Providing the Best Future for Children Orphaned by HIV

Published February 12, 2013 under Research News

orphaned child in Uganda

98% of orphaned and abandoned children experience one or more traumatic events like physical and sexual abuse, or family violence, in addition to the loss of their parent.

Children’s lives are being saved as a result of innovative technologies like the Duke ARV pouch, which contains life-saving medicine to prevent the spread of HIV from mother to baby. But, the reality is more than 50 million children in sub-Saharan Africa have lost one or both parents to HIV/AIDS. They are part of an estimated 153 million orphaned and abandoned children living across the world who face tough odds.

Concerned about how best to care for these children, researchers from the Duke Center for Health Policy and Inequalities Research (CHPIR) are undertaking one of the largest known studies to examine the health and well-being of 3,000 orphans across five countries – Cambodia, Ethiopia, India, Kenya and Tanzania.

The groundbreaking research has challenged the policies of children’s rights organizations on a global scale. While organizations like UNICEF and UNAIDS have held that orphanages should only be a last resort, CHPIR research suggests orphanages are viable options for children. Findings show that children in orphanages have the same, or better, physical and emotional health as children living with extended family or neighbors.

"This is not the time to be creating policies that shut down good options for kids. Our research just says slow down and let’s look at the facts,” said Kathryn Whetten, who leads the positive outcomes for orphans (poFo) research. “It’s assumed that the quality of caregiving is a function of being institutionalized, but you can change the caregiving without changing
the physical building.”

The POFO team, which also includes Duke researchers Lynne Messer, Karen O’Donnell, Jan Ostermann, Brian Pence, Nathan Thielman, Rachel Whetten and international grassroots organizations, is working with UNICEF to update its caregiving policies. Duke researchers are also proposing new criteria for defining institutional care, with the hope that global policies can more closely align with differences in care between cultures and countries.

In addition to important policy changes, Whetten’s research has found that nearly all orphans have experienced physical and sexual abuse or family violence. Translating this research into service, Whetten and her team are scaling up a childhood traumatic stress and grief intervention, which is helping orphans and their guardians cope. The cognitive behavioral therapy program supports more than 300 orphans ages 7-13 in two East African countries. The novel program is also building capacity among local lay counselors to provide the training and support these children need.

"This is not the time to be creating policies that shut down good options for kids. Our research just says slow down and let's look at the facts."

- Kathryn Whetten, DGHI