Strengthening systems to support children's healthy development in communities affected by HIV/AIDS

The terms of reference for the assignment mandated a review of the scientific evidence and programmatic experience in providing psychosocial support to children infected with and affected by HIV, and their caregivers. A great deal of attention is currently focused on psychosocial support for children living in communities affected by HIV/AIDS. Psychosocial support includes a range of interventions such as awareness raising, counseling, group experiences for children, opportunities for recreation, and the like. However, several technical consultations, as well as the available evidence and experience, suggest that it is necessary, in the face of the combined effects of the HIV/AIDS epidemic and poverty, to support the psychosocial wellbeing of vulnerable children through as many avenues as possible. Efforts to promote the psychosocial wellbeing of vulnerable children require conditions and assistance that go beyond psychosocial support, and there is now a strong call for integrated services to families and children affected by HIV/AIDS. Amongst these services, the health system plays a critical role, both in providing direct comprehensive services to affected children and families. However, health systems also have the potential to play a powerful indirect role by assisting and supporting community-based initiatives to provide assistance to the most affected children and their families. This review covers the reasons for the shift in focus from psychosocial support to the psychosocial wellbeing of children, and from psychosocial support programmes to the need to strengthen services, especially health services. The review takes as its starting point, the consensual strategies outlined in the Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS. Access to services, including for health is one of the five key strategies. Health services can assist vulnerable children and families, as well as provide the infrastructure, organizational capacity and integrative approached needed to draw together the many efforts at the family and community level to respond to the hardships of children affected by HIV/AIDS.