Showing posts with label Children Affected by HIV. Show all posts
Showing posts with label Children Affected by HIV. Show all posts

Monday, April 4, 2016

Exposure to Violence & Psychological Well-Being Over Time in Children Affected by HIV/AIDS in South Africa & Malawi

Many of the risk factors for violence against children are particularly prevalent in families and communities affected by HIV/AIDS. Yet, in sub-Saharan Africa, where HIV rates are high, efforts to prevent or address violence against children and its long-lasting effects are hampered by a lack of evidence. 

We assessed the relationship between violence exposure and mental health among HIV-affected children attending community-based organisations in South Africa (n = 834) and Malawi (n = 155, total sample n = 989) at baseline and 12-15-month follow-up. Exposure to violence in the home and in the community was high. HIV-negative children who lived with an HIV-positive person experienced most violence overall, followed by HIV-positive children. Children unaffected by HIV experienced least violence (all p < .05). 

Interpersonal violence in the home predicted child depression, trauma symptoms, lower self-esteem, and internalising and externalising behavioural problems, while exposure to community violence predicted trauma symptoms and behavioural problems. Harsh physical discipline predicted lower self-esteem and behavioural problems for children. Exposure to home and community violence predicted risk behaviour. Over time, there was a decrease in depressed mood and problem behaviours, and an increase in self-esteem for children experiencing different types of violence at baseline. This may have been due to ongoing participation in the community-based programme. 

These data highlight the burden of violence in these communities and possibilities for programmes to include violence prevention to improve psychosocial well-being in HIV-affected children.

Purchase full article at:   http://goo.gl/dDdbur

  • 1 Department of Psychology , Stellenbosch University , Stellenbosch , South Africa.
  • 2 Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.
  • 3 Department of Infection and Population Health , University College London , London , UK.
  •  2016 Mar;28 Suppl 1:16-25. doi: 10.1080/09540121.2016.1146219.



Friday, March 11, 2016

Re-Thinking Children’s Agency in Extreme Hardship: Zimbabwean Children’s Draw-and-Write About Their HIV-Affected Peers

We compare two analyses of the same ‘draw-and-write’ exercises in which 128 Zimbabwean children represented their HIV-affected peers. The first, informed by the ‘New Social Studies of Childhood’, easily identified examples of independent reflection and action by children. The second, informed by Sen’s understandings of agency, drew attention to the negative consequences of many of the choices available to children, and the contextual limits on outcomes children themselves would value: the support of caring adults, adequate food, and opportunities to advance their health and safety. Conceptualisations of agency need to take greater account of children’s own accounts of outcomes they value, rather than identifying agency in any form of independent reflection and action per se.

…In line with the New Social Studies of Childhood, our first analysis dutifully sought out and documented instances of independent reflection and action by children. To what extent might we regard these as evidence for agency? Children were depicted as exercising agency in the sense of reflecting and acting, but because they often had so little access to significant power, resources or support, the actions they performed did not bring them closer to the outcomes they would value. We argue for the need for renewed debate about how best to conceptualise children’s actions in contexts that (i) provide them with a highly constrained set of options for exercising initiative, (ii) where the exercise of choice in one arena of their lives might be associated with negative long term outcomes in another; and/or (iii) where the outcomes of their actions may not take them any closer to their own perceptions of a good life. In conceptualising agency, instead of positing independent action as an end in itself, we prefer to regard independent action as the means to end that actors themselves would value.

