Care and Support

What Works

Women and Girls
  • Continued counseling (either group or individual) for those who are HIV- positive and those who are caregivers can relieve psychological distress.
  • Peer support groups can be highly beneficial to women living with HIV.
Orphans and Vulnerable Children
  • Accelerating treatment access for adults with children can reduce the number of orphans, improve pediatric mortality and social well-being.
  • Programs that promote the strength of families and offer family-centered integrated economic, health and social support result in improved health and education outcomes for orphans.
  • Highly-active antiretroviral therapy (HAART) with good nutritional intake and regular medical care can improve health and survival of HIV-positive children in resource-poor settings.
  • Psychological counseling and mentoring for OVC improves their psychological well-being.
  • Programs that provide microenterprise opportunities, old age pensions or other targeted financial and livelihood assistance can be effective in supporting orphans.

Possibly no other aspect of HIV and AIDS is as “gendered” as care and support (Esplen, 2009).  Care and support generally includes both care of people living with HIV and AIDS and of families and children affected by HIV and AIDS.  UNAIDS includes in its definition home- and community-based care (HCBC), palliative care, psychological support, carer support, and nutrition support.  Among these, HCBC is meant to be the foundation on which national antiretroviral treatment programmes are built (UNAIDS 2009c).  A 2004 UNAIDS report estimated that in Africa, only 12% of HIV-positive people in need of home-based care actually received it (UNAIDS, 2004 cited in Newman et al., 2009). Under PEPFAR, the term palliative care covers clinical services for opportunistic infections, social care (community mobilization, leadership development, legal services, linkages to food support and income-generating programs, among other activities to strengthen families and communities), psychological services, spiritual care, and positive prevention efforts (PEPFAR, 2009). 

Of particular concern is the care and support of the growing number of orphans and vulnerable children. Worldwide, the number of orphans (children under age 18 who have lost one or both parents) to AIDS stands at approximately 17.5 million (UNICEF et al., 2009). Many more children live with one or more chronically ill parent. The vast majority of these children live in sub-Saharan Africa. The Joint Learning Initiative on Children and HIV/AIDS, which compiled over 50 systematic reviews by working groups of world orphan and vulnerable children (OVC) experts, contend that the definition of ‘orphan’ leads the international community to assume that these children are without family support. “The UN definition of an orphan, ‘a child who has lost one or both parents,’ distorts the global response to children affected by HIV and AIDS. Instead, “some 88% of children designated as ‘orphans’ by international agencies actually have a surviving parent” (Irwin et al., 2009: 12, based on Belsey, 2008; Sherr, 2008; Richter, 2008).  For example, an assessment of 12 out of 39 community groups that currently support 3,975 OVC, 200 PLWA and 1,375 HIV-affected households in Uganda in 2005 found a functioning extended family system playing a significant role in the care and support of PLHA and OVC in all communities (Balaba et al., 2008).  Supporting family systems is therefore essential. 

This chapter covers interventions that work in caring for and supporting women and girls in general, both with respect to their own needs in illness and the burden of caring for others who are ill.  It also covers the care and support of orphans and vulnerable children, especially the particular vulnerabilities and needs of orphaned girls.