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

BMC Public Health

Simon Gregson⁵  Constance Nyamukapa⁵  Morten Skovdal⁴  Claudius Madanhire¹  Alice Mutsikiwa²  Louise Andersen³  Catherine Campbell³ 

[1] School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa;Biomedical Research and Training Institute, Harare, Zimbabwe;Department of Social Psychology, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK;Department of Public Health, University of Copenhagen, Copenhagen, Denmark;Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, UK

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

Others  :  1131480
DOI  :  10.1186/1471-2458-14-402

 received in 2013-11-04, accepted in 2014-04-08,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Campbell et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]UNICEF, Child Friendly Schools http://www.unicef.org/education/index_focus_schools.html webcite
• [2]UNESCO, HIV & AIDS and Supportive Learning Environments http://unesdoc.unesco.org/images/0014/001461/146122e.pdf webcite
• [3]Ansell N: Substituting for Families? Schools and Social Reproduction in AIDS-affected Lesotho. Antipode 2008, 40(5):802-824.
• [4]UNAIDS http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/ webcite
• [5]UNICEF: The State of the World’s Children 2012: Children in an Urban World. New York: UNICEF; 2012.
• [6]Global AIDS response progress report 2012, Zimbabwe Country report http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_ZW_Narrative_Report.pdf webcite
• [7]Parsons R: Growing up with HIV in Zimbabwe: one day this will all be over. Suffolk: James Currey; 2012.
• [8]Van Blerk L, Ansell N: Alloparenting in the context of AIDS in southern Africa: complex strategies for care. In Substitute Parents: Biological and Social Perspectives on Alloparenting Across Human Societies. Edited by Bentley G, Mace R. Oxford: Berghahn Books; 2009:241-265.
• [9]Nyamukapa CA, Foster G, Gregson S: Orphans’ household circumstances and access to education in a maturing HIV epidemic in Zimbabwe. J Soc Dev Afr 2003, 18:7-32.
• [10]World Health Organisation Definition of Health http://www.who.int/about/definition/en/print.html webcite
• [11]Ansell N: Children, Youth and Development. London: Routledge; 2005.
• [12]Kleinman A: Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Los Angeles: University of California Press; 1980.
• [13]Campbell C, Skovdal M, Mupambireyi Z, Gregson S: Exploring children’s stigmatisation of AIDS-affected children in Zimbabwe through drawings and stories. Soc Sci Med 2010, 71:975-985.
• [14]Riessman C: Narrative analysis. London: Sage; 1993.
• [15]Moscovici S: The phenomenon of social representations. In Social representations. Edited by Farr R, Moscovici S. Cambridge: Cambridge University Press; 1984.
• [16]Duveen G, Lloyd B: Social representations and the development of knowledge. Cambridge: Cambridge University Press; 1990.
• [17]James A, Prout A: Constructing and reconstructing childhood: Contemporary issues in the sociological study of childhood. London: Falmer; 1997.
• [18]Campbell C, Skovdal M, Mupambireyi Z, Madanhire C, Nyamukapa C, Gregson S: Building adherence-competent communities: factors promoting children’s adherence to anti-retroviral HIV/AIDS treatment in rural Zimbabwe. Health Place 2012, 18(2):123-131.
• [19]Skovdal M, Ogutu V, Aoro C, Campbell C: Yong carers as social actors: coping strategies of children caring for ailing or aging guardians in Western Kenya. Soc Sci Med 2009, 69(4):587-595.
• [20]Nhamo M, Campbell C, Gregson S: Obstacles to local-level AIDS competence in rural Zimbabwe: putting HIV prevention in context. AIDS Care 2010, 22:1662-1669.
• [21]Bourdieu P: The forms of capital. In Handbook of Theory and Research for the Sociology of Education. Edited by Richardson JG. New York: Greenwood Press; 1986.
• [22]Kawachi I, Kennedy B, Glass R: Social capital and self-rated health: a contextual analysis. Am J Public Health 1999, 89(8):1187-1195.
• [23]Kawachi I, Kim D, Subramanian S: Social capital and health. New York: Springer; 2008.
• [24]Wilkinson R: Unhealthy societies: the afflications of inequality. London: Routledge; 1996.
