Use HIV's lessons to help children orphaned by COVID-19

"It's a 50/50 Thing You Know": Exploring the Multileveled Intersections of Gender and Power Within the Relationships of Young South African Men and Women

Efforts to advance sexual health globally require greater understandings of youth intimate relationship dynamics. Among 38 South African youth (21 women/17 men aged 21-30 from Durban and Soweto) we conducted qualitative cognitive interviews to explore how gender and power intersect to shape intimate relationship dynamics (October 2019-March 2021). Participants discussed perceptions and relevance of each of 13 items comprising the Sexual Relationship Power (SRP) scale, a widely used measure of gender equity, and the influence of SRP on youth sexual health. Data analysis was guided by constructivist grounded theory. The findings were organized using the socio-ecological model, revealing how gender and power intersected at multiple levels to influence youth intimate relationships. Key influencing factors included individual-level gender attitudes, male partner expectations, and women's resistance to dominance; intimate relationship-level power dynamics, consent, and intimacy; family-level household configurations and parental monitoring of daughters; and societal-level traditional gender norms. At all levels, women discussed resisting power inequities through communication and rejection of inequitable relationships. While men also displayed resistance to inequitable power structures, most upheld traditional gender norms through institutional affiliation (e.g. church) and deep-rooted socialized beliefs and attitudes. Efforts to improve youth sexual health require multileveled approaches that address inequitable power dynamics.

Global and regional estimates of orphans attributed to maternal cancer mortality in 2020

Despite women being disproportionally affected by cancer deaths at young ages, there are no global estimates of the resulting maternal orphans, who experience health and education disadvantages throughout their lives. We estimated the number of children who became maternal orphans in 2020 due to their mother dying from cancer in that year, for 185 countries worldwide and by cause of cancer-related death. Female cancer deaths-by country, cancer type and age (derived from GLOBOCAN estimates)-were multiplied by each woman's estimated number of children under the age of 18 years at the time of her death (fertility data were derived from United Nations World Population Prospects for birth cohort), accounting for child mortality and parity-cancer risk associations. Globally, there were 1,047,000 such orphans. Over half of these were orphans due to maternal deaths from breast (258,000, 25%), cervix (210,000, 20%) and upper-gastrointestinal cancers (136,000, 13%), and most occurred in Asia (48%: India 15%, China 10%, rest of Asia 23%) and Africa (35%). Globally, there were 40 new maternal orphans due to cancer per 100,000 children, with a declining trend with a higher Human Development Index (range: 121 in Malawi to 15 in Malta). An estimated 7 million children were prevalent maternal orphans due to cancer in mid-2020. Accelerating the implementation of the World Health Organization's cervical and breast cancer initiatives has the potential to avert not only millions of preventable female cancer deaths but also the associated, often-overlooked, intergenerational consequences of these deaths.

Children orphaned by COVID-19: A grim picture and the need of urgent actions

The COVID-19 had caused as a global pandemic and resulted in enormous burdens. In addition, faced with the proliferation of SARS-CoV 2 variant strains, this pandemic is continuing unremitting. The world seemed to focus primarily on middle-aged and elderly deaths, however the interest of the impact of COVID-19 on children is limited. Scientists have estimated that orphanhood and caregiver death related to COVID-19 had increased twice in the last six months compared with the first 14 months of the pandemic. Orphans face directly the health consequences.

The Silent Pandemic: the Impact of COVID-19 on the Mental Health of Adolescents Living with HIV

Purpose of Review

The pandemic caused by the coronavirus disease (COVID-19) has resulted in millions of confirmed cases and likely more than six million deaths globally Worldometer (2022). We sought to understand secondary mental effects in adolescents living with HIV (ALHIV) on the African continent caused by lockdowns, school closures, and other restriction measures for infection control. We reviewed the broader literature and conducted 86 retrospective chart reviews of mental health disorders of ALHIV and interventions utilized at a pediatric clinic in Eswatini.

Recent Findings

ALHIVs are disproportionately affected by mental health disorders. The COVID-19 pandemic has exacerbated adverse mental health outcomes of adolescents on the African continent, especially for ALHIV. There have been many calls for researchers, clinicians, and governments to prioritize mental health in adolescents going forward.

Summary

In pediatric clinics in Eswatini, Malawi, and Uganda, there were psychosocial measures in place prior to the COVID-19 pandemic for ALHIV. After looking closely at a pediatric clinic in Eswatini, we found that many interventions were paused and new psychosocial interventions compatible with social distancing were instead utilized by clinicians. Even so, after multidisciplinary management comprising of interventions such as psychotherapy, pharmacotherapy, referral to psychologists/psychiatrists, and enrollment in peer support groups, the PHQ-9 depressions scores of ALHIV during the COVID-19 significantly improved. We found that there is a need for age-specific standardized tools to measure depression in ALHIV. Furthermore, more research is needed on the effectiveness and scope of psychosocial interventions for ALHIV post-COVID-19 throughout Eswatini and the African continent.