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Protecting Childhood in the AIDS Pandemic: Finding Solutions That Work

Protecting Childhood in the AIDS Pandemic: Finding Solutions That Work Edited by Jody Heymann, Lorraine Sherr, and Rachel Kidman 336 pp, $55 Oxford, United Kingdom, Oxford University Press, 2012 ISBN-13: 978-0-19-976512-6 The world is beginning to appreciate how human immunodeficiency virus (HIV) has affected children's lives. Because the authors of Protecting Childhood in the AIDS Pandemic have worked closely with children touched by AIDS and have witnessed their ordeals, this book is not simply an academic exercise. The text presents numerous pearls of wisdom and information about how to mount large-scale HIV/AIDS interventions. The pandemic is stabilizing, but the disadvantaged are hit hardest. The book underscores the trauma that AIDS visits on children and points out that families are clearly the best protection for children. Unmistakably, the first step is to prevent HIV in children, followed by treatment of infected children. Regrettably, treatment has lagged behind. A major problem is that programs target children but exclude their families and communities. Part 1 does an excellent job of explicating the role of families in the pandemic. Contrary to media depictions, children orphaned by AIDS do have extended family, kin, and community support—especially in poor countries with postcolonial strife and ineffective or corrupt governments. The section mentions the erosion of rural lifestyles and lack of employment in urban areas. HIV prevention work that I and my colleagues conducted in Durban1 revealed that 40% of black Zulu people, 6% of white South Africans, and 1% of East Indian South Africans had HIV. Durban's East Indian culture is tightly knit and creates villages, enforces connectedness, teaches social and emotional skills, provides opportunities for self-esteem, forms adult protective shields, and provides opportunities for mastery. Epidemics are driven by the destruction—often by colonialism—of the social fabric.2 The book wisely recommends that, rather than programs giving toys to orphaned children, the toys should be given to the surviving parent or relatives so they can give the toys to the children—thereby increasing family connectedness, power, and protection. Efforts to prevent the spread of HIV by vertical transmission (from HIV-positive mothers to their unborn children) are grossly inadequate in developing countries. Community efforts do not access external support and are burdened with external monitoring requirements. Often, external funding benefits intermediaries more than beneficiaries. African countries' responses to children's crises have been slow, and efforts would have been more effective if funding streams were aligned with each other, coordinating structures were stronger, and reporting systems were standardized. Part 2 examines what would work to meet youths' full range of needs. The discussion explores each stage of early life, covering topics such as psychosocial issues, childhood development, and educational needs. The section notes that 90% of HIV-infected children (1.9 million-2.3 million) live in sub-Saharan Africa and that 90% of those children acquired the virus in utero, during birth, or through breastfeeding. This section is well-organized, categorizing interventions into those with evidence suggesting effectiveness, those lacking sufficient evidence, and those with firm evidence of effectiveness. Fifteen percent of all people living with HIV/AIDS are 15 to 24 years old (p 144), and this population needs information and health services, sustainable livelihoods, and safe and supportive environments. Efforts must go beyond knowledge and work to shift perceptions of risk, safer-sex intentions, assertive communication, and condom-use skills. Schools and media can have significant influence in this regard. Part 3 does an excellent job of outlining medical interventions such as preventing transmission during pregnancy, birth, and breastfeeding. The book includes helpful tables outlining the prevention of postnatal transmission through breastfeeding and providing a plethora of solutions for vulnerable, hard-to-reach populations. It is critical to prevent pediatric HIV infection by providing early access to antenatal services via timely testing and treatment initiation, access to antiretroviral drugs, and maintenance of women in care; encouraging appropriate infant feeding practices; and providing follow-up for HIV-exposed infants. Part 4 includes a pithy discussion about whether to target at-risk populations and the consequences of both approaches. A case is made that programs should target poor populations because poverty drives HIV infection risk; however, targeting poor orphaned children stigmatizes them. An argument is also made for community-based targeting in Eastern and Southern Africa by cash transfer strategies. Four diverse leaders opine that everyone and governments are to blame and that efforts need to move toward shared responsibility by everyone. Multisectoral collaboration under government coordination is recommended, along with control of the aid for AIDS and an end to corruption. The chapter authors are experts from sub-Saharan Africa, Europe, South Asia, Australia, and Central and North America and come from diverse professional backgrounds. The examples of working programs in multiple countries are a plus. There are no references per se but rather notes that cluster citations by themes; for academics used to seeing numbered references, this approach will be a shortcoming. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Bell CC, Bhana A, Petersen I, et al. Building protective factors to offset sexually risky behaviors among black youths: a randomized control trial. J Natl Med Assoc. 2008;100(8):936-94418717144PubMedGoogle Scholar 2. Fullilove MT. Root Shock. New York, NY: Ballantine Books; 2004 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Protecting Childhood in the AIDS Pandemic: Finding Solutions That Work

