Children and COVID-19 Research Library

Recognizing the persistent and harmful impact that COVID-19 and related lockdown measures pose for the HIV response, governments across ESA region continue to implement interventions to sustain and further advance hard won gains toward ending AIDS. One year after the release of UNICEF’s Compendium  of innovative approaches to HIV programming in Eastern and Southern Africa in the context of COVID-19, this new Volume II describes results achieved in the nine countries highlighted in Volume I and shares experiences from an additional eight countries. This collective work demonstrates how countries are building upon the learning and architecture of the HIV response to proactively mitigate the impact of the COVID-19 pandemic while scaling up efforts to achieve global HIV goals, resulting in stronger responses and resilient systems for both HIV and COVID-19.

Central to measuring the impact of the COVID-19 pandemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. This paper uses a comprehensive list of HIV prevention services in four corridors of the US heavily impacted by HIV, developed as part of a large RCT, to illustrate the potential impact of service closure on LGBTQ+ youth.

Adolescents living with HIV (ALHIV, ages 10–19) experience complex challenges to adhere to antiretroviral therapy (ART) and remain in care, and may be vulnerable to wide-scale disruptions during the COVID-19 pandemic. We assessed for a range of effects of the pandemic on ALHIV in western Kenya, and whether effects were greater for ALHIV with recent histories of being lost to program (LTP).

The COVID-19 pandemic and its control measures have impacted health and healthcare provision in various levels. Physical distancing measures, for instance, may affect sexual health, impacting access to HIV prevention supplies and changing sexual behaviour, as well as mental health, increasing feelings of unsafety and weakening community support ties. These effects can be worsened among socially marginalised groups, such as men who have sex with men (MSM) and transgender women (TGW). Brazil is among the countries most affected by COVID-19 in the world, where control measures have been inconsistently implemented. This study aims to investigate the effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult MSM and TGW in Brazil.

Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. This article draws on a prospective longitudinal cohort study undertaken in South Africa to address this question.

Adolescent girls (10–19 years) and young women (20–24 years) are a key part of the 1·8 billion people who live in fragile contexts. In 2019, adolescent girls and young women comprised an estimated 10% of the population in sub-Saharan Africa but accounted for 59% of new HIV infections. Adolescent girls and young women are disproportionally affected by HIV and COVID-19.

UNICEF's 2020 World AIDS Day report presents key global data and an overview of the HIV epidemic among children and adolescents. The report also discusses the impact of the COVID-19 pandemic on UNICEF's results and achievements. Finally, the report concludes with a proposed way forward that highlights fighting stigma, which has been a persistent and debilitating challenge to people living with and vulnerable to HIV over the past four decades.

Recent data collection has shown that the COVID-19 pandemic has had a significant impact on HIV testing services but the impact on HIV treatment has been less than originally feared. The impact on services for the prevention of vertical transmission of HIV (from mother to child) is mixed—by April, countries generally saw a decline in the number of women tested for HIV at their first antenatal clinic visit, but by June that decline had been reversed.

Protecting pregnant and breastfeeding women, infants, children and adolescents from acquiring SARS‐CoV‐2 while sustaining essential HIV services is an immense global health challenge. Tailored, family friendly programme adaptations for case‐finding, ART delivery and viral load monitoring for these populations have the potential to limit SARS‐CoV‐2 transmission while ensuring the continuity of life‐saving HIV case identification and treatment efforts.

Coronavirus-related service disruptions threaten to reverse the decade-long progress made for children and pregnant women in the fight against HIV.

 

This rapid review collates and synthesizes evidence on the child protection impacts of COVID-19 and previous pandemics, epidemics and infectious disease outbreaks. It provides lessons for global and national responses to COVID19 and recommendations for future research priorities.

The evidence on the impacts of pandemics and epidemics on child protection outcomes is limited and skewed towards studies on the effects of HIV/AIDS on stigma. There is also some evidence on the effects of Ebola on outcomes such as orphanhood, sexual violence and exploitation, and  school enrolment, attendance and dropout. The evidence on other pandemics or epidemics, including COVID-19, is extremely limited.

There are various pathways through which infectious disease outbreaks can exacerbate vulnerabilities, generate new risks and result in negative outcomes for children. Outcomes are typically multi-layered, with immediate outcomes for children, families and communities - such as being orphaned, stigmatization and discrimination and reductions in household income - leading to further negative risks and outcomes for children in the intermediate term. These risks include child labour and domestic work, harmful practices (including early marriage), and early and adolescent pregnancy.

