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

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6000080000

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140000

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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

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200000

400000

600000

800000

1000000

1200000

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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