UNICEF, New York, USA.
Correspondence to Pia Rebello Britto, Senior Advisor and Chief Early Childhood Development, UNICEF, 3 UN Plaza, New York, NY 10017, USA. Tel: +1 212 303 7955; e-mail: firstname.lastname@example.org
Received 6 June, 2014
Revised 6 June, 2014
Accepted 6 June, 2014
Date: May 12, 2014
Families are the first and most significant influence on a child's development. They are the architects of the contexts in which children grow, learn, and are nurtured. During the formative years of life, from conception to 8 years of age, also known as the early childhood period, the foundation is laid for physical health, cognitive functioning, social interactions, emotional relationships, and ability to succeed and achieve. The great strides in development in early childhood are the result of a combination of genetic and environmental factors demonstrating a lyrical dance between early relationships and the developing brain . Research has also demonstrated early caregiving can alter brain chemistry and architecture in ways that reverse negative development, not just for the immediate generation but also for the subsequent generations .
Children living with HIV, as well as those exposed to or affected by HIV, very often face multiple forms of adversity early in life that can set in motion a downward spiral of negative life outcomes. Developmental delays, as well as physical and mental health challenges and stresses, can occur . The economic burden of HIV on families, as well as stigma and discrimination, can further add to the challenges experienced .
UNICEF's mandate to promote the rights of all children and our programmatic focus on achieving equity in the survival, growth, development, protection, and participation of the most disadvantaged and socially excluded children demand particular attention to young children affected by HIV and AIDS. A situational analysis of the health and developmental status of young children living in high-burden HIV communities in Kenya, Tanzania, and Zambia found that although it is challenging to get a complete picture of the conditions of young children infected and affected by HIV, there are a few areas that warrant consideration. For example, while the number of new infections among children in poor countries has dropped by over 50% between 2001 and 2012, children living with HIV are only half as likely to receive treatment as adults (34 versus 64% coverage; ); the number of children orphaned because of HIV has increased by 20–30% in the same time . Second, most children who are affected by AIDS, including those who have lost one or both parents, rely on families as their main source of care. Family-centered services are the best option for those children, as they reinforce the family care that is already in place, and they consistently produce improved health outcomes.
UNICEF is emphasizing in its HIV programming support to countries to better align programmatic approaches used by HIV and early childhood development (ECD) sectors to best serve the needs of young children living with or affected by HIV high-burden settings. We have initially focused efforts on the three countries, supported by a grant from the Conrad N Hilton Foundation. The HIV/ECD work is linked to a broader effort, known as the ‘Double Dividend’ approach to better align programming for HIV with programming for maternal and child survival, as well as health, growth, social, and child protection . We know that an early-integrated approach to addressing HIV, especially in high HIV prevalence settings, can more effectively protect children and can be more efficient.
At the beneficiary level, given the foundational importance of ECD for all children, efforts are focused on improving young child development and well being. While recognizing the context is the most important influence on children's development, the programmes and approaches focus on families, parents, and caregivers. At the levels of both the facility-based clinical service and the community-based services, we focus on the multiple adversities that face young children and families. Community-based settings address a wide range of health and social services, including HIV prevention, treatment, care, and support, and ECD by incorporating three broad areas of services. First, initiatives that create zones that allow for young children to play and have positive interactions with adults and peers. Second, support parents in parenting and feel empowered in doing so. Third, strengthen referral linkages for treatment and child health services. In Kenya, this emphasis is noted with respect to improving learning outcomes for young children and has resulted in strengthening the quality of community-based childcare centers in high-burden municipalities.
At the clinical level, we are integrating HIV prevention and treatment into broader maternal, newborn and child health service delivery platforms, to ensure that clinical service delivery models recognize the need for a broader range of protection, care, and support services for vulnerable children, and are able to effectively link with the community-based service delivery networks. For example, in Tanzania, mothers support groups across several districts, in addition to prevention of mother to child transmission interventions for HIV-infected mothers, those provide nutrition counseling for their children's development and psychosocial support for parenting.
At the policy level, we are working in Kenya, Tanzania, and Zambia, to support government linkages across sectors and national and decentralized levels of government through policy guidance. In Zambia, for example, through coordination between the ministries of education, community development, and local government, several districts have established multisectoral ECD committees that have been able to advocate for recruitment of over 1000 trained ECD teachers in HIV high-prevalence districts. In Tanzania, the national integrated ECD policy has been merged into a broader child development policy that covers all children from birth to 18 years of age. This new policy has allowed an entry point for programming throughout childhood, taking a life course perspective.
We are working in an innovative manner to establish convergence between ECD and HIV programmes that are supporting the treatment of pediatric AIDS, prevention of maternal-to-child transmission, and treatment for the health of the mother, with a broad range of community-level protection, care, and support programmes for vulnerable children and children affected by HIV. However, this nascent work needs to be further developed and evaluated in order to fully maximize the breadth, coverage, and impact of ECD programmes for young children and families in high-burden HIV communities.
Conflicts of interest
There are no conflicts of interest.
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