Post on 08-Feb-2016
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Transitions to adulthood
Opportunities and Challenges for Children with HIV6 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
Trends in the estimated number of children (age 0-14 years) living with HIV and AIDS, Zimbabwe, 1980-2007
0
2000040000
6000080000
100000120000
140000
Year
Nu
mb
er
Orphan-hood trends
Source: Ministry of Health and Child Welfare. Zimbabwe National HIV and AIDS Estimates 2007, final draft report
Trends in the estimated number HIV and AIDS orphans, Zimbabwe, 1980-2007
0
200000
400000
600000
800000
1000000
1200000
Year
Nu
mb
er
Adolescence a period of transition
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
Now he/she must become an adult.
What are the challenges?
Education related challenges
• Education– Continuity in
the context of chronic ill health
– Potential for stigma and discrimination
‘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
householdsWill 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
Models of Psychosocial Support
Hospital basedChiedza 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
Thank you