Globally, more than 35 million individuals are living with HIV, the majority of which are found in sub-Saharan Africa (SSA). Advancements in availability of Anti-Retrovirals (ARVS) have played a significant role in reducing the impact of HIV – with 90% of those who are aware of their status in SSA on treatment. The availability of life-saving drugs to children is of particular importance to new efforts to mediate the disease- as early exposure to drugs enables most infected individuals to lead long and healthy lives, with only minimal medical implications if drugs are managed effectively. However, successes championed by pillars of the global health apparatus such as the WHO and UNAIDS – tell only one side of the picture – with little attention to the broader psycho-social impacts of the realities of ‘living’ with HIV. For many, life is not immediately improved by access to drugs – living with chronic conditions in a low income country are difficult to say the least – with factors such as food and income insecurity, as well as stigma emerging as psycho-social drivers affecting drug adherence.
The impact of the above factors are further exacerbated by the dynamics of childhood. Issues linked to formation of identity, parental influence, and relative power within broader families and communities will also have impacts on how children make use of HIV services – an interest which forms the focus of a newly released special issue in the journal Children and youth services Review, titled Children and Youth Growing Up with HIV Infection in Sub-Saharan Africa: Implications for Health Service Delivery, edited by Morten Skovdal from the university of Copenhagen, and Sara Belton from the LSE.
The idea that medicine alone will lead to a better quality of life for those affected by HIV/AIDS is an illusion that is well in need of dismantling. The evidence presented in this special issue goes a long way in highlighting not only the why, but also providing directions for the how. Contributions highlight the importance of services that adhere to culture, power, identity, poverty and gender – in order to ensure that HIV-positive children have access to the most comprehensive care possible. Lessons highlighted by papers from countries across sub-Saharan Africa (Uganda, Kenya, South Africa and Mozambique – to name a few) are valuable for those planning services for HIV affected children – in both low and high-income country settings.