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Open Access Research article

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

Catherine Campbell1*, Louise Andersen1, Alice Mutsikiwa3, Claudius Madanhire5, Morten Skovdal2, Constance Nyamukapa34 and Simon Gregson34

Author Affiliations

1 Department of Social Psychology, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK

2 Department of Public Health, University of Copenhagen, Copenhagen, Denmark

3 Biomedical Research and Training Institute, Harare, Zimbabwe

4 Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, UK

5 School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa

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BMC Public Health 2014, 14:402  doi:10.1186/1471-2458-14-402

Published: 26 April 2014

Abstract

Background

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. 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.

Methods

Contextualised 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.

Results

Children 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.

Conclusions

Our 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.

Keywords:
Children; HIV/AIDS; Policy; Teachers; Peers; Care; Support; Stigma; Social exclusion; Coping; Schools