1. Beyond being HIV-free: Time to survive & thrive?
4th HIV-Exposed Uninfected (HEU) Child and Adolescent Workshop Pre-conference Workshop. Sunday, 22 July 2018
Ute Feucht
with Watsamon Jantarabenjakul and Gabriel Loni
No conflicts of interest to declare

2. HIV-exposed uninfected children
HEU=
HIV-exposed uninfected children
Very large numbers of affected children in high burden countries
Children with varied HIV- and ART exposure

3. Early Childhood Development (ECD) & HEU
First 1000 days
HEU= Vulnerable group
Preterm birth, LBW, differential feeding practices, HIV-affected households, etc
Childhood development =
Genetic blueprint + environment
Window of opportunity during period of vulnerability
Need for intervention
Nurturing care framework
Nurturing care framework already exists
Need for interventional package like nurturing care framework is important for all children, but especially for vulnerable children like the HEU

4. ECD in HEU
Some HIV-affected parents find nurturing care more challenging due to life events
Example from Malawi
B+ & Nurturing Care: Blending of implementation
Paradigm shift needed:
How to get families to go to health facilities when they are not sick
Involve fathers
Integration
Scalability
Can improve retention in care

5. Affected mother from Malawi:
"My experience in managing my HIV status while also taking care of my children has been quite a challenge. I got my first child, my daughter, and when she was 1 year 4 months, I was so weak, I could not even lift her up, cuddling her (…), she was constantly in my mother’s care or my sister, that created a gap between us.”
Bonding with her 2nd child disrupted due to illness of her 1st (HIV+) child
“But because I was constantly taking care of my daughter who was sick, I didn’t have time to concentrate on my pregnancy (…) do everything that a mother could have done (…) that also created a gap between me in my son.“

6. HEU Adolescents: Psychosocial Implications
First 1000 weeks
Very high mental health morbidity
Similar to adolescents living with HIV
Any mental health diagnosis: 58%
Very little data
From 1st world countries
Because of use as control group for HIV+ children
“Invisible” at-risk population

7. Way forward: Unfinished business!
Adolescent HEUs:
We need to make them “visible”
Need extra care, especially mental health care
Full ramification of HIV/ART exposure is unknown
HEU infants
Move beyond narrow, short-term HIV targets
Identify vulnerabilities and provide support to families
Need to implement nurturing care
Integration (HIV + ECD) has the potential to improve retention in care

8. Way forward: Unfinished business!
Painting with water colours
With purpose, but flowing
Moving beyond strict (programmatic) lines
What we do NOW will matter for the next generation
Yellow Accompaniment
Wassily Kandinsky
Misty Morning
Painter unknown

9. Acknowledgements: Contributors, session chairs, panel members
Marissa Vicari
Kate Powis
Martina Penazzato
Nigel Rollins
Lisa Bohmer
Steven Lye
Bernadette Daelmans
Alan Schooley
Evelyn Udedi
Shaffiq Essajee
Clara Banya
Lorraine Sherr
Amy Slogrove
Claude Ann Mellins
Lucie Cluver
Stephanie McCann
Alexis Galloway
Anurita Bains
Rohan Hazra

10. HIV-free - Survive & Thrive
We thank Kate Powis, Amy Slogrove and Daphnée Blanc for organising the workshop
HIV-free - Survive & Thrive
Feedback provided by Ute Feucht, Watsamon Jantarabenjakul and Gabriel Loni