Nelson Chiziza, Sue Holdon, Martha Kamuhabwa & Dr. Dorothy Mandwa Communicating with children using the Stepping Stones With Children approach in Tanzania   Pastoral Activities and Services for People with AIDS Dar es Salaam Archdiocese (PASADA) Salamander Trust Nelson Chiziza, Sue Holdon, Martha Kamuhabwa & Dr. Dorothy Mandwa

Results: better management of living with HIV Disclosure: At baseline, 93% of caregivers knew their child’s HIV status, but 27% had told the child. At end line all knew the status and 93% had told the child. Adherence and health: We compared clinical data for study participants with a control group of PASADA children clients. The participants had statistically significant greater improvements in their CD4 count and weight, compared to the control group. The children reported better school attendance. 224 participants were involved in this study (112 children and 112 parents/caregivers)

Results: improved relationships Children and caregivers reported more affection and respect between them. Children said they were more free to talk to their caregivers if something is worrying them. They also reported less physical violence: How many times has your caregiver physically punished you in the past week? Baseline End line 5-8 year olds 2.5 times 1.0 times 9-14 year olds 3.0 times 0.7 times

Results: improved services Stepping Stones with Children Counseling Guide has improved the competence of PASADA’s counsellors, in supporting children and their caregivers. Counsellors reported changes in their practice and better handling of child clients. Caregivers and children reported improved ratings of attendance for the staff and clinics.

Results: knowledge and attitudes All groups showed improved knowledge regarding sexual health and HIV. We asked the older children and caregivers whether they agreed with statements about gender, and both groups showed more equitable attitudes in their mean scores out of 5: Statements and peer groups Baseline End line ‘Men sometimes need to pressure girls to have sex because girls can be shy.’ 9-14 year olds Not sure (2.6) Strongly disagree (1.2) Caregivers Agree (3.9) Not sure (2.5) ‘Boys and men should protect their sexual partners by using condoms.’ Not sure (2.8) Strongly agree (4.8) Not sure (3.1) Strongly agree (4.6)

Results: greater confidence among caregivers Caregivers reported: Greater confidence in supporting their children; Better knowledge e.g. learned to attend to a child who is upset or angry; Better ability to calm a child who is upset or angry; More willingness to be honest with their child e.g. to tell the truth about the death of a loved one.

Conclusion: Stepping Stones with Children can… Our forest of love: 9-14s group, Dar Involve children from 5 to 14 years old. Enable children and caregivers to explore sensitive issues. Lead to a range of positive results for both children and caregivers.