Understanding what Aids does to kids
Oxford-led collaboration focuses on survival and support
THE GIRL was eight when her neighbour started to rape her, every day until she was 12. When she went to school, he would stand outside his house and draw his finger across his throat ensuring her silence.
By the time Dr Lucie Cluver met her, the girl was suicidal. “We helped her to take him to court, and it took several months, but after a whole set of other children revealed he had raped them too, he was convicted and sent to prison,” the Oxford University researcher said.
The girl went back to school, passed her year with flying colours and was planning to apply to become a doctor.
“But only a few months later, he was released because the prison was full. She dropped out of school and became suicidal again.
“Sometimes, I just don’t know what to do,” said Cluver, who is leading the world’s largest longitudinal study to understand the impacts of Aids on millions of South Africa’s children and teenagers.
Cluver and her team of researchers have sat in countless homes like these, scattered all over South Africa, gently interviewing these Aidsaffected children who continue to open their doors and their hearts to them, telling them of their desperate fight for survival.
“We’ve sat in thousands of homes, from mats outside rural huts in KwaZulu-Natal to townships in the Cape Flats, to shacks on the side of mountains in Mpumalanga. And we’ve seen children growing up and surviving in pretty terrible adversity.”
Cluver’s Young Carers project, a pioneering study highlighting the little- known impacts of the epidemic, researched more than 6 000 South African children who care for their sickly parents, or have lost their parents to the disease. It aims to provide “high-quality evidence” to help guide policymakers and the government when they tackle the devastating fallout of HIV/Aids.
The project is a collaboration between the universities of Oxford, KwaZulu-Natal, Cape Town and Wits, along with the Department of Social Development, with the support of the departments of Health and Basic Education. Also involved are the National Action Com- mittee for Children Affected by HIV/Aids, as well as Unicef, Pepfar-USAID and NGOs Cape Town Child Tholulwazi.
Cluver’s latest research, gleaned from more than 3 000 children in Mpumalanga and the Western Cape, has shown how child support grants can halve the infection risk for adolescent girls by reducing their reliance on “sugar daddies”, a leading cause of infection.
These findings were published this week in the journal, the Lancet Global Health.
Cluver said systematic reviews were now showing that behavioural interventions, such as training and educating teens, “don’t really seem to be making enough of a difference to HIV risk behaviours”.
“Although the media often says that teenage girls are choosing to have sugar daddies to pay for luxuries and cellphones, the scientific research evidence says exactly the opposite.
“The greatest predictors of transactional sex in our fouryear study were extreme poverty, abuse and family Aids.”
Cluver said that if a girl had enough to eat at least five days a week, wasn’t physically or emotionally abused, and lived in a healthy family, she had a 1 percent chance of having transactional sex. If she was hungry, abused and lived in an Aids-affected family, she had a 57 percent chance.
“The grants don’t change all risky behaviour, but they give teenage girls the opportunity to make a choice about who they have sex with, rather than having to have a sugar daddy just to survive,” she said.
Their ongoing research had made Cluver and her team realise three things: “The first was that we now know that Aids-affected children have a much worse time than other kids, but we needed to properly understand the pathways that caused this.
“And what we see is that family Aids impacts children through making other social problems worse. It makes par- ents more disabled, families more stigmatised and poor, and child abuse much more likely.
“But the second thing we realised is that it’s not enough to understand why things are going wrong for Aids-affected kids.
“We also need to work out what can help. One of them is the social grants – and we’re also working flat-out on testing whether other social programmes like school feeding schemes, food gardens and social care like positive parenting and teacher support might be helping kids.
“The third thing it made us realise was that there are some issues that we just don’t yet have the programmes to deal with. A major one is child abuse.”
Cluver said it was essential that eligible children are assured access to grants, that social welfare programmes seen to make a difference were upscaled, and that families were supported so they could support their children.
“Parents really want to know how to do the best for our kids,” she said.
RAISING AWARENESS: Women labourers carry water to sprinkle on a sand sculpture created by artist Sudarshan Pattnaik on the eve of World Aids Day on a beach in Konark, about 60km from Bhubaneswar, India, yesterday.
SOUTH AFRICA CARES: About 120 doctors, nurses, staff, bystanders and employees of firms in the CBD formed a line around the Christaan Barnard Memorial Hospital yesterday to honour people suffering from HIV/Aids, in a Netcare-hospital initiative. After a moment of silence, balloons were released.
AID FOR AIDS: Dr Lucie Cluver of Oxford University has been involved in a study assessing the mental and physical health of Aids-affected orphans.