The state of the science

1
The state of the science

• A look behind the findings

2
A review of the state of the art

• To capture what is known and not known about the
  risks to children affected by HIV/AIDS in Africa
• To identify the content gaps and methodological
  limitations
• To inform the design management of programmes

3
Guiding questions

• In what ways are children with HIV parents
  orphans disadvantaged?
• How is their survival, health, nutrition,
  education and emotional well-being at risk?
• What other groups of children have been made
  vulnerable by HIV and AIDS?
• What are the contributions and limitations of
  research to date?

4
Selection of studies

• Measure disparity and disadvantage
• Sub-Saharan Africa
• Recent
• Empirical - rigorous and reliable

5
First finding
Many of the relevant studies are hard to find.
6
Drawing from many disciplines
7
The Gambia N774 children
Rakai, Uganda N19,983
Masaka, Uganda N10,000
Longitudinal studies
Kisesa, Tanzania N20,000
Karonga, Malawi 593 index adults 2520 offspring
Manicaland, Zim N34,000 (14,169 children)
Blantyre, Malawi 808 children
KwaZulu Natal, SA 10,000 households
8
What have we learned?
In Manicaland, Zimbabwe (14,169 children in over
8000 households)
Primary school completion
9
What have we learned?

• Differential impact of losing a father, mother or
  both parents
• Timing of vulnerability
• Causal pathways behind the risk
• (love or money?)

10
Mother termin-ally ill
Guardian dies
Mother HIV
Household dissolves
Mother dies
Child moves
Birth 2 4 6 8 10 12 14 16 18
Age (yrs)
11
Research gaps

• What about orphaned and affected adolescents?
• Specific health and education risks?
• Their risk of HIV compared to other adolescents?
• Lasting emotional effects
• Their role as caregivers?

12
Gaps

• Who are the other children affected by HIV and
  AIDS?
• Those with parents alive but absent
• Those who experience death of an adult member of
  household
• Those with parents diagnosed with HIV
• Those in households that have fostered orphans

13
Gaps

• Capturing the most vulnerable
• Those between households
• Those in dissolved or relocated households
• Those who are not in households

14
Challenges

• like driving a Mercedes down a cow-track
• Thomas Mayer, economist, on application of fancy
  tools to real-world phenomena that are not easy
  to model, much less to measure.

15
Challenges

• How can we use what we know
• To design and direct programs?
• To allocate resources?
• To expand coverage of support for affected
  children?

16
Suggestions ensure application of research

• Meaningful community involvement in research
• Map research, distil findings inform
  practitioners
• Speed it up