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For every child, end AIDS

UNICEF statistics expert honoured for research on the needs of children affected by AIDS

Dr. Priscilla Akwara and team receive award at XVIII International AIDS Conference

© UNICEF/2010/Kuderna
Julio Montaner, President of the International AIDS Society, with UNICEF statistics expert Dr. Priscilla Akwara during announcement in Vienna of the IAS/CCABA Prize for Excellence in Research Related to the Needs of Children Affected by AIDS.

By Roderick Huntress

VIENNA, Austria, 22 July 2010 – When UNICEF statistics expert Dr. Priscilla Akwara looked at the usual ways of assessing a child’s vulnerability in the face of HIV and AIDS, what she saw wasn’t true to her own experience. And so, collaborating with nine co-authors, she became a detective, combing through data to find out which factors can reliably be seen to make a child vulnerable.

The conclusions reached by Dr. Akwara and her co-authors have led to a prestigious award given at the XVIII International AIDS Conference, which is under way this week in Vienna, Austria.

In a ceremony at the conference today, the International AIDS Society (IAS) and the Coalition on Children Affected by AIDS (CCABA) honoured Dr. Akwara and her team with the IAS/CCABA Prize for Excellence in Research Related to the Needs of Children Affected by AIDS. 

‘Who is the vulnerable child?’

IAS President Prof. Julio Montaner and Prof. Lorraine Sherr of the CCABA Steering Committee gave Dr. Akwara a certificate and the $2,000 prize for her abstract, ‘Who is the vulnerable child? Using survey data to identify children at risk in the era of HIV and AIDS’.

© UNICEF/NYHQ2009-1989/Nesbitt
Dr. Priscilla Akwara’s research shows that living with a chronically ill adult or becoming orphaned does not always make children more vulnerable to certain negative impacts. Here, Leontine Mwema of Zambia cares for her nephew Bright, whose mother was gravely ill with AIDS when the photo was taken.

The prize recognizes research that the two sponsoring organizations believe is likely to lead to improved services for children affected by HIV and AIDS.

“I’m very excited about the difference this research is making to policy and programming for children affected by HIV,” said Dr. Akwara, “and about having some of the work I’ve been involved in getting international recognition – especially in a prestigious meeting like this.”

Firsthand knowledge

Dr. Akwara’s research focuses not only on a child’s vulnerability to HIV infection but also on the many ways in which living in a household affected by AIDS can indirectly affect children for the worse.

If an adult falls ill or dies, for instance, the child may have to leave school and work to support the family. Meals may not be available regularly, and the child’s access to health care may be limited. That’s why children who are orphaned or living with a chronically ill adult are frequently considered vulnerable. 

Dr. Akwara comes from Kenya, in sub-Saharan Africa, the region where the global AIDS epidemic has taken the greatest toll. Some of her family members have died of AIDS, and she has cared for children left orphaned by the disease. 

Based on this personal understanding of the epidemic’s impact, she believed that children affected by AIDS don’t necessarily miss school or go without meals. But she needed to prove it – and to find out which other conditions could be linked to vulnerability.

New recommendations

Dr. Akwara and her co-authors studied 60 surveys of household data from 36 low- and middle-income countries, mainly in sub-Saharan Africa. They wanted to determine whether being orphaned or living with a chronically ill adult consistently led to three specific negative outcomes for children: hunger, lower school attendance and a first sexual experience at an early age.

Their findings bore out Dr. Akwara’s observations. The data showed that a parent’s death or chronic illness from AIDS could not consistently be tied to these negative outcomes. In the course of their work, however, she and the research team found one factor, in particular, that was reliably linked to vulnerability – namely, the level of wealth in a child’s household. 

Based on their results, Dr. Akwara and her co-authors recommend looking beyond the usual measures of vulnerability and instead using a broader range of criteria, including household wealth. They also suggest that measures of vulnerability be calibrated to account for each country’s unique conditions.

Improved care and protection

This research has led UNICEF and other organizations to redefine the vulnerability of children affected by AIDS, as well as the measures of progress toward making children less vulnerable. Until new measures are developed, some standard questions have been removed from the main surveys used to collect data about children and the epidemic.

The changes reflect a determination to think more precisely about how children become vulnerable to HIV and AIDS, and to find better ways to safeguard them.

Dr. Akwara says some people were baffled when questions once routinely included on the data surveys disappeared. But in time, she notes, they realized that the new approach could lead to improved care and protection for children.

“People seem to understand,” she says, “that we needed to go back to the drawing board and get our measurements right.”



Co-authors of 'Who is the vulnerable child?'

The report honoured at the XVIII International AIDS Conference was co-authored by Dr. Priscilla Akwara and her team:

  • Upjeet Chandan, Consultant, New York, USA
  • Kiersten B. Johnson, Senior Research Associate, ICF Macro, Calverton, MD, USA
  • Jimmy Kolker, Chief, HIV and AIDS Section, UNICEF, New York, USA
  • Patricia Lim Ah Ken, Programme Specialist, HIV and AIDS Section, UNICEF, New York, USA
  • Chewe Luo, Senior Adviser, HIV and AIDS Section, UNICEF, New York, USA
  • Doreen Mulenga, Representative, UNICEF, Gaborone, Botswana
  • Behzad D. Noubary, Programme Specialist, HIV and AIDS Section, UNICEF, New York, USA
  • William Winfrey, Senior Economist, Futures Institute, Glastonbury, CT, USA
  • Rachel Yates, Senior Adviser, HIV and AIDS Section, UNICEF, New York, USA

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