Executive Summary

Thank you! The Power of Love team and our Zambian families are grateful for your support for our pediatric HIV care program in Zambia. Your continued support and love over the last several years is building a community of healthy, well-informed children, and families self-reliant in taking care of their health.

Impact of COVID: A recent report by UNAIDS concludes that during the last two years of COVID and other global crises, progress against HIV prevention has slowed and millions of lives are at risk. Teenage girls and young women are especially vulnerable. These findings imply that the UNs goal to end AIDS by 2030, will not be met unless spending on HIV prevention efforts is accelerated. In addition, more countries are facing growing levels of food insecurity and lack of income opportunities due to COVID, climate change, and conflict.

Global HIV status: In December 2020, UNAIDS set up new goals calling for 95% of all people living with HIV to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95% of all people receiving antiretroviral therapy to have viral suppression by 2025. These targets are ambitious as only 68% of all people living with HIV were virally suppressed in 2021, as compared to a goal of 86% to be reached by 2025 to eradicate AIDS by 2030.

Rationale for a Pediatric HIV Care Program: Globally, 17 million children have been orphaned due to AIDS and 83% live in Sub-Saharan Africa. In 2021, 99,000 children died of AIDS related causes and 2.4 million children were living with HIV but only 52% had access to treatment as compared to 76% for adults. Children fall through the cracks in accessing treatment. Moreover, life expectancy for a child born with HIV is at best 4-5 years without treatment. Hence, there is a continuing need to provide adequate care (including food) to children living with HIV and to prevent new HIV infections.

About Zambia and its children: Zambia is a democratic country, rich in mineral resources and a young population (53% of its population is under the age of 18 with a median age of 17 years). In addition, most of its estimated one million orphans live with grandmothers/extended family who have little knowledge of HIV and no source of income. However, considerable progress has been made in reducing vertical transmission of HIV with over 90% of pregnant women on treatment.

Our response: Recent studies conclude that the provision of food, clean energy, education, health, water, and sanitation can lead to reducing the impact of climate change and poverty while boosting human well-being. The goals of poverty alleviation and mitigating climate change need not be in conflict. Accordingly, over the last two years our focus has been on monitoring the health of families and school progress of children, tracking, and referring graduates (children who are >18 years or completed high school) to vocational/university courses, and education for families. This approach has gone a long way towards family sustainability and self-reliance.

Plan for 2023: Our plan is to continue to monitor the health and academic progress of children, track graduates, and increase skills levels of community members. Also, safe water filtration systems will be provided to families who do not have access to clean water.

Program Need, Achievements, and Next Steps 

Impact of COVID: A recent report by UNAIDS concludes that during the last two years of COVID and other global crises, progress against HIV prevention has slowed and millions of lives are at risk. In 2021, new HIV infections fell by just 3.6%; the smallest drop since 2016. In Asia and the Pacific, new HIV infections are rising where they had been falling for the past 10 years. Teenage girls and young women are especially vulnerable. These findings imply that the UN's goal to end AIDS by 2030, will not be met unless spending on HIV prevention efforts is accelerated.

Need and Location: The ongoing pandemic has magnified the need for a comprehensive pediatric HIV care program for several reasons. In Sub-Saharan Africa only 52% of children living with HIV (as compared to 76% adults) were on treatment due to:

• Children rely on their caregivers for access to treatment,
• Pediatric doses are more likely to be out of stock (happened during COVID),
• It is much more difficult to track and treat children,
• Children do not spread HIV, and hence are not a priority,
• It is not standard practice to test all children and,
• COVID aggravated the situation with supply disruptions for all drugs and taking away attention from HIV and AIDS.

In Zambia, 59% of children live in poor households with 45% living in extreme poverty, and 35% of children under five have stunted growth. Most of Zambia’s estimated one million orphans live with grandmothers/relatives. Many children suffer from trauma, abuse, lack of food, or grief after losing a parent, and are in need counseling. Also, 800,000 school age children are not in school. Family members need support as they lack resources and skills to care for children and other household members.

Program Beneficiaries: Current beneficiaries are 500 HIV+ children and their families, a total of about 3,500 adults and children. Indirect beneficiaries are an additional 2,200 residents as families share their knowledge with others. In addition, 8,100 families benefitted from the receipt of clean cooking stoves. For a testimonial and stories, see page 9.

Programmatic Changes Made to Reduce the Impact of COVID:

• Provided COVID education workshops and PPE (face masks, sanitizers, and gloves) to families. These workshops have resulted in better knowledge about COVID prevention and the importance of getting vaccinated against COVID.
• Increased health monitoring and regular testing for viral loads.
• Increased support for school expenses for all school-aged children.
• Increased the provision of food to children. According to a recent World Bank analysis, an increasing number of countries are facing growing levels of acute food insecurity, due to COVID and high food prices (supply disruptions and currency devaluations) which has been aggravated by COVID. Higher food prices impact people with lower incomes more as they spend a larger share of their income on food. The World Food Program estimates that 272 million people are at risk of becoming acutely food-insecure due to the aggravating effect of the COVID-19 crisis. If current trends continue, the number of people affected by hunger would surpass 840 million by 2030. In young children, insufficient food leads to stunted growth and malnutrition.
• ARV medications are now collected for six months as compared to three months to minimize visits to the government clinic.

