Living environment and schooling of children with HIV-infected parents in southwest China

An appraisal of China's progress toward the Millennium Development Goals as they relate to children

Since their inception in 2000, the Millennium Development Goals (MDGs) have improved understanding of the global development process. Although the goals will not be significantly achieved on a global scale, each country has had accomplishments deserving of attention and analysis. With regard to the MDGs as they relate to children, China has made significant achievements, the deeper understanding of which might help in the process of refreshing the MDGs beyond 2015. China's accomplishments in economic development and human welfare, and the benefits this has brought to its children potentially teach lessons that can be modelled by other countries moving from low- to middle-income status.

Actor and partner effects of perceived HIV stigma on social network components among people living with HIV/AIDS and their caregivers

BACKGROUND

Few studies have investigated the relationship between HIV stigma and social network components at the dyadic level. The objective of this study was to examine the actor and partner effects of perceived HIV stigma by people living with HIV/AIDS (PLWHAs) and their caregivers on social network variables at the dyadic level.

METHOD

An egocentric social network study was conducted among 147 dyads consisting of one PLWHA and one caregiver (294 participants) in Nanning, China. The actor-partner interdependence model (APIM) was used to analyze the relationships between perceived HIV stigma and social network components (network relations, network structures, and network functions) at the dyadic level.

RESULTS

We found in this dyadic analysis that: (1) social network components were similar between PLWHAs and their caregivers; (2) HIV stigma perceived by PLWHAs influenced their own social network components, whereas this influence did not exist between caregivers' perceived HIV stigma and their own social network components; (3) a few significant partner effects were observed between HIV stigma and social network components among both PLWHAs and caregivers.

CONCLUSION

The interrelationships between HIV stigma and social network components were complex at the dyadic level. Future interventions programs targeting HIV stigma should focus on the interpersonal relationship at the dyadic level, beyond the intrapersonal factors.

Do children orphaned by AIDS experience distress over time? A latent growth curve analysis of depressive symptoms

This longitudinal study aimed to examine the enduring effects of parental HIV/AIDS on children's psychological well-being in Asia. A sample of 1625 children aged from 6 to 18 years old were assessed annually for their depressive symptoms over three years. Latent growth curve modeling (LGCM) was used to examine the trajectories of depressive symptoms among AIDS orphans and vulnerable children in comparison with children from HIV-free families. AIDS orphans demonstrated the highest initial level of depressive symptoms among the three groups. On average, children's depressive symptoms' scores can be expected to realize an approximate 25% decrease for AIDS orphans, 19% decrease for vulnerable children, and 15% decrease for comparison children over a three-year period. Individual differences within the groups showed that children with higher initial level of depressive symptoms can be expected to decrease slower over time. Multiple group LGCM showed that the three groups of children demonstrated significantly different trajectories of depressive symptoms. Among the key demographic factors, only age exerted an effect on the trajectory of depressive symptoms of vulnerable children, indicating that the younger children showed higher level of initial depressive symptoms and lower rate of decrease than the older children. The current study enriched our knowledge on the longitudinal effect of parental HIV/AIDS on children's emotional distress. Future psychological support might take the children's developmental stages and cultural appropriateness into consideration and deliver service for the most vulnerable group of children affected by HIV/AIDS.

Pathways to poor educational outcomes for HIV/AIDS-affected youth in South Africa

A recent systematic review of studies in the developing world has critically examined linkages from familial HIV/AIDS and associated factors such as poverty and child mental health to negative child educational outcomes. In line with several recommendations in the review, the current study modelled relationships between familial HIV/AIDS, poverty, child internalising problems, gender and four educational outcomes: non-enrolment at school, non-attendance, deficits in grade progression and concentration problems. Path analyses reveal no direct associations between familial HIV/AIDS and any of the educational outcomes. Instead, HIV/AIDS-orphanhood or caregiver HIV/AIDS-sickness impacted indirectly on educational outcomes via the poverty and internalising problems that they occasioned. This has implications for evidence-based policy inferences. For instance, by addressing such intervening variables generally, rather than by seeking to target families affected by HIV/AIDS, interventions could avoid exacerbating stigmatisation, while having a more direct and stronger impact on children's educational outcomes. This analytic approach also suggests that future research should seek to identify causal paths, and may include other intervening variables related to poverty (such as child housework and caring responsibilities) or to child mental health (such as stigma and abuse), that are linked to both familial HIV/AIDS and educational outcomes.

