Family Centred

Approach
HIV/AIDS
“ A definition of the family-centred approach that is
widely used in the area of HIV is:

‘A comprehensive coordinated care approach that

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“
The above definition highlights two principles that are important in
family-centrednprogramming and policy development:
● Social care and health needs are both addressed, including
developmental, cognitive and emotional needs.
● The holistic needs of the family are met by a number of different
groups, so referral and coordination between groups and agencies is
needed

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● From this definition we can see that in family-centred programmes we need
to know where the family of the child is and who the family members are
– direct relatives, extended family, or carers in different settings.
● We need to know how the situation of the family affects the child, their
wellbeing and their opportunities for development.
● The family-centred approach recognises that supporting the family is one of
the most effective means of ensuring the best possible quality of life for
the child.
● Supporting and strengthening families so that children can be cared for in a
family setting, where possible, rather than in institutions such as orphanages,
is key to a family-centred approach

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“ Why should we apply a
family-centred approach
to our work with children
affected by HIV?

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● Families are the primary unit of care for children
Research shows that the health of female carers, particularly mothers and
grandmothers, has a significant impact on household welfare, including the nutritional
status of children. The deaths of adult women decrease opportunities for children to
attend school, while increasing nutritional insecurity and household poverty.
• Families provide the best outcome for children
The United Nations (UN) Guidelines for the Alternative Care of Children produced in
2009 also endorse the concept that children should be cared for within families
whenever possible. However, while keeping children within a family is usually
preferable, not every family is functional, and abuse and neglect within families does
occur. Alternative care should be available when children are at risk, but in a family-
like setting wherever possible

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● HIV within families
HIV can be transmitted within families: sexually
between adult partners; through transmission
from mother to child; and through sexual abuse
between adults and children. If one member of a
family is HIV positive it is likely that other
members of the family have been exposed, either
sexually or through parent-to-child
transmission.

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● Impacts of HIV are experienced within families
When a person is diagnosed with HIV the impacts go beyond the
individual themselves and affect other family members. The cost of
treatment, travelling to medical appointments and the loss of income
when they are unable to work reduces the money available within the
family for essentials like food and school fees.
Illness or death of the adult breadwinner may mean children need to
leave school in order to work. Young girls may have to engage in sex
work, or families may split when members migrate to find work and
others stay behind.

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“ How do we go about implementing a family-
centred programme, or adapting our current
programmes to be more family centred?

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 Health
● Providing health services for family members together in one place

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Programmes should consider:
● Promoting access to both adult and paediatric specialist health workers to meet the
different needs of adults and children in one location limited settings this may mean
additional training so health workers can respond to the specific needs of children and
communicate effectively with different age groups)
● creating linkages and referrals between departments and service areas, where case
management is not possible, to ensure that all family members can access the range of
services they need
● providing services together to improve care to families and reduce the time and cost of
travelling to separate service providers
● adapting individual health interventions using a family-centred approach so they have
a greater impact for families and children; for example, encouraging men to
accompany their partners for PPTCT, and referring siblings for testing through PPTCT
interventions(in resource-

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● Prevention of parent-to-child transmission

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HIV counselling and testing
Programmes should consider:
● making early contact with families, especially through PPTCT, to increase early infant
diagnosis, initiation of co-trimoxazole39 prophylaxis and testing of young children who
may otherwise remain untested
● Taking testing into the home as an effective way of reaching people previously untested,
and supporting family disclosure (while recognising that maintaining individual informed
consent and confidentiality may be difficult in families where some members have
authority or power over others and may coerce them into testing or sharing their results)
● Recognising the possibility of negative impacts of a positive test, such as rejection or
domestic violence, and ensuring they are addressed within the family as well as the
resulting need for support to parents

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● recognising the specific considerations around testing children and their right to be
involved in decisions that affect their lives as well as the lifelong commitment required
of family members to a child’s HIV treatment and care
● ensuring that tests are done in the best interests of the child, and that parents’ decision
about when to test and disclose results is done in their child’s best interests
● ensuring that when testing children there is consent for the counselling as well as the
testing process ensuring that children know that they can withdraw at any time
● ensuring that counsellors support children to understand the implications of tests and
next steps, depending on the result.

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Disclosure
Programmes need to consider:
● supporting parents to disclose to their children, and helping them understand the process
of disclosure and acceptance, and the different stages and emotions a child may go
through depending on their age and maturity
● recognising that adolescents face specific challenges in sharing their HIV status with
their families and peers, and adapting to their diagnosis
● addressing the different psychosocial impacts on parents, adolescents and children of a
positive diagnosis, and tailoring responses accordingly
● developing psychological support to families over the long term as well as at the time of
diagnosis
● promoting among clinical staff the value of engaging with families and supporting them
to carry out disclosure.

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Treatment and adherence
Programmes should consider:
● tackling common barriers to adherence with the whole family, including costs of
treatment, transport to clinics, nutrition and other health issues
● promoting mutual support between family members, which can improve adherence
● providing nutritional support and guidance to the whole family, alongside treatment
support
● recognising that adherence issues change with the age of the child, related to their
understanding of treatment, growing independence and ability to take personal
responsibility for their own treatment.

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Home-based and palliative care
Programmes should consider:
● training home-based carers to provide physical and emotional care in the home for adults who are unwell, and to assess
all the family and identify the needs of children and other vulnerable adults in the household
● home-based carers providing training and support to children who are caring for adult family members in order to
address gaps in their knowledge, which can be a significant source of anxiety for them
● addressing the specific needs of children in dealing with grief, bereavement and end-of-life decisions
● supporting families in succession planning, dealing with property and land nheritance, care options and death
registration
● providing practical advice about burial and legal processes on the death of a family member, and including children in
the decision-making process

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Other sectors
● Economic strengthening
● Food and nutrition
● Education and early childhood development
● Care and protection
● Emotinal and psychological support

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Thanks!
Any questions?
You can find me at [email protected]

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Maps

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