Children's representations of school support for HIV-affected peers in rural Zimbabwe.

Catherine Campbell,Claudius Madanhire,Morten Skovdal,Louise Andersen,Alice Mutsikiwa,Constance Nyamukapa,Simon Gregson

doi:10.1186/1471-2458-14-402

Abstract

BackgroundHIV has left many African children caring for sick relatives, orphaned or themselves HIV-positive, often facing immense challenges in the absence of significant support from adults. With reductions in development funding, public sector budgetary constraints, and a growing emphasis on the importance of indigenous resources in the HIV response, international policy allocates schools a key role in ‘substituting for families’ (Ansell, 2008) in supporting child health and well-being. We explore children’s own accounts of the challenges facing their HIV-affected peers and the role of schools in providing such support.MethodsContextualised within a multi-method study of school support for HIV-affected children in rural Zimbabwe, and regarding children’s views as a key resource for child-relevant intervention and policy, 128 school children (10–14) wrote a story about an HIV-affected peer and how school assisted them in tackling their problems.ResultsChildren presented harrowing accounts of negative impacts of HIV on the social, physical and mental well-being of peers, and how these manifested in the school setting. Whilst relationships with fellow learners and teachers were said to provide a degree of support, this was patchy and minimal, generally limited to small-scale and often one-off acts of material help or kindness (e.g. teachers giving children pens and exercise books or peers sharing school lunches), with little potential to impact significantly on the wider social drivers of children’s daily challenges. Despite having respect for the enormity of the challenges many HIV-affected peers were coping with, children tended to keep a distance from them. School was depicted as a source of the very bullying, stigma and social exclusion that undermined children’s opportunities for well-being in their lives more generally.ConclusionsOur findings challenge glib assumptions that schools can serve as a significant ‘indigenous’ supports of the health and well-being of HIV-affected children in the absence of a very significant increase in outside training, support and additional resources. Schools are an extension of communities, with members of school communities subject to many of the same deprivations, anxieties and prejudices that drive the health-limiting exclusion, impoverishment and stigmatisation of HIV-affected children in their households and wider communities.

Highlights

HIV has left many African children caring for sick relatives, orphaned or themselves HIV-positive, often facing immense challenges in the absence of significant support from adults
What role can schools play in supporting the health and well-being of HIV affected children in Sub-Saharan Africa? Increasingly, international policy-makers [1,2] are pointing to schools as possible “substitutes for families” [3] p. 802 in contexts where HIV/AIDS has disrupted the ability of adults to support children’s physical and emotional health
We report on a qualitative study nested within a wider multi-method investigation of the potential for schools to support the health and well-being of HIV-affected children in Sub-Saharan Africa

Summary

Introduction

HIV has left many African children caring for sick relatives, orphaned or themselves HIV-positive, often facing immense challenges in the absence of significant support from adults. Given the relative neglect of children’s own perspectives in the research literature in this field [11] and the key role that lay people’s own understandings play in responding to health challenges [12], we focus on children’s views of the potential for the school to support their well-being. Conceptual framework Our analysis was underpinned by the methodological assumption that, in constructing stories, children draw on the social representations that they and their peers have collectively constructed to give meaning to their social worlds [13,14] Such social representations constitute the symbolic resources children use to make sense of the everyday and to act within it [15,16]. Children’s own views are potentially important resources for public health specialists since they constitute the lens through which children will interpret and respond to efforts to enhance their health and well-being in challenging settings

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