Students and their parental attitudes toward the education of children affected by HIV/AIDS: a cross-sectional study in AIDS prevalent rural areas, China

OBJECTIVE

To investigate the prevalence and determinants of student and parental attitudes toward the education of children affected by HIV/AIDS in areas of rural China where AIDS is prevalent.

METHODS

A cross-sectional study of a random sample of students (n=732) and their parents (n=732) conducted in April 2010, using a questionnaire and in-depth interview.

RESULTS

Twenty-six per cent of students and 29% of parents had a 'good' attitude toward the education of children affected by HIV/AIDS. Following adjustment for sociodemographic characteristics, students' attitudes were significantly associated with knowledge of HIV/AIDS non-transmission (adjusted odds ratio [aOR]= 3.13) and their parents' attitudes (aOR= 2.38), but not with knowledge of HIV/AIDS transmission, prevention or their parents' knowledge. Parents' attitudes were significantly associated with knowledge of HIV/AIDS non-transmission (aOR= 2.12) and their children's attitudes (aOR= 2.52), but not with knowledge of HIV/AIDS transmission, prevention or their children's knowledge.

CONCLUSION

Stigma and discrimination undermine the right to education of HIV/AIDS-affected children in rural China. Improving non-transmission knowledge may improve caring attitudes.

IMPLICATIONS

HIV/AIDS public health educational campaigns highlighting non-transmission and extending family education, combined with school education, may help to enhance an environment of non-discrimination and safeguard public support programs for the right to education of children affected by HIV/AIDS.

A social epidemiological study on HIV/AIDS in a village of Henan Province, China

The HIV/AIDS epidemic caused by commercial blood donation in rural Henan Province of China in the early- to mid-1990s is the largest known cohort in the world related to blood donation but is not fully described. The objectives of this study were to describe the epidemic, epidemiology, and social epidemiology of commercial blood donation and HIV/AIDS. Both qualitative and quantitative mixed methods were used. A village was randomly selected from the 38 key HIV/AIDS pandemic villages in Henan Province. "Demographic Data Form" was applied to collect demographic information of each resident. Focus groups were held for the managers, some residents, members of "HIV/AIDS Work-Team" (organized by the Henan Provincial Government) in the village. Every village physician, people living with HIV/AIDS (PLWHA), school header, and other stakeholders were interviewed individually. The social epidemiology of HIV/AIDS was analyzed under three perspectives of the framework: individual, social, and structural perspectives. In this village, there were 2335 residents, 484 (20.3%) were former donors, 107 (4.6%) were PLWHA, and 96.3% of PLWHA were infected through commercial blood donation. Individually, low education and plasma donation were the risky factors of HIV/AIDS infection. Socially, the epidemic was geography-, kinship-, and conformity-related. Structurally, the related macrostructure factor was policy endorsement of national blood products. The microstructure factors were poverty and value belief on male child in passing down generations. It is concluded that commercial blood donation and HIV/AIDS epidemic in the village are symbiotically related. The epidemic is temporary and socially determined.

The impact of HIV/AIDS on children's educational outcome: a critical review of global literature

The number of children losing one or both parents to HIV/AIDS has continued to rise in the past decade, with most of them being school-aged children. This study reviews global literature on the effects of HIV/AIDS (e.g., parental HIV-related illness or death) on children's schooling. Systematic review procedures generated 23 studies for examination. Existing studies show educational disadvantages among children affected by AIDS in various educational outcomes, including school enrollment and attendance, school behavior and performance, school completion, and educational attainment. A number of individual and contextual factors potentially moderate or mediate the effect of HIV/AIDS on children's education. These factors include gender of child, pattern of parental loss (maternal vs. paternal vs. dual), living arrangement (relationship with caregivers, gender of the household head), and household poverty. Current literature indicates limitations in number and scope of existing studies and in educational outcome measurements. There is a lack of studies with longitudinal design and data collection from multiple sources (e.g., students, teachers, caregivers), and a lack of studies on the relationship between psychosocial well-being of children affected by AIDS and their educational outcomes. Future studies need to employ more rigorous methodology and incorporate both individual and contextual factors for children affected by AIDS in various regions. More efforts are needed to design and implement culturally appropriate and context-specific approaches to improve the educational outcomes of children affected by AIDS.

