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Improving early childhood development outcomes for children affected by HIV and AIDS

Hilton, Steven M.

doi: 10.1097/QAD.0000000000000358
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Chairman, President and CEO, The Conrad N. Hilton Foundation.

Correspondence to Steven M. Hilton, 30440 Agoura Road Agoura Hills, CA 91301, USA. Tel: +1 818 851 3700; e-mail:

Improving the lives of the disadvantaged and most vulnerable has been a central component of the Conrad N. Hilton Foundation's mission since 1944. Conrad N. Hilton's last will and testament specifically stated his desire to ‘… shelter little children with the umbrella of [charity].’ When we made the decision to address the needs of children affected by HIV and AIDS in the east and southern African region, HIV and AIDS had already taken a heavy toll on individuals, families and communities. Children had been and continue to be particularly vulnerable and overlooked. We therefore consulted with numerous experts and organizations to determine how we could make a difference and to understand the gaps.

We learned that the first 5 years are critical to a child's ability to be able to learn and gain life skills. We also now know that children in any society who lack nurture and stimulation for their early development face lifelong gaps in education and income compared to their peers, and struggle to achieve their full potential. For children in sub-Saharan Africa, a large proportion of whom are affected by HIV and AIDS, the absence of early development support is more acute and the consequences are more critical. We learned that families and communities play a key role in helping these children. Consequently, the Foundation wanted to maintain, reinforce and bolster families and community groups, ensuring that they are linked to government policies, and health and education systems.

Our research identified a particular gap in essential services to meet the special needs of children under 5, a critical stage for healthy development and well being. Therefore, the Foundation's focus over the past 2 years has supported the ability of families to provide better age-appropriate care – including cognitive stimulation and learning for children birth to 5 years of age. Our strategy seeks to enhance the ability of community-based organizations to deliver quality programs and services, and promotes effective practice and policy informed through global and national knowledge sharing. Through our support, a virtual learning community has been created, involving a total of 17 implementing partners working to improve cognitive, social, and physical development outcomes for young children affected by HIV and AIDS. Program approaches include home visiting, child care centers, parent support groups, and linkages to integrated services among HIV-affected communities in east and southern Africa.

At this early stage, we are encouraged by the leadership our partners are demonstrating to foster coordination at multiple levels with national and local governments. They have found multiple entry points to integrate services which put the vulnerable young child at the center of our efforts. The examples include: community-based nutrition, economic strengthening, HIV and AIDS-prevention programs, as well as clinic-based efforts for prevention of mother-to-child HIV transmission (PMTCT).

The Foundation is committed to continual learning to generate new culturally appropriate knowledge. In partnership with the Human Sciences Research Council in South Africa, we are finding the ongoing need: to build expertise in early childhood development at all levels of the program; to support the development of assessment tools by which children's improvement can be gauged; to find cost-effective approaches to training to enhance program quality; to enhance support for caregivers and community volunteers; and to ensure that impact is rigorously assessed and knowledge disseminated. We are also experimenting with scaling-up efforts to reach greater numbers of local organizations with training and ongoing mentoring.

Key questions remain as to how best to integrate interventions and address stimulation and early learning as part of other aspects of prevention, treatment and care. We acknowledge the challenge of taking a multisectoral, integrated approach that puts children front and center, but we believe that the effort is well worth it. Although we are seeing encouraging progress in breaking down the silos that have traditionally existed between sectors including HIV and AIDS, child survival and early childhood education, there is much more that needs to be done. We are gratified to be part of the movement to address early childhood in this context and we invite all stakeholders to come together to better integrate and coordinate services to help all children to realize their full potential.

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Conflicts of interest

There are no conflicts of interest.

© 2014 Lippincott Williams & Wilkins, Inc.