"Not Strong Enough to Protect Children": Using Photovoice to Identify Systems Risks Among Youth Orphaned Due to HIV/AIDS in Vietnam

Background: This project aimed to create social change in the lives of orphaned adolescents in Hai Phong, Vietnam, focusing specifically on health equity as both a historic and emerging social justice issue within this community. Adolescents who have been orphaned by HIV and raised by their grandparents often adopt adult responsibilities, such as generating income and/or caregiving for grandparents and younger siblings. Existing challenges facing Vietnamese adolescents may increase societal exclusion and push adolescents into behavior that can increase risk of contracting and spreading HIV. In Vietnam, families of persons living with HIV are also vulnerable to HIV-related stigma and discrimination. Macro level policies embedded within social, political, or criminal legal systems (referred to hereafter as “systems risks”) may compound existing risk factors for youth by fostering feelings of distrust, skepticism, or animosity. This research aims to describe youth-identified systems risks in the lives of youth who have been orphaned due to HIV and raised by their grandparents in Northern Vietnam. A further goal of this project is to create an adolescent-led social or policy change that addresses structural inequalities such as stigma and societal exclusion while promoting strengths and resilience within this community.

Methods: The photovoice (PV) project was embedded within the existing summer youth development program offered at a nonprofit organization in northern Vietnam serving grandparents and grandchildren affected by HIV. Twenty-five adolescents between the ages of twelve and nineteen participated in a summer camp, which focused on photovoice and the youth-identified topic of child labor. The youth participated in daily focus groups, wrote journal entries, and presented their photographs to the group and facilitators. Additional data was collected through two focus groups which took place one and two years after the camp, to understand the longer-term outcomes of the photovoice process.

Results: Thematic analysis identified risks, experiences, and concepts of importance for youth, which included a) rationalizing child labor, b) emotional responses to child labor, c) impacts on education and wellbeing, d) exploitation and lack of protection, e) the role of law enforcement, f) being used by adults, and g) powerlessness. Following conclusion of PV, youth identified similarities in experiences related to predatory working conditions. In partnership with the host organization, youth successfully sought to create business for income stability and better working conditions.

Conclusions: Youth expressed empowerment in acting on areas of risk and offered ideas for interventions, including community education, raising funds for the host organization, and leading Information, Education, and Communication (IEC) Campaigns. An international art-advocacy exhibition was launched across three countries, compiling youth photos to raise awareness for social action. The photovoice process served as a source of connection, consciousness building, and collective action to begin a youth-led business and engagement in a vocational training program, thus reducing the risks of child labor. We recommend that researchers include youth-driven action planning into their photovoice projects to increase longer-term, feasible, and sustainable changes rooted in this process. It may be necessary to spend more time to build critical consciousness and formulate strategies for action.