Stigma against children affected by AIDS (SACAA): psychometric evaluation of a brief measurement scale

The current study was designed to develop and evaluate a brief scale measuring perceived public stigma against children affected by HIV/AIDS. The participants include 755 children who have lost one or both parents to HIV/AIDS (AIDS orphans), 466 children facing the potential of losing their parents to HIV/AIDS (vulnerable children), and 404 comparison children who did not have HIV-related illness or death in their families. The data in this study demonstrated that the SACAA scale provides a psychometrically sound measure of perceived stigma against children affected by AIDS in China. The SACAA scale is a reliable measure for children of both genders, at different developmental stages, and for both children affected by HIV/AIDS and comparison children. Known-group validation and correlation analysis demonstrate excellent construct validity of this brief SACAA scale. The SACAA score was positively associated with psychopathological symptoms and negatively associated with psychosocial well-being among participating children.

Sibling caregiving among children orphaned by AIDS: synthesis of recent studies for policy implications

OBJECTIVE

The HIV/AIDS epidemic has increased the number of orphans who have to care for their younger siblings. However, their caregiving practices are poorly reported. This review aimed to explore and accumulate available evidences on sibling caregiving among children orphaned by AIDS.

METHODS

We conducted a systematic review of sibling caregiving among AIDS orphans in developing countries and identified 25 relevant articles. We analysed the compiled literature and extracted information on the prevalence of sibling caregiving, the framework of sibling caregiving, factors influencing caregiving, and the impact of sibling caregiving on caregivers and those cared for.

RESULTS

Sibling caregiving, which includes economic, physical, psychological, and educational care, was influenced by children's, familial, community, and policy factors. Unlike sibling caregiving that occurs under adequate adult supervision, sibling caregiving among AIDS orphans negatively impacts both the sibling caregivers and the cared for. However, the lack of studies about such sibling caregiving had prevented measurement of the level of burden and impact of sibling caregiving on orphans.

CONCLUSIONS

Policy makers need to be aware that older children caring for younger siblings risk physical and psychological ill health and information must be collected so that measures can be developed to mitigate this burden on orphans.

Care arrangements of AIDS orphans and their relationship with children's psychosocial well-being in rural China

There is an estimated 100,000 children orphaned by AIDS in China, but data on the care arrangement of these orphans are limited. In this study, we examine the relationship between AIDS orphans' care arrangement and their psychosocial well-being among a sample of AIDS orphans in rural China. A total of 296 children who lost both parents to AIDS participated in the study, including 176 in orphanages, 90 in kinship care and 30 in community-based group homes. All participants completed a cross-sectional survey assessing their traumatic symptoms, physical health and schooling. Data reveal that the AIDS orphans in group homes reported the best outcomes in three domains of psychosocial well-being, followed by those in the orphanages and then the kinship care. The differences in psychosocial well-being among the three groups of children persist after controlling for key demographic characteristics. The findings suggest that the appropriate care arrangement for AIDS orphans should be evaluated within the specific social and cultural context where the orphans live. In resource-poor regions or areas stricken hardest by the AIDS epidemic, kinship care may not sufficiently serve the needs of AIDS orphans. Community-based care models, with appropriate government and community support preserving the family style and low child-to-caregiver ratio may constitute an effective and sustainable care model for the best interest of the AIDS orphans in developing countries.

Quality of life of children living in HIV/AIDS-affected families in rural areas in Yunnan, China

The aim of this study was to explore the main influencing factors of the health-related quality of life (HRQL) of children living in HIV/AIDS-affected families in rural areas in Yunnan, China. The HRQL of 116 children aged 8-17 from HIV/AIDS-affected families and 109 children from unaffected families was evaluated by the Chinese Version of PedsQL 4.0. Some potential influencing factors were questioned, such as demographic characteristics, the families' social and economic status, foster models, children's self-esteem, etc. The HRQL of children's caregivers may also have been among the influencing factors, as measured by short-form 36 (SF-36). Multiple regression analysis was used to explore the influence of independent variables on children's HRQL. The findings showed that children from HIV/AIDS-affected families reported lower scores of HRQL than those from unaffected families, especially in domains of psychosocial functioning, emotional functioning, and school functioning. Results of multiple regression analysis showed that lower levels of children's self-esteem and caregivers' SF-36 reduced the majority of PedsQL domains. Children living with grandparents reported higher PedsQL scores in psychosocial health, social functioning, and school functioning. Disclosure of parental HIV/AIDS status reduced children's PedsQL scores in emotional functioning and social functioning. Caregivers spending more hours accompanying the children appeared to increase the PedsQL scores in psychosocial health and school functioning. The findings indicate that the child's self-esteem, the caregiver's perceived quality of life, the child's foster pattern, the average hours of company provided by the caregiver, and whether the child was informed of the parent's HIV/AIDS status are important factors influencing HRQL. Interventions aiming at these factors should be developed to improve the HRQL of children affected by HIV/AIDS.

