Transcript Transitions to adulthood Opportunities and Challenges for Children with HIV 6 August 2008 By Mutsa F Bwakura-Dangarembizi.

Transitions to adulthood
Opportunities and Challenges
for Children with HIV
6 August 2008
By Mutsa F Bwakura-Dangarembizi
Outline
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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
Number
Trends in the estimated number of children (age 0-14 years)
living with HIV and AIDS, Zimbabwe, 1980-2007
140000
120000
100000
80000
60000
40000
20000
0
81 983 985 987 989 991 993 995 997 999 001 003 005
9
1
1
1
1
1
1
1
1
1
1
2
2
2
Year
Source: Ministry of Health and Child Welfare. Zimbabwe National HIV and AIDS
Estimates 2007, final draft report
Orphan-hood trends
Trends in the estimated number HIV and AIDS
orphans, Zimbabwe, 1980-2007
1200000
Number
1000000
800000
600000
400000
200000
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
20
03
20
05
0
Year
Source: Ministry of Health and Child Welfare. Zimbabwe National HIV and AIDS
Estimates 2007, final draft report
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
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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
Models of Psychosocial
Support
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
Thank you