This study investigates predictors of resilience in young people orphaned by AIDS, living in poor, urban settlements in Cape Town, South Africa. This is the developing world’s first longitudinal study of AIDS-affected children. It has followed 1025 children and youth over four years. The study includes a longitudinal quantitative dataset on psychological, educational and sexual health outcomes, and a detailed qualitative study focusing on AIDS-orphaned children’s perceptions of religion as a supportive or unsupportive factor in their lives.

The study has produced a number of key findings and outputs. These include 5 papers either published or in press at high ranking peer-reviewed journals (e.g. Journal of Child Psychology and Psychiatry, Journal of Acquired Immune Deficiency Syndromes, and Journal of Pediatric Psychology), and an invited commentary piece in Nature. Findings have been presented to the Global Fund, as well as in plenary presentations at the ICASA, AIDS Impact, and World Mental Health conferences.

The project and it’s sister study, the Young Carers Study, has had good press coverage, with at least 17 newspaper and internet media articles, and podcasts totalling 10,700 viewings (including Radio 4, BBC World Service, and Voice of America).

Several key national and international policies have directly utilised the research findings, including the Southern African Development Community (SADC) Minimum Package of Services for Vulnerable Children, the South African National Action Plan for children Infected and Affected by HIV/AIDS, the Lesotho Government programme of care for OVC, and the World Health Organisation Ethical Guidance notes for working with adolescents.

This project is made possible by funding from the Nuffield Foundation.

Young Carers Project

The Young Carers study is an innovative collaboration between the South African Government (Departments of Social Development, Health and Education, Department of Agriculture), Universities (Oxford, University of Kwa-Zulu Natal, University of Witwatersrand) and major NGOs (Save the Children, UNICEF and the South African National Action Committee for Children Affected by AIDS).

This ongoing study has interviewed 6002 children and 2744 adult caregivers in six urban and rural sites in South Africa. Stratified random sampling of census enumeration areas in health districts of over 30% HIV-prevalence was used in three provinces, and one-year followup data collection is underway. The study examines the impact on children of having a parent who is sick with HIV/AIDS or other illnesses, and especially on those children who act as 'Young Carers' for sick adults in the home. We look at mental health, physical health, sexual health and educational outcomes, and identify policy-relevant risk and protective factors which can inform interventions.

Policy briefs of all findings are available from the website (www.youngcarers.org.za). Two participant-led movies are underway, and the Teen Advisory Group’s participatory ‘Young Carers’ film will be used as part of a Save The Children guide for NGOs in programming for work with vulnerable children.

More details on this project can be found on the Young Carers website.

Most at risk groups for HIV infection in coastal Kenya

The Department of Public Health collaborates with Kenya Medical Research Institute (Kilifi), The Wellcome Trust, University of Washington & Brown University in ongoing epidemiological, behavioural, clinical, genetic and intervention studies amongst groups at high risk of HIV in Kenya. To date, this work has provided compelling indications of marked HIV risk in a hitherto understudied MSM population: our studies of MSM in coastal Kenya have examined HIV seroprevalence, STI symptoms, and sexual risk behaviours. HIV prevalence was 21% among men who had sex - more than 3 times higher than estimates from adult Kenyan men. Most MSM (82%) report unprotected sex during the past 3 months, and most report selling sex for money or goods in the past 3 months. Forty percent of these men had sex exclusively with other men, and 60% had sex with men and women, and genotyping of HIV-1 viral strains from MSM with acute HIV infection support behavioural observations that the epidemic in MSM is not discrete from the general epidemic in this setting and suggesting mixing between sexual networks in the region. Owing to these recent findings, National AIDS Control Council of Kenya included MSM as a target risk group for behaviour change in its National Strategic Plan to 2014. Ongoing and future projects aim to further describe the social and sexual networks of MSM, female sex worker and drug users in Kenya, to identify amenable risks for HIV infection amongst these populations as well as their role within generalized HIV epidemics, and to develop, adapt and test interventions aimed at reducing HIV transmission and increasing access to diagnosis and care.

Financing and Governance of HIV/AIDS

This research initiative examines the financing and governance of HIV/AIDS. It includes projects tracking funding for HIV/AIDS both at the global level from the major donors as well as in-country, identifying lessons from the global response to HIV/AIDS for other chronic diseases such as diabetes and heart disease, and analysing the factors explaining government response to the disease. In addition, in 2008, the Global Economic Governance Programme and the Center for Global Development jointly convened a working group on UNAIDS which re-examined the role of the institution within global health governance.