20th International AIDS Conference - Melbourne, Australia


WEPE254 - Poster Exhibition

The contribution of schools to supporting the wellbeing of children affected by HIV in Eastern Zimbabwe

E.L. Pufall1, S. Gregson1, J.W. Eaton1, T. Masoka2, E. Mpandaguta2, L. Andersen3, M. Skovdal4, C. Nyamukapa1,2, C. Campbell3

1Imperial College London, Department of Infectious Disease Epidemiology, London, United Kingdom, 2Biomedical Research and Training Institute, Harare, Zimbabwe, 3London School of Economics, Department of Social Psychology, London, United Kingdom, 4University of Copenhagen, Department of Public Health, Copenhagen, Denmark

Background: Schools are often cited as sources of support for orphaned and vulnerable children (OVC) in populations experiencing generalised HIV epidemics and severe poverty. Even in conditions of poverty, schools have portfolios of assets they can use to support children. ''HIV-competent schools'' are theorised as an environment where people work collectively to reduce stigma, promote positive behaviour change, and support children affected by HIV. We use the concept of ´HIV-competence´ to investigate the success of schools at including and supporting the wellbeing of OVC in rural eastern Zimbabwe.
Methods: Data from a cross-sectional household survey of 4,577 children (2,328 girls and 2,249 boys, aged 6-17) conducted between 2009 and 2011 as part of the Manicaland Project were linked to data on characteristics of 28 primary and 18 secondary schools from a parallel facility survey. We developed a composite indicator of school HIV-competence, which included measures of physical infrastructure, HIV policies, fee structure, community links, teaching, and extracurricular activities. We used multivariable regression (adjusting for age, gender, socio-economic status, community type, and contextual community-level factors) to test if HIV-competence was associated with improved educational outcomes (attendance and being in the correct grade-for-age) and wellbeing for children overall and for OVC specifically.
Results: HIV-competence was not associated with primary or secondary school attendance, but was associated with children being in the correct grade-for-age (p=0.04). Additionally, females were 2.20 times (p=0.001) more likely to be in the correct grade than males; gender had no effect on any other outcomes. For primary school-age children, schools with the highest level of HIV-competence were associated with better wellbeing for children overall (p=0.04), but the association did not differ between vulnerable and non-vulnerable children. For secondary school-age children, HIV-competence was not associated with wellbeing. Community-level contextual factors, including higher levels of community group participation (p=0.04) and lower HIV prevalence (p=0.001), were associated with greater child wellbeing. Community group participation was also associated with higher levels of secondary school attendance (p=0.01).
Conclusions: HIV-competence is associated with greater wellbeing in primary school children in eastern Zimbabwe. Local community context also plays a role in schools´ ability to include and support children.

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