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With improved accessibility to life-prolonging antiretroviral therapy, the treatment and care requirements of people living with HIV and AIDS resembles that of more established chronic diseases. As an increasing number of people living with HIV and AIDS in Kenya have access to ART, the primary caregivers of poor resource settings, often children, face the challenge of meeting the requirements of rigid ART adherence schedules and frequent relapses. This, and the long-term duty of care, has an impact on the primary caregiver's experience of this highly stigmatised illness -an impact that is often described in relation to psychological deprivation. Reflecting the meanings attached to caregiving by 48 children in Western Kenya, articulated in writing, through photography and drawing, individual and group interviews, this paper presents three case studies of young caregiving. Although all the children involved in the study coped with their circumstances, some better than others, we found that the meanings they attach to their circumstances impact on how well they cope. Our findings suggest that only a minority of young caregivers attach either positive or negative meanings to their circumstances, whilst the majority attaches a mix of positive and negative meanings depending on the context they are referring to. Through a continuum of psychosocial coping, we conclude that to provide appropriate care for young carers, health professionals must align their understanding and responses to the psychosocial cost of chronic care, to a more nuanced and contextual understanding of children's social agency and the social and symbolic resources evident in many African communities.

Children living in households affected by HIV face numerous challenges as they take on significant household-sustaining and caregiving roles, often in conditions of poverty. To respond to their hardships, we must identify and understand the support systems they are already part of. For this reason, and to emphasise the agentic capabilities of children, this article explores how vulnerable children cope with hardship through peer social capital. The study draws on the perspectives of 48 HIV-affected and caregiving children who through PhotoVoice and draw-and-write exercises produced 184 photographs and 56 drawings, each accompanied with a written reflection. The themes emerging from the essays reveal that schools provide children with a useful platform to establish and draw on a mix of friendship structures. The children were found to strategically establish formalised friendship groups that have the explicit purpose of members supporting each other during times of hardship. The children also formed more natural friendship groups based on mutual attraction, with the implicit expectation that they will help each other out during times of hardship. In practice, the study found that children help each other through sharing (e.g. schools material and food) as well as through practical support (e.g. with domestic duties, securing food, and income-generation) — thus demonstrating that children are able to both accumulate and benefit from ‘peer social capital.’ The study concludes that a key coping strategy of HIV-affected and caregiving children is to mobilise and participate in friendship groups which are characterised by sharing and reciprocity of support. Development responses to support children affected by the HIV epidemic need to take heed of children's ability to draw on peer social capital.

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