1. Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Health Emerging Research

2. Our Motivation To Do Better For Children: Challenges Faced By Children Orphaned By AIDS When a parent dies of AIDS, his or her child:  Is more likely to face stigmatization, rejection, and a lack of love and care.  Often suffer from emotional distress, malnutrition, a lack of health care, and poor or no access to education.  AIDS orphans are also at high risk for labor exploitation, sex trafficking, homelessness, and exposure to HIV.  Increasingly, extended families and communities in highly affected areas find that their resources are inadequate to provide the basics for all needy children.

3. A Closer Look At The National Picture  TRAINER/POST WILL FILL IN.

4. HIV infection of Parents Possible distancing by parent, disclosure issues Children may become caregivers Psychosocial distress Deaths of parents Increasingly serious illness Children withdraw from school Inadequate food Problems with shelter & material needs Economic problems Problems with inheritance Reduced access to health services Children without adequate adult care Discrimination Increased vulnerability to HIV infection Life on the street Institutionalization Sexual exploitation Exploitative child labor Poverty Stigma & discrimination How HIV Affects Children

5. Promoting Resilience World’s First Longitudinal Study  Question: Are there long-term impacts of parental AIDS on child mental health, education, and sexual health?  Sampling  In 2005: N=1021 (ages 10-18)  In 2009: 71.5% follow up  Three provinces in South Africa  Comparing AIDS orphaned/other- orphaned/non-orphaned children

6. National Young Carers Study (2009-2012)  Questions:  How does parental AIDS-illness impact children?  Can social protection services improve outcomes?  Sampling  Main study: N-6000 (aged 10-18) + pilot: 850 children  Six randomly selected sites >30% prevalence, three provinces  Urban/rural, one-year follow up

7. “This is what I want to say to my parents: ‘My heart is broken. Things go wrong for me all the time. I am lonely. Please come back to me’.” (boy, 10, urban area) Cluver, L. and F. Gardner. 2007. AIDS Care 19(3): 318-325. What it Feels Like

8. Cluver, L., D. Operario, T. Lane, and M. Kganakga. 2012. Journal of Adolescent Research. Child Education Difficulties

9. Cluver, L., F. Gardner, and D. Operario. 2007. Journal of Child Psychiatry & Psychology, 48(8): 755-763. Depression and Post-Traumatic Stress

10. Cluver, L., M. Orkin, M. Boyes, and F. Gardner. 2011. Journal of Child Psychiatry and Psychology. Over time: AIDS-orphaned children get worse, faster

11. Cluver, L., M. Orkin, M. Boyes, and F. Gardner. 2012. Journal of Pediatric Psychology. Anxiety and Depression Results

12. Hunger and Nutrition Cluver, L., F. Gardner, and D. Operario. 2009. AIDS Care 21 (6): 732-741.

13. Stigma and Bullying Cluver, L., F. Gardner, and D. Operario. 2008. Journal of Adolescent Health, 42 (4): 410-418.

14. Transactional Sex Sex for: Food Shelter School fees Money Transport Cluver, L. et al. 2012. XIV International AIDS Conference, Washington DC.

15. Cluver, L. 2011. Nature, 474: 27-29. Child Abuse in the Home

16. Link to Transactional Sex Cluver, L, M Orkin, Boyes et al, (2011) ‘Transactional Sex amongst AIDS-orphaned & AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty’. JAIDS

17. Thinking about life changes for AIDS-affected children “I just couldn’t understand the way my life completed. I couldn’t accept that my mother is gone for good. I was pregnant. I left school. It was hard for me to accept that.” (girl, 17, urban)

18. Additional Research  Schenk, K.D., A. Michaelis, T.N. Sapiano, L. Brown, and E. Weiss, E. 2010. Improving the lives of vulnerable children: Implications of Horizons research among orphans and other children affected by AIDS. Public Health Reports, 125, 325-336.  Cluver, L., F. Gardner, and D. Operario, D. 2007. Psychological distress amongst AIDS-orphaned children in urban South Africa. Journal of Child Psychology and Psychiatry, 48, 755-763. www.youngcarers.org.za for all their papers for free.www.youngcarers.org.za  Atwine, B., E. Cantor-Graae, and F. Bajunirwe. 2005. Psychological Distress among AIDS orphans in rural Uganda. Social Science and Medicine, 61, 555-564.  Kumakech, E., E. Cantor-Graae, S. Maling, and F. Bajunirwe. (2009). Peer-group support intervention improves the psychosocial well-being of AIDS orphans: Cluster randomized trials. Social Science and Medicine, 68, 1038-1043.  Rotheram-Borus, M.J., J.A. Stein, and Y.Y. Lin. 2001. Impact of parent death and intervention on the adjustment of adolescents whose parents have HIV/AIDS. Journal of Consulting and Clinical Psychology, 69, 763-773.