In a tangentially related debate in the field of gender studies, critical researchers of women in the global south are increasingly concerned by a tendency to exaggerate the agency of women in situations of extreme subordination and coercion. Attempts by well-meaning academics, activists and policy makers to avoid depicting marginalised women as victims have led to a situation where “the search for agency in the least favourable situations has reached almost epidemic proportions” (: loc 554). In the process, they argue that feminist scholars – motivated by the desire to avoid potentially offensive depictions of ‘third world women’ as passive victims – have sometimes unwittingly aligned themselves with individualistic neoliberal understandings of agency and personhood. They have done this through advancing understandings of agency as any form of decontextualised individual choice and through celebrating actions by women that lead to nothing more than their basic survival. In the process they “neglect the oppressive structures of material and discursive power”, generating understandings of agency that undermine attention to, and analysis of, gendered oppression (): loc 2253)…

There is no doubt that, as the NSCC has now firmly established, children are able to act, show resourcefulness and survive, often with little help or input from adults. To that extent they are ‘competent social actors’. This was a vitally important point to make in the 1990s. However in the light of the strong body of research generated by the NSCC tradition, we believe this can now be taken as a given. We argue that the next step for researchers is to pay greater attention to the factors that mediate between so-called agency and its outcomes, and, most important, pay particular attention to children’s own accounts of their hopes for the future, and children’s own visions of what would constitute a ‘good life’ from one social setting to another.

Below:  Draw-and-write of a child suffering with HIV/AIDS




Below:  Draw-and-write about a child carer



Full article at:   http://goo.gl/w98rLE

aDepartment of Social Psychology, The London School of Economics and Political Science, London WC2A 2AE, United Kingdom
bBiomedical Research and Training Institute, Harare, Zimbabwe
cSchool of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa
dDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark
eDepartment of Infectious Disease Epidemiology, Imperial College School of Public Health, London SW7 2AZ, United Kingdom
*Corresponding author. Tel.: +44 207 955 7701. 




Wednesday, March 9, 2016

Association of Caregiver Quality of Care with Neurocognitive Outcomes in HIV-Affected Children Aged 2-5 Years in Uganda

Children affected by HIV are at increased risk of developmental and neuropsychological disturbances due to direct effects of HIV on the brain and direct effects associated with living in poverty. Caregivers can play an important role, through quality caregiving, in mitigating the negative effect of these stressors. 

This study used baseline data from an ongoing caregiver training intervention trial to evaluate the association between quality of caregiver-child interactions and neurocognitive outcomes in rural HIV-infected and HIV-exposed but uninfected children in Uganda. We also assessed the extent to which caregiver distress moderated this relationship. Data on 329 caregiver-child dyads were collected between March 2012 and July 2014, when the children were between 2 and 5 years of age. 

Child outcomes include the Mullen Scales of Early Learning to assess general cognitive ability and the Color Object Association Test to assess immediate memory and total recall. Caregiving quality was assessed using the Home Observation for the Measurement of the Environment (HOME) total and subscale scores. Caregiver distress was assessed using the Hopkins Symptom Checklist. General linear regression models assessed the association between the HOME total and subscale scores and child outcomes, with interaction terms used to test moderation by caregiver distress. Total HOME scores were positively and significantly associated with Mullen scores of cognitive ability; HOME acceptance subscale scores were positively and significantly associated with immediate recall scores. No other associations were statistically significant. 

As hypothesized, there is a strong association between the HOME and Mullen scores of cognitive ability in our study population, such that children who were assessed as living in environments with more stimulation also presented with a higher level of general neurocognitive development. 

Our results support the view of program guidance for HIV-affected children that suggest family-oriented care with emphasis on parent-child relationships for optimal child development.

Purchase full article at:   http://goo.gl/m6RYmt

  • 1 Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
  • 2 Department of Psychiatry , Makerere University , Kampala , Uganda.
  • 3 Department of Psychiatry , Michigan State University , East Lansing , MI , USA.
  • 4 Department of Statistics and Probability , Michigan State University , East Lansing , MI , USA.
  • 5 Department of Paediatrics & Child Health , Makerere University , Kampala , Uganda.
  •  2016 Feb 17:1-8. 



Friday, March 4, 2016

Integration of HIV Care into Community Management of Acute Childhood Malnutrition Permits Good Outcomes: Lusaka, Zambia

Background
While HIV has had a major impact on health care in southern Africa, there are few data on its impact on acute malnutrition in children in the community. We report an analysis of outcomes in a large programme of community management of acute malnutrition in the south of Lusaka.

