Vulnerability Multiplied: Health Needs Assessment of 13–18‐Year‐Old Female Orphan and Vulnerable Children in Kenya

• Date: 01 June 2018
• Author: Nehama Teitelman,Laurie J. Bauman,Rosy Chhabra,Jill Raufman,Ellen J. Silver
• DOI: http://doi.org/10.1002/wmh3.267
• Published date: 01 June 2018

Vulnerability Multiplied: Health Needs Assessment of

13–18-Year-Old Female Orphan and Vulnerable Children

in Kenya

Rosy Chhabra , Nehama Teitelman, Ellen J. Silver,

Jill Raufman, and Laurie J. Bauman

Globally, orphans and vulnerable children (OVCs)affected/infectedbyHIV/AIDSfacemanyhealth

risks, including malnutrition, early/unprotected sex, early forced marriage, HIV and other sexually

transmitted infections (STIs), substance abuse, child labor, and high rates of mental health problems.

We conducted formative research on mental health issues and HIV/STI risk behavior in Kasarani,

a large slum in Nairobi, to guide the development of future interventions. Collaborating with a local

community hospital, we used focus groups in the community to gather information that was used

to generate a survey of 261 OVCs aged 13–18 years. Focus groups converged in deeming that OVCs

were a high-risk group, and girls were especially at higher health risk. Living within an impoverished

environment makes these girls vulnerable to marginalization and exploitation. Specif‌ic concerns for girls

included peer pressure, depression, suicidal ideation, sexual relationship with infected partners, lack

of health education (specif‌ically HIV/STI prevention information), and sexual exploitation by older men.

KEY WORDS: HIV/STI prevention, mental health, OVC

Introduction

Globally, an estimated 16.5 million children have lost one or both parents to

AIDS; the large majority (>80 percent) reside in sub-Saharan Africa (UNAIDS

[Joint United Nations Programme on HIV/AIDS], 2017; UNICEF [United Nations

Children’s Fund], 2013) and most have unmet health needs (Fawzi et al., 2011).

In low-income and developing countries, just estimating the number of orphans

and vulnerable children affected by HIV/AIDS (OVC-HIV) and describing their

needs is daunting. OVC-HIV are those who live with an HIVþparent; have had a

mother, father, or both die of HIV/AIDS; and/or are HIVþthemselves. Most

OVC-HIV in sub-Saharan Africa are poor and lack food, shelter, clothing, health

care, and the opportunity to go to school. They often take on caregiving

responsibilities for their siblings or ill parents, which makes them particularly

vulnerable (Bauman et al., 2006; President’s Emergency Plan For AIDS Relief

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doi: 10.1002/wmh3.267

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[PEPFAR], 2006; Sengendo & Nambi, 1997). Many OVC-HIV adolescents do not

attend school, and their access to sexual and reproductive health information is

limited, which further contributes to their susceptibility to HIV, other sexually

transmitted infections (STIs), and pregnancy (Juma, Alaii, Bartholomew, Askew,

& Van den Born, 2013). In addition, they have to cope with HIV stigma because

of their own status and/or assumed association with AIDS, leading to fear and

rejection by community members (Cluver, Gardner, & Operario, 2007, 2008;

Cluver, Orkin, Gardner, & Boyes, 2012). Studies have reported a link between the

death of a parent and higher mortality among young OVCs (<10 years) even if

the child was HIV-negative (Mermin et al., 2005).

Researchers have proposed linkages among epidemics, chronic diseases, and

lower life expectancies and social-structural conditions: “Structural violence” is

used to refer to the ways these conditions restrict the growth of individuals

and communities (Farmer, Nizeye, Stulac, & Keshavjee, 2006; Galtung, 1969;

McKeown, 1980; Porter, 2006). In this framework, risk factors (e.g., physical injury

or abuse, emotional neglect, death of a parent, lack of educational opportunities,

being a caregiver, poverty, stigma, economic and sexual exploitation, and food

insecurity) not only create vulnerability for psychological distress and disorder

for OVCs (Cluver et al., 2008; Killian & Durrheim, 2008; Lee et al., 2014), they also

support an environment that makes their daily lives susceptible to marginaliza-

tion and oppression.

Kenya, like many other developing sub-Saharan African countries, is struggling

to meet the needs of OVCs. The National Plan of Action for Orphans and Vulnerable

Children Kenya 2007–2010 was enacted in 2007 when the estimate of OVCs aged 0–17

was about 2.4 million; at least half were orphaned by HIV/AIDS. The plan focused

on seven strategic targets of support for OVCs: Strengthening the capacity of

families to protect and care for OVC, mobilizing community level response to OVC

needs, providing essential services, creating a supportive environment for children/

families affected by HIV/AIDS, improving policy and legislation to protect

vulnerable children, improving national capacity for evaluating program effective-

ness, and supporting institutional coordination and structures (Hussein, 2008). The

overall policy was based on a developmental approach tailored to the needs of each

age group. The early childhood (0–5 years) program focused on providing

nutritional needs and supplements, the middle childhood (6–13 years) program

focused on providing life skills and psychosocial support, and the adolescent

program (14–18 years) focused on providing vocational training for f‌inancial

independence (Zhou, 2012). Current governmental r eports estimate that there are

now about 3.6 million orphans living in the country with at least one third orphaned

due to HIV/AIDS (National Council for Children’s Services [NCCS], 2015) and the

emphasis is still on developmental aspects of fulf‌illing OVC needs, with the NCCS

in charge of implementing the national plan in all districts. They are supported by

the area advisory councils (AAC) at the regional and local level, which manage a

network of community volunteers and home visitors who are supported by local

community-based organizations (CBOs), businesses, and faith-based organizations

in providing and evaluating services for OVCs in the area.

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