Measuring health-related quality of life in children living in HIV/AIDS-affected families in rural areas in Yunnan, China: Preliminary reliability and validity of the Chinese version of PedsQL 4.0 generic core scales

OBJECTIVES

To investigate the preliminary reliability and validity of the Chinese Mandarin version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales in a sample of general children and children living in HIV/AIDS-affected families.

METHODS

The PedsQL 4.0 was administered to 116 children aged 8-18 years from HIV/AIDS-affected families and 115 of their caregivers. The questionnaire was also administered to a control group of 109 children and 107 of their caregivers.

RESULTS

Most of the self-report and proxy-report scales in both groups exceeded the reliability standard of 0.70, whereas the self-report emotional functioning and school functioning subscales were slightly less than 0.70. On average, children living in HIV/AIDS-affected families scored significantly lower than the control group. The level of agreement between self-reports and proxy reports was low. Correlations were higher on average for the younger age group than for the older age group.

CONCLUSIONS

The Chinese Mandarin version of PedsQL 4.0 is a valid and reliable instrument for use with children living in HIV families. The health-related quality of life for children living in HIV families is lower than children from ordinary families.

The situation of children affected by HIV/AIDS in Southwest China: Schooling, physical health, and interpersonal relationships

OBJECTIVE

To investigate the schooling, physical health and interpersonal relationships of children affected by HIV/AIDS in rural areas of southwest China.

METHODS

Using a structured survey, quantitative data were collected on a total of 116 children and 114 of their caregivers.

RESULTS

Parental illness or death adversely affected children's school attendance and school performance. Over one-third (36.2%) of children reported being ill for more than 3 days during the previous 6 months; more orphans were hospitalized during the latest illness than nonorphans, although the difference was not statistically significant. One-third (33.6%) of children were aware that their parents were HIV positive. Ten percent of orphans reported that their relationships with peers became worse after parental illness or death, which was significantly higher than nonorphans. Twenty-five percent of orphans reported they were teased by others compared with 1.9% of nonorphans.

CONCLUSIONS

HIV infection has impacted negatively on the children in terms of education, health, and peer association. These findings can be used as preliminary data supporting intervention strategies and activities to improve the general welfare of children affected by HIV/AIDS in China.

School performance and school behavior of children affected by AIDS in China

It is generally recognized that the AIDS epidemic will have a negative effect on the orphans' school education. However, few studies have been carried out to examine the school performance and school behavior of AIDS orphans and vulnerable children (children living with HIV-infected parents). Using both self-report and teacher evaluation data of 1625 children from rural central China, we examined the impact of parental HIV/AIDS on children's school performances (academic marks, educational expectation, and student leadership) and school behaviors (e.g., aggression, shy/anxious and assertive social skills). Results indicate that AIDS orphans and vulnerable children had disadvantages in school performances in comparison to their peers from the same community who did not experience AIDS-related death and illness in their family (comparison children). AIDS orphans had the lowest academic marks based on the reports of both children and teachers. Educational expectation was significantly lower among AIDS orphans and vulnerable children than comparison children from teacher's perspective. AIDS orphans were significantly more likely to demonstrate aggressive, impulsive and anxious behaviors than non-orphans. Moreover, orphans have more learning difficulties. Vulnerable children were also at a disadvantage on most measures. The data suggest that a greater attention is needed to the school performance and behavior of children affected by AIDS. The findings also indicate that AIDS relief and assistance program for children should go beyond the school attendance and make efforts to improve their school performance and education aspiration.

Parental HIV/AIDS and psychosocial adjustment among rural Chinese children

OBJECTIVE

To assess the relationship between parental HIV/AIDS and psychosocial adjustment of children in rural central China.

METHODS

Participants included 296 double AIDS orphans (children who had lost both their parents to AIDS), 459 single orphans (children who had lost one parent to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV/AIDS-related illness and death in their families. The measures included depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future.

RESULTS

AIDS orphans and vulnerable children consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The level of psychosocial adjustment was similar between single orphans and double orphans, but differed by care arrangement among double orphans.

CONCLUSION

The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the psychosocial wellbeing of these children.