Lessons from previous pandemics and epidemics suggest that the following could mitigate the child protection risks:

• Responding to children in vulnerable circumstances, including orphans (e.g. throughpsychosocial interventions focused on improving mental health and community-based interventions that provide families with resources and access to services)
• Responding to stigmatization and discrimination (e.g. throughinformation and communication campaigns and support from public health systems, communities and schools)
• Investing in social protectionenable livelihoods during outbreaks and to counteract shocks
• Promoting access to health, protective and justice services, which may be restricted or suspending during infectious disease outbreaks
• Ensuring continued access to education, particularly for girls, who may be adversely affected

There is a high burden of proof for data collection during the current COVID-19 outbreak than there would be in normal circumstances. Evidence generation strategies during and after the COVID-19 crisis should consider rigorous retrospective reviews and building upon monitoring, evidence and learning functions of pre-existing programmes – particularly where there is ongoing longitudinal data collection. There should also be efforts to synthesize evidence from existing research on the effectiveness of interventions that respond to the key risk pathways identified in this review.

 

 

• The research brief can be found here.
• Access the Evidence Gap Map on child protection and violence outcomes here.
• Access the study protocol here.

 

 

This research brief summarizes the findings of a rapid review that collates and synthesizes evidence on the child protection impacts of COVID-19 and previous pandemics, epidemics and infectious disease outbreaks. It provides lessons for global and national responses to COVID19 and recommendations for future research priorities.

The evidence on the impacts of pandemics and epidemics on child protection outcomes is limited and skewed towards studies on the effects of HIV/AIDS on stigma. There is also some evidence on the effects of Ebola on outcomes such as orphanhood, sexual violence and exploitation, and  school enrolment, attendance and dropout. The evidence on other pandemics or epidemics, including COVID-19. is extremely limited.

There are various pathways through which infectious disease outbreaks can exacerbate vulnerabilities, generate new risks and result in negative outcomes for children. Outcomes are typically multi-layered, with immediate outcomes for children, families and communities - such as being orphaned, stigmatization and discrimination and reductions in household income - leading to further negative risks and outcomes for children in the intermediate term. These risks include child labour and domestic work, harmful practices (including early marriage), and early and adolescent pregnancy.

Lessons from previous pandemics and epidemics suggest that the following could mitigate the child protection risks:

• Responding to children in vulnerable circumstances, including orphans (e.g. throughpsychosocial interventions focused on improving mental health and community-based interventions that provide families with resources and access to services)
• Responding to stigmatization and discrimination (e.g. throughinformation and communication campaigns and support from public health systems, communities and schools)
• Investing in social protectionenable livelihoods during outbreaks and to counteract shocks
• Promoting access to health, protective and justice services, which may be restricted or suspending during infectious disease outbreaks
• Ensuring continued access to education, particularly for girls, who may be adversely affected

There is a high burden of proof for data collection during the current COVID-19 outbreak than there would be in normal circumstances. Evidence generation strategies during and after the COVID-19 crisis should consider rigorous retrospective reviews and building upon monitoring, evidence and learning functions of pre-existing programmes – particularly where there is ongoing longitudinal data collection. There should also be efforts to synthesize evidence from existing research on the effectiveness of interventions that respond to the key risk pathways identified in this review.

 

• The full report can be found here.
• Access the Evidence Gap Map on child protection and violence outcomes here.
• Access the study protocol here.

 

 

This rapid review seeks to inform the initial and long-term public policy responses to the COVID-19 pandemic, by assessing evidence on past economic policy and social protection responses to health and economic crises and their effects on children and families. The review focuses on virus outbreaks/emergencies, economic crises and natural disasters, which, like the COVID-19 pandemic, were 'rapid' in onset, had wide-ranging geographical reach, and resulted in disruption of social services and economic sectors, without affecting governance systems. Evidence is also drawn from the HIV/AIDS pandemic, due to its impacts on adult mortality rates and surviving children.

The available evidence on the effects of economic policy and social protection responses is uneven across outcomes, regions, and type of policy response as a large body of literature focused on social assistance programmes. Future research on the COVID-19 pandemic can prioritize the voices of children and the marginalized, assess the effects of expansionary and austerity measures,  examine the role of design and implementation, social care services, pre-existing macro-level health, demographic and health conditions and the diverse regional health and economic impacts of the pandemic. The paper also provides key lessons for public policy responses to the COVID-19 pandemic.