A person-centred approach to preventing HIV in Khayelitsha’s children

By Laura Mundy

Laura Mundy is an advisor for communications at the Alliance.

Home to one million people, Khayelitsha is the second largest township in South Africa. In a country where 18.9% of adults are living with HIV, protecting the next generation must involve prevention programming that is centred around the child as they grow.

<p>Pamela is a Community Mother with Yabonga. Each day she opens up her home as a safe space for vulnerable children to come after school. Her son Phawulothando enjoys playing and learning with the other children.</p>Pamela is a Community Mother with Yabonga. Each day she opens up her home as a safe space for vulnerable children to come after school. Her son Phawulothando enjoys playing and learning with the other children. © Laura Mundy for the Alliance.

Nestled into the heart of Khayelitsha is one of Yabonga’s children centres; dedicated to ensuring children and young people who are affected by HIV are able to reach their full potential.

When I visited the centre recently, I was overwhelmed by how the totality of their programming is person-centred, human rights based and community-driven.

Yabonga’s HIV prevention work starts with the Children’s Programme, which supports those under the age of 13 and affected by HIV. The children are affected by orphan hood, are living with parents who are struggling with HIV-related illness, or are living with HIV themselves. The impact of these life experiences on a child can be wide-ranging, and Yabonga have designed a community-driven response to help them thrive.

Women-led approach to prevention

Each day after school, Community Mothers in Khayelitsha open up their homes to groups of around 20 children where they can eat, learn, play and express their emotions in a safe space.

The 42 Community Mothers are trained in psychosocial support; HIV and health education; and early childhood development, and are a vital sanctuary for young children who may otherwise be on the street after school. “The children see me as an example,” says one 20-year-old Community Mother who joined Yabonga at 11.

The work of Yabonga is person-centred and takes a child’s entire support network into consideration. Parents are supported on disclosure of their child’s HIV status, and staff visit the parents’ homes from time to time to make sure they are coping. This circle of support is impressive.

The children see me as an example.

Pamela, who has been a Community Mother for a year and a half lives just 200 metres from the Khayelitsha centre we visited. Yabonga supported Pamela to transform part of her home into a safe space for children, and also provide a stipend to buy food and educational materials.

Pamela wears a branded Yabonga uniform that exerts her presence and acceptance in the community where HIV stigma is rife. By not hiding the work they do, Yabonga has created a vital sense of community around their work on HIV prevention. Their women-led approach also challenges ingrained gender norms and stereotypes.

Growing with the children

During our visit, a group of young people from the Youth Programme performed a play about various temptations and dangers they are exposed to when living in Khayelitsha. From alcohol and drugs, to early sexual initiation, these young people demonstrated how to say no to situations that could put them at risk of HIV.

The Youth Programme grew out of a need for the organisation to grow with its children. Ending their support when they’ve turned 13 is not person-centred. So, Yabonga grew too. A range of activities for young people aged over 13 were designed to focus on psychosocial support as they grow into young adults.

Eric, the Youth Centre Manager tells us that some of the youth have an element of arrogance about HIV; they have seen older people living with HIV and as a result are not as worried about it. Eric explained that “the problem is not a lack of information but a lack of inspiration. The challenge we have here is inspiring people to speak up and be role models.”

Despite providing extra educational support to all children in the programme, there are many reasons why Yabonga’s children struggle in school. It became apparent that some school leavers are not ready for tertiary education and yet also outgrow the Youth Programme, and so the Gap Programme was born.

The problem is not a lack of information but a lack of inspiration. The challenge we have here is inspiring people to speak up and be role models.

This 10-month programme works on skills to help school leavers in adult life and in their future careers. They also attend Community Mothers’ homes to provide homework help, and assist older children in their activities. Some of these young people began life at Yabonga as children in the Community Mothers homes, and are now role models for the younger children.

A circle of support

With holistic care from childhood, through adolescence and into adulthood, Yabonga is a prime example of a person-centred approach to HIV prevention programming that ensures continuity of care in a country where 320,000 children are living with HIV.

But Yabonga doesn’t only support children. It also runs support groups for parents living with HIV, help with HIV disclosure to children, nutritional support at home, and outreach work at clinics and in community spaces.

Three days a week, staff from the Education and Training team attend HIV clinics to talk to patients. They are often the first source of support for people just receiving a positive HIV diagnosis. This immediate connection to support has enhanced engagement in their support groups, which is where they recruit many Community Mothers.

Among all the examples of a person-centred approach to HIV prevention, Yabonga runs regular training sessions and counselling for all staff members, including for the Community Mothers who are often affected by HIV too.

The day after our visit was the monthly Staff Appreciation Day, a token of gratitude to their staff and display of the holistic nature of Yabonga’s person-centred HIV prevention and care.

Yabonga is a partner of Alliance Linking Organisation NACOSA, and a sub-recipient of Global Fund funding.