Parents Living with HIV in China: Family Functioning and Quality of Life

In China, HIV shifts the lifestyle of not only parents living with HIV/AIDS, but also their children, partners, and extended families. We examined factors related to the quality of life of parents living with HIV and the relation between family functioning and individual quality of life. Interviews were conducted with a total of 116 parents living with HIV/AIDS. Analyses of variance, Pearson correlations, and multiple regression analyses were performed to examine the relation between family functioning and quality of life. We found a significant association between family functioning and individual quality of life for parents living with HIV. In particular, family sociability had a strong relationship with the quality of life of parents living with HIV. Parents living with HIV from families where both parents are HIV-positive reported a lower level of family sociability than those from families with only one HIV-positive parent. HIV disclosure, family sociability, and number of children per family were found to be significant predictors of overall quality of life for the population. Study findings underscore the importance of developing interventions that improve family functioning for people living with HIV/AIDS in China.

A developmental psychopathology framework of the psychosocial needs of children orphaned by HIV

In addition to the obstacles to a successful resolution of grief normally faced by children whose parents have died, children orphaned by AIDS may face additional psychological and social challenges. However, limited attention has been paid to psychosocial and developmental needs of children orphaned by HIV/AIDS, particularly in resource-poor countries or regions. In this article the authors review the global literature on child bereavement and AIDS orphan care experiences in developing countries and present a developmental psychopathology model of the psychosocial issues facing AIDS orphans. The authors identify gaps in the literature and provide suggestions for future research on AIDS orphans in resource-poor countries and regions. They emphasize that future studies need to assess the status of behaviors and mental health of children orphaned by AIDS within a developmental framework, identify those individual and social factors associated with grief, and examine the long-term impact of quality of care, developmental maturation, and attachment with caregivers on the psychosocial well-being of AIDS orphans.

Care arrangements, grief and psychological problems among children orphaned by AIDS in China

The China Ministry of Health has estimated that there are at least 100,000 AIDS orphans in China. The UNICEF China Office estimates that between 150,000 and 250,000 additional children will be orphaned by AIDS over the next five years. However, limited data are available regarding the sociodemographic characteristics, care arrangements, barriers to appropriate grief resolution and psychological problems among AIDS orphans in China. In this article, we review secondary data and reports from scientific literature, government, non-governmental organisations and public media regarding children orphaned by AIDS in China to address their living situation, bereavement process and psychological problems. Our review suggests that AIDS orphans in China are living in a stressful environment, with many orphans struggling with psychological problems and unmet basic needs such as food, shelter, education and medical care. Based on our review, we suggest that future studies should address the psychosocial needs of AIDS orphans in China and develop health promotion programmes to mitigate the negative impact of parental death on the physical and psychosocial well-being of these orphans.

Children's body mass index and nutrition intake in HIV/AIDS

HIV/AIDS in China poses many challenges for caregivers and their children. A total of 154 caregivers of HIV/AIDS-affected families were interviewed to examine the children's nutrition intake and body mass index (BMI) in the context of HIV/AIDS in the family. The results showed that 25% of children in HIV/AIDS-affected families were underweight or at risk of being underweight according to US criteria. More than half the children reported that their consumption of protein such as meat, eggs or milk ranged from not at all to two times during the past month. About 40% of the children sometimes or often went hungry due to insufficient food. The study findings underscore the need to improve the nutrition and general health of children of people living with HIV/AIDS.

The impact of HIV/AIDS on families and children--a study in China

OBJECTIVE

The goal of the study was to understand the needs of families and children affected by HIV/AIDS.

DESIGN

This study used a mixed method combining qualitative and quantitative approaches.

METHODS

Focus groups were conducted with local health workers, local schoolteachers, village leaders, persons living with HIV/AIDS, and caregivers for children affected by HIV/AIDS in Anhui, China. Face-to-face interviews were conducted with 154 caregivers of HIV-affected children.

RESULTS

The majority of the caregivers interviewed in the quantitative study were parents (84%), 80% were HIV-positive, and 58% were female. About 54% of the caregivers rated quality of life as poor and 85% reported frequent negative feelings. The annual income per person for HIV/AIDS affected families was much lower than the provincial average. HIV also impacted family relations and family economic situation. The impact of HIV on children was reflected in children's school performance. Children's nutrition and health were also compromised.

CONCLUSIONS

Interventions that address the challenges that families face, build families' coping skills, and form supportive local community networks, are needed.