Programme Activities and Analysis
Over 3 years, 68,707 assessments for undernutrition were conducted house-to-house, and children with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) were enrolled into either Outpatient Therapeutic Programme (OTP) or Supplementary Feeding Programme (SFP) respectively. Case records were analysed using tabulation and unconditional logistic regression.

Findings
1,859 children (889 boys, 970 girls; median age 16 months) with MAM (n = 664) or SAM (n = 1,195) were identified. Of 1,796 children whose parents consented to testing, 185 (10.3%) were HIV positive. Altogether 1,163 (62.6%) were discharged as recovered from acute malnutrition. Case fatality while in the programme was 4.2% in children with SAM and 0.5% in those with MAM, and higher in children with HIV infection. In multivariate analysis, HIV, MUAC <11.5cm and the first year of the program all increased mortality. Children with HIV infection who were able to initiate antiretroviral therapy had lower mortality.

Interpretation
Our programme suggests that a comprehensive community malnutrition programme, incorporating HIV care, can achieve low mortality even in a population heavily affected by HIV.

Below:  Flow of children with MAM through the program



Full article at:   http://goo.gl/N84AKd

By:  
Beatrice Amadi, Mercy Imikendu, Milika Sakala, Rosemary Banda 
Department of Paediatrics, University Teaching Hospital, Nationalist Road, Lusaka, Zambia

Beatrice Amadi, Paul Kelly 
Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia

Paul Kelly 
Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, 4 Newark Street, London, United Kingdom




Monday, February 15, 2016

Are Adolescent Orphans More Likely to be HIV-Positive? A Pooled Data Analyses Across 19 Countries in Sub-Saharan Africa

BACKGROUND:
Despite extensive resources and numerous programmes directed towards orphans in sub-Saharan Africa, evidence of their disadvantage is surprisingly limited. While initial research suggests that orphans are at greater risk of being HIV-positive, the evidence is limited in geographic scope.

METHODS:
To rigorously test disparities in HIV prevalence related to orphanhood and parental HIV status in sub-Saharan Africa, we used Demographic and Health Survey data from 19 countries in sub-Saharan Africa. We conducted pooled multilevel logistic regression on adolescents aged 15-17 years with HIV test results (N=22 837 girls and 20 452 boys).

RESULTS:
Regardless of their gender, orphans who lost their mother, lost both parents or had an HIV-infected mother were two to three times more likely to test positive for HIV infection (ORs 1.87-3.17). The loss of a father was also associated with HIV infection risk for females, but of slightly lower magnitude (OR 1.63).

CONCLUSIONS:
To better inform interventions, future research is needed to quantify the relative contribution of perinatally-acquired and sexually-acquired infections, and to investigate the specific mechanisms that may account for disparities in the latter. In the meantime, programmes servingHIV-infect adults as well as those serving orphaned and vulnerable children should invest in family-based HIV testing in order to identify adolescents in need of treatment.

Purchase full article at:   http://goo.gl/3hx3pm

By:  Kidman R1Anglewicz P2.
  • 1Program in Public Health and Department of Family, Population & Preventative Medicine, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA.
  • 2Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA. 
  •  2016 Feb 10. pii: jech-2015-206744. doi: 10.1136/jech-2015-206744.



A Model for HIV Disclosure of a Parent's and/or a Child's Illness

HIV prevalence in Kenya remains steady at 5.6% for adults 15 years and older, and 0.9% among children aged below 14 years. Parents and children are known to practice unprotected sex, which has implications for continued HIV spread within the country. Additionally, due to increased accessibility of antiretroviral therapy, more HIV-positive persons are living longer. Therefore, the need for HIV disclosure of a parent's and/or a child's HIV status within the country will continue for years to come. 

We conducted a qualitative phenomenological study to understand the entire process of disclosure from the time of initial HIV diagnosis of an index person within an HIV-affected family, to the time of full disclosure of a parent's and/or a child's HIV status to one or more HIV-positive, negative, or untested children within these households. Participants were purposively selected and included 16 HIV-positive parents, seven HIV-positive children, six healthcare professionals (physician, clinical officer, psychologist, registered nurse,social worker, and a peer educator), and five HIV-negative children. All participants underwent an in-depth individualized semistructured interview that was digitally recorded. Interviews were transcribed and analyzed in NVivo 8 using the modified Van Kaam method. 