• [25]Campbell C, Williams B, Gilgen D: Is social capital a useful conceptual tool for exploring community level influences on HIV infection? An exploratory case study from South Africa. AIDS care 2002, 14(1):41-54.
• [26]Portes A, Landolt P: The downside of social capital. Am Prospect 1996, 26:18-21.
• [27]Campbell C, Scott K, Nhamo M, Nyamukapa C, Madanhire C, Skovdal M, Sherr L, Gregson S: Promoting HIV Competent Communities: the role of community groups in managing HIV/AIDS in rural Zimbabwe. AIDS Care 2013, 25(Suppl 1):114-122.
• [28]Gregson S, Mushati P, Grusin H, Nhamo M, Schumacher C, Skovdal M, Nyamukapa C, Campbell C: Social capital and reduced female vulnerability to HIV infection in rural Zimbabwe. Popul Dev Rev 2011, 37(2):333-359.
• [29]Pronyk PM, Harpham T, Busza J, Phetla G, Morison LA, Hargreaves JR, Kim JC, Watts CH, Porter JD: Can social capital be intentionally generated? a randomized trial from rural South Africa. Soc Sci Med 2008, 67(10):1559-1570.
• [30]Pronyk PM, Harpham T, Morison LA, Hargreaves JR, Kim JC, Phetla G, Watts CH, Porter JD: Is social capital associated with HIV risk in rural South Africa? Soc Sci Med 2008, 66:1999-2010.
• [31]Skovdal M, Mwasiaji W, Webale A, Tomkins A: Building orphan competent communities: experiences from a community-based capital cash transfer initiative in Kenya. Health Policy Plan 2011, 26(3):233-241.
• [32]Coleman J: Social capital and the creation of human capital. Am J Sociol 1988, 94:95-120.
• [33]UNAIDS http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/jc2434_worldaidsday_results_en.pdf webcite
• [34]Shizha E, Kariwo M: Education and development in Zimbabwe. Rotterdam: Sense Publishers; 2011.
• [35]Campbell C, Skovdal M, Mupambireyi Z, Mandahire C, Gregson S: Can AIDS stigma be reduced to poverty stigma? Child: Care Health and Development 2012, 38(5):732-743.
• [36]Pridmore P, Bendelow G: Images of Health: Exploring Beliefs of Children using the “Draw-and-Write Technique”. Health Educ J 1995, 54:473-488.
• [37]Backett-Milburn K, McKie L: A critical appraisal of the draw and write technique. Health Educ Res 1999, 14(3):387-398.
• [38]Attride-Stirling J: Thematic networks: An analytic tool for qualitative research. Qual Res 2001, 1(3):385-405.
• [39]Propp V: Morphology of the Folktale. Texas: University of Texas Press; 1968.
• [40]Bettelheim B: The Uses of Enchantment. New York: Alfred A. Knopf; 1976.
• [41]Abebe T, Skovdal M: Livelihoods, care and the familial relations of orphans in Eastern Africa. AIDS Care 2010, 22(5):570-576.
• [42]Skovdal M, Magutshwa-Zitha S, Campbell C, Nyamukapa C, Gregson S: Children’s role in the community response to HIV in Zimbabwe. J Int AIDS Soc 2013, 16:18468.
• [43]Barnes M: Care in everyday life: An ethic of care in practice. Bristol: Policy Press; 2012.
• [44]REPSII Launches Teachers Diploma in Social Care and Protection http://www.ovcsupport.net/s/index.php?i=1076 webcite
• [45]CREATE: Exploring the Viability of School-Based Support for Vulnerable Children: A Case Study of Two Township Schools in Johannesburg http://www.create-rpc.org/pdf_documents/PTA46.pdf webcite
• [46]SAIDE: Creating a Caring School - A Guide for School Management Teams with Accompanying Toolkit http://www.col.org/SiteCollectionDocuments/Creating_a_Caring_School_A_Toolkit_for_School_Management_Teams.pdf webcite
• [47]Champions for Children handbook: how to build a caring school community http://www.ci.org.za/depts/ci/pubs/pdf/trainingtools/Champions%20for%20Children%20Handbook%20pilot%202008.pdf webcite
• [48]ZNASP II: 2011–2015 http://www.nac.org.zw/sites/default/files/Zimbabwe-National-HIV-AIDS-Strategic-2011-2015-Plan.pdf webcite
• [49]Global AIDS response progress report 2012, Zimbabwe Country report http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_ZW_Narrative_Report.pdf webcite
• [50]Hochschild A: The Managed HeartNN Commercialization of Human Feeling Berkeley: University of California Press. 2012.
• [51]Machawira P, Pillay V: Writing in policy, writing out lives. J Educ Policy 2009, 24(6):753-767.
• [52]Mangwaya EN: Rural Secondary School Teachers’ Capacity to Respond to Hiv and Aids: The Case of Shurugwi District in Zimbabwe. Asian Soc Sci 2013, 9(2):11-19.