HIV counseling and testing underpin sustainable epidemic control, and international guidelines call for all children in generalized epidemic settings, such as South Africa, to be tested routinely. Identifying effective strategies for expanding pediatric uptake of HIV counseling and testing services is therefore critical.

Adolescent orphans and vulnerable children (OVC) are at heightened risk of HIV infection. Effective preventive strategies are therefore urgently needed. While behavioural interventions are the cornerstone of HIV prevention, psychological interventions may also hold promise as part of a coordinated effort to decrease sexual risk‐taking.

This brief describes the findings and program implications from a study designed to develop critical knowledge on “what works” to improve the well-being of children affected by HIV and AIDS.  Community-based home visiting, in which care workers provide a range of support services during regular visits to the child’s home, is an increasingly popular service delivery approach in South Africa. However, there is enormous variation in how home visiting programs are implemented.  The aim of the study is to evaluate the relative impact on child wellbeing of a range of home visiting models.

Focusing on 13 program sites in KwaZulu-Natal, this report describes the support offered by Isibindi Child and Youth Care Workers (CYCWs) to beneficiary families as well as changes in key measures of children’s wellbeing over a two year period. We further examine differences in the provision of care and support services and changes in wellbeing between beneficiaries at high- and lower-functioning Isibindi sites, according to NACCW’s own site assessment process.

This report concentrates on the physical and emotional maltreatment of orphans and other vulnerable children by adults living in their households. While OVC programs have begun to prioritize child protection interventions, little is known about the prevalence of child maltreatment among the OVC population in South Africa or what factors place children at higher risk.  The findings presented here are drawn from the baseline assessment of a longitudinal study designed to assess the efficacy of a range of interventions for vulnerable children (study methodology and sample characteristics described in greater detail above).

Youth who have been orphaned or otherwise made vulnerable by HIV or AIDS are also at elevated risk for acquiring HIV themselves. Adequate HIV-related knowledge is a critical tool for prevention, and nowhere more so than in the context of a high-prevalence epidemic such as South Africa’s.  Yet, a recent survey found that less than one-third of youth in South Africa had accurate knowledge of HIV.  A particular imperative exists to educate children who are already at increased risk, including those who are socially vulnerable.

Youth who have been orphaned or otherwise made vulnerable by HIV or AIDS are also at elevated risk for acquiring HIV themselves. Adequate HIV-related knowledge is a critical tool for prevention, and nowhere more so than in the context of a high-prevalence epidemic such as South Africa’s.  Yet, a recent survey found that less than one-third of youth in South Africa had accurate knowledge of HIV.  A particular imperative exists to educate children who are already at increased risk, including those who are socially vulnerable.

Living with someone who is chronically ill impacts children’s wellbeing in a number of ways and can exacerbate vulnerability.  Programs for orphans and vulnerable children (OVC) have responded by expanding their enrollment to include children living with sick parents or caregivers, regardless of orphan status. However, relatively little is known about these children’s experiences, and thus about how best to design and implement effective responses. 

This report provides an overview of study methodology and sample characteristics for a study designed to develop critical knowledge on “what works” to improve the well-being of highly vulnerable children (HVC). The study is a longitudinal assessment of several program models — specifically, the National Association of Child Care Workers (NACCW), Heartbeat International, Tswelopele Initiative, Children in Distress Network (CINDI) and their community-based partners — with emphasis on common intervention strategies for providing support to children who have been orphaned or otherwise affected by HIV in South Africa.