Executive Summary

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

Impact of COVID: According to a World Bank analysis, more countries are facing growing levels of acute food insecurity, which has been aggravated by the ongoing COVID pandemic and this is expected to continue through 2022. Also, an erosion of social cohesion due to COVID is the fastest growing threat to our planet. Third, the world is not on track to achieve goal 2 (or zero hunger) of UN’s sustainable development goals for 2030. Consequently, there is an immediate need to prioritize food security, health, and income stability

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 2020, 1.7 million children were living with HIV but only 54% had access to ARV medication. Moreover, life expectancy for a child born with HIV is at best 5 years without treatment. Hence, there is a huge need to provide adequate care to vulnerable children living with HIV and to prevent new HIV infections. This is especially true in view of the ongoing pandemic and its impact on resource poor communities.

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). Even though 55% of its population is living below the national poverty line, the country has made significant progress in reducing vertical transmission of HIV as over 90% of pregnant women are on treatment. However, 59% of children live in poor households with 45% living in extreme poverty, and 35% of children under five have stunted growth. 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. The ongoing pandemic has exacerbated this situation. Consequently, there is an immediate need to prioritize food security and health needs.

Program activities completed in 2021:

• 75 family members received training in hygiene, basic nursing, HIV care and prevention.
• 75 new children were enrolled. This brings the total number of children enrolled to 500.
• The Zambian team, their families, and all children and families enrolled were provided with education on COVID, and PPE.
• All 500 HIV+ children enrolled receive a comprehensive package of life saving health care services. All are stable and/or improving in health.
• 229 children were provided with funds for school expenses such as fees, uniforms, shoes, and book bags in 2021, as compared to 156 children in 2020.
• All families received long lasting insecticide treated bed nets to prevent malaria.
• All families received clean cooking stoves. These stoves have reduced fuel costs and improved health due to reduced smoke inhalation. To date, 8100 stoves have been provided.
• COVID education workshops launched last year have benefitted more than 1,100 children to date.
• Families and staff participated in a workshop to start backyard gardens.

Plan for 2022: For 2022, our plan is to continue to make families self-reliant in taking care of their health, and increasing the skill set of community members.

Program Need, Achievements, and Next Steps 

Need: The ongoing pandemic has magnified the need for a comprehensive pediatric HIV care program for several reasons. In Zambia, 59% of children live in poor households with 45% living in extreme in poverty, and 35% of children under five have stunted growth. In addition, most of Zambia’s estimated one million orphans, live with grandmothers/relatives. Many children suffer from trauma, abuse, lack of food, or grief at losing a parent and are in need counseling. Family members also need support as they lack resources and skills to care for all household members.

Beneficiaries: are 500 HIV+ children and their families, a total of about 3,300 adults and children. Indirect beneficiaries are an additional 2,200 residents as families enrolled share their knowledge with others. In addition, 8,100 families benefitted from the receipt of clean cooking stoves. For a testimonial and stories of two children, see page 9.

Programmatic Changes Made to Reduce the Impact of COVID:

• Provision of COVID19 education and PPE (face masks, sanitizers, and gloves) to all families.
• Converted in-person health check-ups to health monitoring via frequent phone calls. During these calls, information on COVID-19 is provided. Children who are sick/critical continue to be visited in person.
• 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, which has been aggravated by COVID. This is expected to continue through 2022. Food prices are at an all-time high due to supply disruptions and currency devaluations. Higher food prices impact people in low-and middle-income countries since 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 recent 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. This implies that the world is not on track to achieve goal 2 (or zero hunger) of UN’s sustainable development goals for 2030. Consequently, there is an immediate need to prioritize food security in resource poor communities.
• 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:

• Provision of food (mealie meal, beans, cooking oil) and medicines to 500 HIV+ children.
• Provision of high protein soya supplement to 500 undernourished children.
• Regular health monitoring via phone calls/in-person visits. Children who are sick/critical are visited in person. This has resulted in improved health for all chidlren and with 442 children having an undetectable viral load.
• Provision of psychosocial counseling: This is critical as 70% of children live in households headed by older sibling/aunt/grandaunt/grandmothers. These children suffer from trauma, abuse, lack of food, or grief at losing a parent. Family members also need counseling as they have limited resources and may be sick themselves.
• 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.
• Monitoring and training in adherence to medication provided to 312 children.
• Education in HIV provided. As of December 2021, 87% of women caregivers were tested for HIV and several hundred more were encouraged to do the same. Out of 411 tested, 354 or 86% tested positive, 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 47 births, 46 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.
• School support (tuition, books, uniforms, shoes, bags) was provided to 229 and 156 children in 2021 and 2020, respectively. Currently, 93% of school age children are attending school and our goal is for all school age chidlren to be in school next year.
• 8,100 families were provided with environmentally friendly cooking stoves. These stoves generate less smoke, use less fuel, and cook food faster. This has resulted in lower expenses for fuel, improved health due to lower smoke inhalation, ease of cooking, and a cleaner environment.
• More than 1100 children benefitted from “COVID education” workshops. The workshops are free and open to the community and masks are provided.
• 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 more children can attend school. For example, 88% children have an undetectable viral load and 93% 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, 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 more self-reliant in taking care of their health and more sustainable communities.

Plan for 2022

• Add 50 children to bring the total to 550 children under our care.
• Launch an out-reach program for young girls to educate them on STI’s, safe sex, and unwanted pregnancies.
• Continue to provide food, and a comprehensive package of health care services to children enrolled.
• Launch a community wide adherence program for adolescents and young adults as adherence rates are lowest for these age groups.
• Train more families to start kitchen gardens in their homes.
• 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, support them if needed, and encourage them to mentor younger children.
• Continue to educate women to eliminate vertical transmission of HIV.
• Expand the skill set of community members via education and training programs.