Campbell Catherine, Andersen Louise, Mutsikiwa Alice, Madanhire Claudius, Skovdal Morten, Nyamukapa Constance, Gregson Simon
Department of Social Psychology, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
BMC Public Health. 2014 Apr 26;14:402. doi: 10.1186/1471-2458-14-402.
HIV has left many African children caring for sick relatives, orphaned or themselves HIV-positive, often facing immense challenges in the absence of significant support from adults. With reductions in development funding, public sector budgetary constraints, and a growing emphasis on the importance of indigenous resources in the HIV response, international policy allocates schools a key role in 'substituting for families' (Ansell, 2008) in supporting child health and well-being. We explore children's own accounts of the challenges facing their HIV-affected peers and the role of schools in providing such support.
Contextualised within a multi-method study of school support for HIV-affected children in rural Zimbabwe, and regarding children's views as a key resource for child-relevant intervention and policy, 128 school children (10-14) wrote a story about an HIV-affected peer and how school assisted them in tackling their problems.
Children presented harrowing accounts of negative impacts of HIV on the social, physical and mental well-being of peers, and how these manifested in the school setting. Whilst relationships with fellow learners and teachers were said to provide a degree of support, this was patchy and minimal, generally limited to small-scale and often one-off acts of material help or kindness (e.g. teachers giving children pens and exercise books or peers sharing school lunches), with little potential to impact significantly on the wider social drivers of children's daily challenges. Despite having respect for the enormity of the challenges many HIV-affected peers were coping with, children tended to keep a distance from them. School was depicted as a source of the very bullying, stigma and social exclusion that undermined children's opportunities for well-being in their lives more generally.
Our findings challenge glib assumptions that schools can serve as a significant 'indigenous' supports of the health and well-being of HIV-affected children in the absence of a very significant increase in outside training, support and additional resources. Schools are an extension of communities, with members of school communities subject to many of the same deprivations, anxieties and prejudices that drive the health-limiting exclusion, impoverishment and stigmatisation of HIV-affected children in their households and wider communities.
艾滋病毒使许多非洲儿童要照顾生病的亲属，或是成为孤儿，又或是自身感染了艾滋病毒，在缺乏成年人有力支持的情况下，他们常常面临巨大挑战。随着发展资金的减少、公共部门预算的限制，以及在应对艾滋病毒方面对本土资源重要性的日益重视，国际政策赋予学校在“替代家庭”（安塞尔，2008年）方面的关键作用，以支持儿童的健康和福祉。我们探究了儿童自己对受艾滋病毒影响的同龄人所面临挑战的描述，以及学校在提供此类支持方面所起的作用。
在一项关于津巴布韦农村地区学校对受艾滋病毒影响儿童支持情况的多方法研究背景下，并且将儿童的观点视为与儿童相关干预措施和政策的关键资源，128名10至14岁的学童撰写了一个关于受艾滋病毒影响的同龄人的故事，以及学校如何帮助他们解决问题。
儿童讲述了艾滋病毒对同龄人社会、身体和心理健康产生负面影响的惨痛经历，以及这些影响在学校环境中的表现。虽然与同学和教师的关系据说能提供一定程度的支持，但这种支持并不稳定且非常有限，通常仅限于小规模且往往是一次性的物质帮助或善意行为（例如教师给孩子们钢笔和练习本，或者同学分享学校午餐），对儿童日常挑战的更广泛社会驱动因素几乎没有显著影响的潜力。尽管尊重许多受艾滋病毒影响的同龄人所应对挑战的艰巨性，但孩子们往往与他们保持距离。学校被描绘成欺凌、污名化和社会排斥的源头，而这些行为更普遍地破坏了孩子们在生活中获得幸福的机会。
我们的研究结果挑战了那种轻率的假设，即在外部培训、支持和额外资源没有大幅增加的情况下，学校能够成为受艾滋病毒影响儿童健康和福祉的重要“本土”支持力量。学校是社区的延伸，学校社区成员也遭受着许多相同的贫困、焦虑和偏见，这些因素导致了艾滋病毒感染儿童在家庭和更广泛社区中被健康限制、被排斥、陷入贫困和遭受污名化。
