37 less social marginalization, better family functioning, and more positive feelings toward the children in
thei a e tha o suppo t g oup e e s. Fu the o e, hild e ith a egi e s i suppo t g oups
exhibited fewer behavioral problems, higher rates of pro-social behavior, and reported lower incidence of abuse from adults in their household.
100
Support groups are a relatively straightforward and scalable approach to dealing with the psychosocial needs of caregivers.
5.3 Prioritization of Recommended Interventions
The OVC portfolio prioritizes psychosocial interventions that build on existing supports and resources and place and maintain children in stable and affectionate environments. Prioritization should also be
based on what is known of global best practices and evidence-based interventions for psychosocial care and support as well as the principles for their implementation
– first and foremost, to do no harm. PEPFAR programs should prioritize within their country contexts the following psychosocial
interventions: 1 Parents and family support programs
2 Peer and social group interventions 3 Mentorship programs
4 Community caregiver support
Their interventions should build on the lower levels of the intervention pyramid in Figure 4 while also promoting sustainability through culturally appropriate, targeted approaches.
100
Thurman TR, Jarabi B, Rice J. 2012. Caring for the caregiver: Evaluation of support groups for guardians of orphans and vulnerable children in Kenya. AIDS Care. Feb 2. [Epub ahead of print].
38
6. HOUSEHOLD ECONOMIC STRENGTHENING
6.1 Background
The HIV pandemic affects the economic stability of families and the children in their care by interrupting income streams, depleting assets, introducing labor constraints, and increasing dependency ratios.
101
Approaches to strengthening the economic and food security of families affected by AIDS need to be a part of the continuum of response to preempt a descent into more extreme vulnerability, improve
household welfare, and prevent future risk exposure.
102,103
Household economic strengthening HES comprises a portfolio of interventions to reduce the economic vulnerability of families and empower them to provide for the essential needs of the children in their
care. Social protection is a similar area of programming, with some notable differences: a greater focus on longer-term outcomes and a greater need for systemic government-led initiatives to sustain
interventions. HES tends to focus on shorter-term outcomes, especially on how families accumulate and spend their money. The defining features of both HES and social protection are a focus on families as
direct beneficiaries, with
su ess easu ed a fa il s a ilit to i est i the edu atio , ut itio , a d health of its children. School-based businesses, revenue-generating activities for NGOs, and affordable
provision of essential services are not included under HES.
When considering HES, food security must also be considered, as they are related to one another. The USG considers food security to consist of three interrelated components: access, availability, and
utilization. Recently, a fourth factor has also become prominent: resilience or stability. The HES approaches covered in this section relate directly to the access and resilience dimensions of food
security; the utilization dimension of it is covered in the health and nutrition section. Refer to Annex A for definitions of terms, explanation of concepts, and further review of evidence cited in this section.
6.2 Evidence-Based Implementation Recommendations
HES encompasses a broad range of evidence of varying quality, rigor, and validity for OVC programs.
104
Many categories of interventions could be appropriate, each with its own evidence base. The preponderance of evidence to date validates a conceptual framework for the role of HES approaches in
OVC programs and justifies a prioritization of interventions that seem most appropriate and effective for families participating in these efforts.
101
African Forum and Network on Debt and Development AFRODAD. 2007. The Macroeconomic Framework the Fight against HIVAIDS in Africa. No.3. AFRODAD.
102
Bachmann M, Booysen, F. 2003. Health and economic impact of HIVAIDS on South African households: a cohort study. BMC Public Health. 3 14.
103
Fox M et al. 2004. The Impact of HIVAIDS on Labour Productivity in Kenya. TropMed and International Health. 9 3, 318-324.
104
Child Protection in Crisis Network Livelihoods and Economic Strengthening Task Force. 2011. The Impacts of Economic Strengthening Programs on Children: A Review of the Evidence. Child Protection in Crisis Network.
