Health, schooling, needs, perspectives and aspirations of HIV infected and affected children in Botswana: a cross-sectional survey

Abstract

BackgroundAntiretroviral treatment means many HIV infected children are surviving with a highly stigmatised condition. There is a paucity of data to inform policies for this growing cohort. Hence we carried out a study on the health, schooling, needs, aspirations, perspectives and knowledge of HIV infected and affected children in Botswana.MethodsA cross-sectional survey using interviews and focus group discussions among HIV infected children aged 6–8 years versus HIV aged matched HIV uninfected counterparts living in the same households between August 2010 and March 2011. Supplemental clinical data was abstracted from medical records for HIV infected participants.ResultsNine hundred eighty-four HIV infected and 258 affected children completed the survey. Females predominated in the affected group (63.6 % versus 50.3 %, P < 0.001). School attendance was high in both groups (98.9 % versus 97.3 %, P = 0.057). HIV infected children were mostly in primary school (grades 3–7) while affected children were mostly in upper primary or secondary grades. Sixty percent HIV infected children reported having missed school at least 1 day in the preceding month. Significantly more infected than affected children reported experiencing problems at school (78 % versus 62.3 %, P < 0.001). Twenty-two percent of 15–18 year old HIV infected children were in standard seven and below compared to only 8 % of HIV affected children (p = 0.335). School related problems included poor grades, poor health/school attendance, stigma and inadequate scholastic materials. The wish-list for improving the school environment was similar for both groups and included extra learning support; better meals; protection from bullying/teasing; more scholastic materials, extracurricular activities, love and care; structural improvements; improved teacher attendance and teaching approaches. Significantly more HIV infected children reported feeling hungry all the time (50.6 % versus 41 %, P = 0.007) and more trouble hearing (26.8 % versus 12.5 %, P = 0.028). The mean age for HIV disclosure 10 years was high. Sexual activity (9.2 % versus 3 %, P = 0.001) and emotions of anger (71 % versus 55.3 %, P < 0.001) were significantly higher among HIV affected children. Future perspectives were equally positive (93 % versus 96 %, P = 0.080), were predicated on children’s school performance, self-belief/determination and/or ARVs and preference for medical or military careers was common.ConclusionsIn Botswana almost all school-age HIV infected and affected children are attending school but many face daunting challenges that call for the creation of an empowering, empathetic, supportive, caring, and non-discriminating school environment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0643-5) contains supplementary material, which is available to authorized users.

Healthcare workers’ perspectives and practices regarding the disclosure of HIV status to children in Malawi: a cross-sectional study

“…It is expected that most children living with HIV in Malawi and other sub-Saharan countries will in time achieve an average lifespan, similar to that achieved today in high-income countries [ 36 ]. It is critically important that children living with HIV know that they have the disease and that they are able to manage it properly so they maximise their own health and wellbeing and minimise the threat they pose to others [ 37 ].…”

School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand

“…In the TEEWA survey, school attendance was high, above 85%, for both ALPHIV and controls, in the upper range compared to other studies in various age groups (8)(9)(10)(11)(12)14). However, among adolescents living in family settings, school attendance was lower among ALPHIV than among general population controls (83% vs. 94%, respectively).…”

“…In a recent study in South Africa, Fotso et al found that HIV-infection significantly reduced adolescent school attainment and that contextual factors could only explain 18% of the attainment gap (8). While neurocognitive impairments connected to HIV-infection can directly impact academic achievements, school absenteeism for frequent illness or HIV-related stigmatization could mediate the negative effect of HIV-infection on school life (6,11,12,14). In the TEEWA survey, about 20% of ALPHIV mentioned episodes or extended periods of school absenteeism for medical reasons.…”

“…Perinatally HIV-infected children and adolescents often experience difficult living circumstances, such as parental loss, foster care, poverty and stigmatization, which can also have a negative impact on their educational achievements (6). However, studies on their educational achievements are heterogeneous in terms of age groups, study populations, access to ART, outcomes and comparison group (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Effects of Hiv/Aids on Children's Educational Attainment: A Systematic Literature Review

“…In addition, women and girls are the majority of the HIV‐affected population (UNWOMEN, ); therefore, they are more likely to suffer from the effects of this disease. Intergenerational (parent‐to‐child) transmission of education in case of HIV/AIDS: Children with HIV/AIDS‐ill parents may observe that their parents physically deteriorate from the disease and may experience both parents’ deaths, sometimes in quick succession. This may lead to posttraumatic stress syndrome, depression, poverty, and stigma (Cluver et al ., ; Anabwani et al ., ; UNAIDS, ). To the extent that children's educational attainment is highly correlated with parental education (Becker and Tomes, ; Björklund and Salvanes, ), HIV may interfere with intergenerational (parent‐to‐child) transmission of human capital.…”