JAMA , Volume 308 (4) – Jul 25, 2012

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Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.308.4.411
Publisher site
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Abstract

Edited by Jody Heymann, Lorraine Sherr, and Rachel Kidman 336 pp, $55 Oxford, United Kingdom, Oxford University Press, 2012 ISBN-13: 978-0-19-976512-6 The world is beginning to appreciate how human immunodeficiency virus (HIV) has affected children's lives. Because the authors of Protecting Childhood in the AIDS Pandemic have worked closely with children touched by AIDS and have witnessed their ordeals, this book is not simply an academic exercise. The text presents numerous pearls of wisdom and information about how to mount large-scale HIV/AIDS interventions. The pandemic is stabilizing, but the disadvantaged are hit hardest. The book underscores the trauma that AIDS visits on children and points out that families are clearly the best protection for children. Unmistakably, the first step is to prevent HIV in children, followed by treatment of infected children. Regrettably, treatment has lagged behind. A major problem is that programs target children but exclude their families and communities. Part 1 does an excellent job of explicating the role of families in the pandemic. Contrary to media depictions, children orphaned by AIDS do have extended family, kin, and community support—especially in poor countries with postcolonial strife and ineffective or corrupt governments. The section mentions the erosion of rural lifestyles and lack of employment in urban areas. HIV prevention work that I and my colleagues conducted in Durban1 revealed that 40% of black Zulu people, 6% of white South Africans, and 1% of East Indian South Africans had HIV. Durban's East Indian culture is tightly knit and creates villages, enforces connectedness, teaches social and emotional skills, provides opportunities for self-esteem, forms adult protective shields, and provides opportunities for mastery. Epidemics are driven by the destruction—often by colonialism—of the social fabric.2 The book wisely recommends that, rather than programs giving toys to orphaned children, the toys should be given to the surviving parent or relatives so they can give the toys to the children—thereby increasing family connectedness, power, and protection. Efforts to prevent the spread of HIV by vertical transmission (from HIV-positive mothers to their unborn children) are grossly inadequate in developing countries. Community efforts do not access external support and are burdened with external monitoring requirements. Often, external funding benefits intermediaries more than beneficiaries. African countries' responses to children's crises have been slow, and efforts would have been more effective if funding streams were aligned with each other, coordinating structures were stronger, and reporting systems were standardized. Part 2 examines what would work to meet youths' full range of needs. The discussion explores each stage of early life, covering topics such as psychosocial issues, childhood development, and educational needs. The section notes that 90% of HIV-infected children (1.9 million-2.3 million) live in sub-Saharan Africa and that 90% of those children acquired the virus in utero, during birth, or through breastfeeding. This section is well-organized, categorizing interventions into those with evidence suggesting effectiveness, those lacking sufficient evidence, and those with firm evidence of effectiveness. Fifteen percent of all people living with HIV/AIDS are 15 to 24 years old (p 144), and this population needs information and health services, sustainable livelihoods, and safe and supportive environments. Efforts must go beyond knowledge and work to shift perceptions of risk, safer-sex intentions, assertive communication, and condom-use skills. Schools and media can have significant influence in this regard. Part 3 does an excellent job of outlining medical interventions such as preventing transmission during pregnancy, birth, and breastfeeding. The book includes helpful tables outlining the prevention of postnatal transmission through breastfeeding and providing a plethora of solutions for vulnerable, hard-to-reach populations. It is critical to prevent pediatric HIV infection by providing early access to antenatal services via timely testing and treatment initiation, access to antiretroviral drugs, and maintenance of women in care; encouraging appropriate infant feeding practices; and providing follow-up for HIV-exposed infants. Part 4 includes a pithy discussion about whether to target at-risk populations and the consequences of both approaches. A case is made that programs should target poor populations because poverty drives HIV infection risk; however, targeting poor orphaned children stigmatizes them. An argument is also made for community-based targeting in Eastern and Southern Africa by cash transfer strategies. Four diverse leaders opine that everyone and governments are to blame and that efforts need to move toward shared responsibility by everyone. Multisectoral collaboration under government coordination is recommended, along with control of the aid for AIDS and an end to corruption. The chapter authors are experts from sub-Saharan Africa, Europe, South Asia, Australia, and Central and North America and come from diverse professional backgrounds. The examples of working programs in multiple countries are a plus. There are no references per se but rather notes that cluster citations by themes; for academics used to seeing numbered references, this approach will be a shortcoming. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Bell CC, Bhana A, Petersen I, et al. Building protective factors to offset sexually risky behaviors among black youths: a randomized control trial. J Natl Med Assoc. 2008;100(8):936-94418717144PubMedGoogle Scholar 2. Fullilove MT. Root Shock. New York, NY: Ballantine Books; 2004

Journal

JAMAAmerican Medical Association

Published: Jul 25, 2012

References