The role of the health sector in strengthening systems to support children's healthy development in communities affected by HIV/AIDS: a review

Abstract

The evidence and practice experience in providing what has come to be called psychosocial programming and support for children infected with and affected by HIV, and their caregivers. A great deal of attention is currently focused on psychosocial support programmes for children living in communities affected by HIV/AIDS. Psychosocial support programmes include a range of interventions such as awareness raising, counseling, group experiences for children, opportunities for recreation, and the like. However, several technical consultations, as well as the available evidence and experience, suggest that it is necessary, in the face of the combined effects of the HIV/AIDS epidemic and poverty, to support the psychosocial well-being of vulnerable children through as many avenues as possible. Efforts to promote the psychosocial well-being of vulnerable children require conditions and assistance that go beyond psychosocial support programmes, and there is now a strong call for integrated services to families and children affected by HIV/AIDS. Amongst these services, the health sector plays a critical role, in providing direct comprehensive services to affected children and families. However, health systems also have the potential to play a powerful indirect role by assisting and supporting community-based initiatives to provide assistance to the most affected children and their families. This review covers the reasons for the shift in to the psychosocial well-being of children, and from psychosocial support programmes to the need to strengthen services, especially health services. The psychological well-being of children is the outcome of many conditions and processes in addition to psychosocial support programmes. In addition, a broader and stronger response, emanating from and supported by the health sector has the potential to have a far greater impact on the psychosocial well-being of children than can be achieved with stand-alone psychosocial support programmes. Although the greatest wealth of research and experience comes from sub-Saharan Africa, because of the concentration of the epidemic in the region, the arguments made, evidence adduced and conclusions reached regarding the support of children are applicable to all contexts. The review takes as its starting point, the consensual strategies outlined in the Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS. Access to services, including for health, is one of the five key strategies. Health services can assist vulnerable children and families, as well as provide the infrastructure, organizational capacity and integrative approaches needed to draw together the many efforts at the family and community level to respond to the hardships of children affected by HIV/AIDS, and their caregivers.