss • …has lived in more than 3 or 4 households • …is behind with his/her schooling for various reasons • …may even be the head of a household
Education Continuity in the context of chronic ill health Potential for stigma and discrimination Education related challenges ‘When I get an answer wrong in class my teacher makes fun of me-she tells everyone I must have forgotten to take my drugs in the morning’ (Samuel aged 14yr)
Health related challenges • Chronic conditions • Respiratory • Cor-pulmonale • Skin (self-image) • Pubertal delay We can’t play with you because you are always coughing
Health related challenges cont. • Stunting Hi I am 18yr old, will I grow taller if I take ARVs?
Psychosocial challenges • Love and security • Acceptance • Peer pressure • Adult role models • Coping with loss of loved ones • Hope for a future • Child headed households Will I be able to get married and have children?
Models of Care • Public sector • Paediatric clinics in the large cities • Specialized Adolescent clinics in a few hospitals • Family clinics in most district hospitals • Private sector • One NGO-funded nurse run family clinic with dedicated adolescent services
Hospital based Chiedza Support Group
Community based: Africaid • Mission: “..to equip children and teenagers living with HIV with essential skills and confidence to cope better with the events in their lives, to pursue their hopes and dreams and to enjoy happy, fulfilled lives”
Africaid activities • Provision of counseling, training, skills building, recreational activities and educational support • Ensure access to appropriate information through the development of information, materials in partnership with the support groups
Opportunities • Biology • Growth and puberty • Long term ART and adherence • Long-term non progressors
Opportunities cont. • Psychosocial • Developing appropriate models of care • Community support for adherence • Raising community awareness and acceptance of this generation • Integrating adolescent HIV care in the community
In Conclusion… • “Adolescence--- for some a time of play, for some a time of work, for most a period of optimism, but for some a time of dashed hopes” • Adolescent-friendly health services as well as communities and societies that provide love, acceptance and support will assist HIV-infected children make that transition to adulthood
Acknowledgements • Ministry of Health and Child Welfare Zimbabwe • Newlands Clinic • Africaid • Dr Rashida Ferrand • Dr Frances Cowan • Parirenyatwa Hospital Family Care Centre • Chiedza Support Group • The Children