Six themes emerged from the data indicating that factors such as HIV testing, living with HIV, evolution of disclosure, questions, emotions, benefits, and consequences of disclosure interact with each other and either impede or facilitate the HIV disclosure process. Kenya currently does not have guidelines for HIV disclosure of a parent's and/or a child's HIV status. HIV disclosure is a process that may result in poor outcomes in both parents and children. Therefore, understanding how these factors affect the disclosure process is key to achieving optimal disclosure outcomes in both parents and children. 

To this end, we propose an HIV disclosure model incorporating these six themes that is geared at helping healthcare professionals provide routine, clinic-based, targeted, disclosure-related counseling/advice and services to HIV-positive parents and their HIV-positive, HIV-negative, and untested children during the HIV disclosure process. The model should help improve HIV disclosure levels within HIV-affected households. Future researchers should test the utility and viability of our HIV disclosure model in different settings and cultures.

Below:  HIV disclosure themes



Below:  HIV disclosure model



Full article at:   https://goo.gl/EkUQa0

  • 1College of Health Sciences, Walden University , Minneapolis, MN , United States.
  • 2College of Health Sciences, Walden University, Minneapolis, MN, United States; College of Social and Behavioral Sciences, Walden University, Minneapolis, MN, United States; Laureate Education, Inc., Baltimore, MD, United States. 



Thursday, January 28, 2016

Can Schools Support HIV/AIDS-Affected Children? Exploring the 'Ethic of Care' amongst Rural Zimbabwean Teachers

How realistic is the international policy emphasis on schools 'substituting for families' of HIV/AIDS-affected children? We explore the ethic of care in Zimbabwean schools to highlight the poor fit between the western caring schools literature and daily realities of schools in different material and cultural contexts. 

Interviews and focus groups were conducted with 44 teachers and 55 community members, analysed in light of a companion study of HIV/AIDS-affected pupils' own accounts of their care-related experiences. We conceptualise schools as spaces of engagement between groups with diverse needs and interests (teachers, pupils and surrounding community members), with attention to the pathways through which extreme adversity impacts on those institutional contexts and social identifications central to giving and receiving care. 

Whilst teachers were aware of how they might support children, they seldom put these ideas into action. Multiple factors undermined caring teacher-pupil relationships in wider contexts of poverty and political uncertainty: loss of morale from low salaries and falling professional status; the inability of teachers to solve HIV/AIDS-related problems in their own lives; the role of stigma in deterring HIV/AIDS-affected children from disclosing their situations to teachers; authoritarian teacher-learner relations and harsh punishments fuelling pupil fear of teachers; and lack of trust in the wider community. 

These factors undermined: 

  • teacher confidence in their skills and capacity to support affected pupils and motivation to help children with complex problems; 
  • solidarity and common purpose amongst teachers, and between teachers and affected children; and effective bridging alliances between schools and their surrounding communities-all hallmarks of HIV-competent communities. 

We caution against ambitious policy expansions of teachers' roles without recognition of the personal and social costs of emotional labour, and the need for significant increases in resources and institutional recognition to enable teachers to adopt support roles. We highlight the need for research into how best to create opportunities for teacher recognition in deprived and disorganised institutional settings, and the development of more culturally appropriate notions of caring.

Below:  Analysis of teacher data


Below:  Analysis of community data



Full article at:   http://goo.gl/3do3hz

  • 1Department of Social Psychology, The London School of Economics and Political Science, London, United Kingdom.
  • 2Biomedical Research and Training Institute, Harare, Zimbabwe.
  • 3School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa.
  • 4Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom.
  •  2016 Jan 20;11(1):e0146322. doi: 10.1371/journal.pone.0146322. eCollection 2016.