Ongoing Program Activities and Impact:

• 51 family members received training in basic nursing, HIV care and prevention.
• 51 children were enrolled to replace the 50 children who turned 18 years of age.
• Provision of food (mealie meal, beans, high protein soy supplement, cooking oil) and medicines to 500 HIV+ children.
• Regular health monitoring via phone calls/in-person visits. During these calls/visits, information on COVID-19 is provided. Children who are sick/critical are visited in person. This has resulted in improved health for all children, and we now have 98% (491/500) children with an undetectable viral load.
• Education in HIV/STI’s to older children has resulted in practicing safe sex, and fewer STI’s and teen pregnancies. These go a long way toward higher school attendance and high school graduation rates.
• Provision of psychosocial counseling: This is critical as only 28% of children live in households headed by one or both parents. These children suffer from trauma, abuse, lack of food, and/or grief after losing a parent. Family members also need counseling as they have limited resources and may be sick themselves.
• School support (tuition, books, uniforms, shoes, bags) was provided to 283 and 263 children in 2022 and 2021, respectively. Currently, 95% of school-age children are attending school and our goal is for this number to be 100% next year. Our focus is the health and academic progress of children. Over the last four years (2019-202), 54% of children in grade 12 graduated from high school and the rest enrolled for vocational training. The pass rate for grades 7 and 9 were 95% and 63% respectively. In Zambia, children write exams in grades 7, 9 and 12 only.
• Disclosure process: Before, during, and post-disclosure the child (typically around 10-12 years old) is monitored closely to check for distress and behavior changes that could lead to missing medications. A strict disclosure protocol is followed so that the children are better adjusted to their HIV status and committed to following the medication regimen.
• Monitoring and training in adherence to medication provided to 435 children who are aware of their HIV status.
• Education in HIV: As of December 2022, 91% of women caregivers were tested for HIV and several hundred more were encouraged to do the same. Out of 431 tested, 372 or 86% tested positive and are on treatment, and hence poor transmitters of the HIV virus.
• Ongoing training in HIV: Family members (472 in all) were provided with ongoing training in hygiene, HIV care and prevention.
• To reduce vertical transmission, HIV+ pregnant women are provided with education to ensure that their newborn infants are HIV free. To date, out of a total of 48 births, 47 children were born HIV free.
• All families were provided with long lasting insecticide treated nets and education. As a result, there were no cases of malaria amongst beneficiaries.
• All families who received clean cooking stoves, last year have improved in health due to reduced smoke inhalation and are saving on fuel costs. To date, 8100 stoves that are environmentally friendly as compared to traditional stoves were provided.
• More than 700 children benefitted from “COVID education” workshops this year. The workshops are free and open to the community and masks are provided. Since 2020, a total of 2100 children and their families have benefitted.
• A few families and staff participated in a workshop to start backyard gardens. The goal of these backyard gardens is to further improve nutrition and diet.

Long term Impact: All children show an improvement in health (5-6 months after enrollment), and with better health more children attend school. For example, 98% of children have an undetectable viral load and 91% of school age children are in school. Over the last 17 years, survival rates for children are approximately 98%, and opportunistic infections (such as rash, cough, diarrhea, TB, and pneumonia) dropped to 20-25% of pre-enrollment levels.

To sum up, program activities listed above have set off a chain reaction of positive outcomes. For example, better health and improved knowledge leads to a reduction in stigma which encourages more people to get tested resulting in HIV prevention. In addition, better health results in fewer missed days at school/work and more stable incomes. The result is families are more self-reliant and better able to take care of their health as well as more sustainable in the medium and long run.

Plan for 2023

• Add 50 children to bring the total to 550 children under our care.
• Train 30-40 family members in basic nursing and in caring for an HIV positive child.
• Provide safe water filtration systems to families who do not have access to clean water.
• Ensure that all school-age children are in school. Increase school support (fees, uniforms, bags, and shoes) to more children this year.
• Provide long lasting insecticide treated bed nets to all families.
• Stay connected with graduates, connect them to vocational/professional/university courses, and encourage them to mentor younger children.
• Educate more pregnant women in elimination of vertical transmission of HIV.
• Expand the skill set of community members via education and training programs.

Building More Sustainable and Peaceful Communities

The comprehensive package of services provided takes care of physical, educational, social, psychological, and income generation, needs of the women and children. Every day we see families transform themselves from a state of poor health, low education, and poverty transformed to being informed and self-reliant in caring for their health and taking charge of their lives. The result is residents have better skills, improved gender equity, and sustainable families and communities.