Children affected by HIV/AIDS: SAFE, a model for promoting their security, health, and development

Abstract

A human security framework posits that individuals are the focus of strategies that protect the safety and integrity of people by proactively promoting children's well being, placing particular emphasis on prevention efforts and health promotion. This article applies this framework to a rights-based approach in order to examine the health and human rights of children affected by HIV/AIDS. The SAFE model describes sources of insecurity faced by children across four fundamental dimensions of child well-being and the survival strategies that children and families may employ in response. The SAFE model includes: Safety/protection; Access to health care and basic physiological needs; Family/connection to others; and Education/livelihoods. We argue that it is critical to examine the situation of children through an integrated lens that effectively looks at human security and children's rights through a holistic approach to treatment and care rather than artificially limiting our scope of work to survival-oriented interventions for children affected by HIV/AIDS. Interventions targeted narrowly at children, in isolation of their social and communal environment as outlined in the SAFE model, may in fact undermine protective resources in operation in families and communities and present additional threats to children's basic security. An integrated approach to the basic security and care of children has implications for the prospects of millions of children directly infected or indirectly affected by HIV/AIDS around the world. The survival strategies that young people and their families engage in must be recognized as a roadmap for improving their protection and promoting healthy development. Although applied to children affected by HIV/AIDS in the present analysis, the SAFE model has implications for guiding the care and protection of children and families facing adversity due to an array of circumstances from armed conflict and displacement to situations of extreme poverty.

HIV and Child Mental Health: A Case-Control Study in Rwanda

“…Other variables included were: parenting, measured by a locally derived scale comprising 16 items to capture the concept uburere bwiza (good parenting), that also included 16 additional items from the Parental Acceptance and Rejection Questionnaire, 34 which displayed good internal consistency (a = 0.80); harsh punishment, measured by a 12-item scale adapted from the United Nations Children' s Fund' s Multiple Indicator Cluster Survey 35 (a = 0.78); daily hardships, measured by an adapted version of the Post-War Adversities Index (18 items), which had been used previously in sub-Saharan Africa 36 and included items such as food insecurity and illness in the family (internal consistency in this sample a = 0.80); social service access, including medical and social support services, reported by caregivers and measured by 17 items adapted from the SAFE child protection checklist 15 (a = 0.70); and HIV-related stigma, measured by 13 items adapted from the Young Carers Project. 37 Frequency of experiencing interpersonal interactions indicative of HIV-related stigma was reported on a 4-point Likert scale of "never," "sometimes," or "often/a lot."…”

“…1 HIV-positive children and children affected by HIV (ie, those who have caregivers living with HIV or family members who have died of AIDS) may face greater family stress and conflict, 2 difficulties with peer relationships due to HIV-related stigma, [3][4][5][6] and increased risk of depression, anxiety, and social withdrawal. [7][8][9][10][11][12] For HIVaffected children, parental illness or death may shift family responsibilities to them at a young age, contributing to school dropout, emotional and behavioral problems, and risky survival strategies, such as exchanging sex for money, [13][14][15] further perpetuating a cycle of HIV risk and infection. 16,17 Although the elevated risks facing HIV/ AIDS-affected orphans and vulnerable children are well documented, the risk in HIV-negative children who live with HIV-positive caregivers compared with HIV-positive children and children unaffected by HIV is less clear.…”

A qualitative case study of child protection issues in the Indian construction industry: investigating the security, health, and interrelated rights of migrant families

“…Situating child protection within the nested social ecologies of families, communities, and the larger political, cultural and historical context, the SAFE model examines interrelatedness among four core domains of children’s basic needs and rights: S afety/freedom from harm; A ccess to basic physiological needs and healthcare; F amily and connection to others; E ducation and economic security [57]. Of central importance to SAFE is the idea that insecurity in any of these fundamental domains threatens security in the others.…”

Interventions for Children Affected by War

“…92,93 Although few child-tracing interventions have been formally evaluated for effectiveness in improving mental health outcomes, reunification of separated families is often an important first step in promoting mental health in war zones. 94,95 A number of interventions are available for preventing separation (e.g., universal registration at birth, registration during movements, computer-assisted databases), providing interim and durable care options (e.g., foster care, peer-group care), 33,34 and reunifying families (e.g., tracing separated children, reintegrating child soldiers).…”