Anabwani Gabriel, Karugaba Grace, Gabaitiri Lesego
Botswana-Baylor Children's Clinical Centre of Excellence, Plot 1836 Hospital Road, Private Bag BR129, Gaborone, Botswana.
Baylor College of Medicine, Pediatric Retrovirology, Houston, Texas, USA.
BMC Pediatr. 2016 Jul 22;16:106. doi: 10.1186/s12887-016-0643-5.
Antiretroviral treatment means many HIV infected children are surviving with a highly stigmatised condition. There is a paucity of data to inform policies for this growing cohort. Hence we carried out a study on the health, schooling, needs, aspirations, perspectives and knowledge of HIV infected and affected children in Botswana.
A cross-sectional survey using interviews and focus group discussions among HIV infected children aged 6-18 years versus HIV aged matched HIV uninfected counterparts living in the same households between August 2010 and March 2011. Supplemental clinical data was abstracted from medical records for HIV infected participants.
Nine hundred eighty-four HIV infected and 258 affected children completed the survey. Females predominated in the affected group (63.6 % versus 50.3 %, P < 0.001). School attendance was high in both groups (98.9 % versus 97.3 %, P = 0.057). HIV infected children were mostly in primary school (grades 3-7) while affected children were mostly in upper primary or secondary grades. Sixty percent HIV infected children reported having missed school at least 1 day in the preceding month. Significantly more infected than affected children reported experiencing problems at school (78 % versus 62.3 %, P < 0.001). Twenty-two percent of 15-18 year old HIV infected children were in standard seven and below compared to only 8 % of HIV affected children (p = 0.335). School related problems included poor grades, poor health/school attendance, stigma and inadequate scholastic materials. The wish-list for improving the school environment was similar for both groups and included extra learning support; better meals; protection from bullying/teasing; more scholastic materials, extracurricular activities, love and care; structural improvements; improved teacher attendance and teaching approaches. Significantly more HIV infected children reported feeling hungry all the time (50.6 % versus 41 %, P = 0.007) and more trouble hearing (26.8 % versus 12.5 %, P = 0.028). The mean age for HIV disclosure 10 years was high. Sexual activity (9.2 % versus 3 %, P = 0.001) and emotions of anger (71 % versus 55.3 %, P < 0.001) were significantly higher among HIV affected children. Future perspectives were equally positive (93 % versus 96 %, P = 0.080), were predicated on children's school performance, self-belief/determination and/or ARVs and preference for medical or military careers was common.
In Botswana almost all school-age HIV infected and affected children are attending school but many face daunting challenges that call for the creation of an empowering, empathetic, supportive, caring, and non-discriminating school environment.
抗逆转录病毒治疗意味着许多感染艾滋病毒的儿童在带着一种备受污名化的状况生存。缺乏数据为这一不断增长的群体制定政策提供依据。因此，我们对博茨瓦纳感染艾滋病毒及受其影响的儿童的健康、上学情况、需求、愿望、观点和知识进行了一项研究。
2010年8月至2011年3月期间，采用访谈和焦点小组讨论的方式，对6至18岁感染艾滋病毒的儿童以及与他们年龄匹配、生活在同一家庭中未感染艾滋病毒的儿童进行了横断面调查。从感染艾滋病毒参与者的医疗记录中提取补充临床数据。
984名感染艾滋病毒的儿童和258名受影响儿童完成了调查。受影响组中女性占多数（63.6%对50.3%，P<0.001）。两组的入学率都很高（98.9%对97.3%，P = 0.057）。感染艾滋病毒的儿童大多在小学（3至7年级），而受影响儿童大多在上小学高年级或中学。60%感染艾滋病毒的儿童报告在前一个月至少缺课1天。报告在学校遇到问题的感染儿童明显多于受影响儿童（78%对62.3%，P<0.001）。15至18岁感染艾滋病毒的儿童中有22%处于七年级及以下，而受艾滋病毒影响的儿童中这一比例仅为8%（P = 0.335）。与学校相关的问题包括成绩差、健康/出勤状况不佳、污名化以及学习材料不足。两组改善学校环境的愿望清单相似，包括额外的学习支持；更好的膳食；免受欺凌/取笑；更多的学习材料、课外活动、关爱；结构改善；提高教师出勤率和改进教学方法。明显更多感染艾滋病毒的儿童报告一直感到饥饿（50.6%对41%，P = 0.007），听力问题也更多（26.8%对12.5%，P = 0.028）。艾滋病毒披露的平均年龄为10岁，这一数字较高。受艾滋病毒影响的儿童中的性活动（9.2%对3%，P = 0.001）和愤怒情绪（71%对55.3%，P<0.001）明显更高。对未来的展望同样积极（93%对96%，P = 0.080），这基于儿童的学业成绩、自我信念/决心和/或抗逆转录病毒药物，并且对医学或军事职业的偏好很常见。
在博茨瓦纳，几乎所有学龄感染艾滋病毒及受其影响的儿童都在上学，但许多儿童面临严峻挑战，这需要营造一个赋权、有同理心、支持性、关爱且无歧视的学校环境。
