Family-based care and psychological problems of AIDS orphans: does it matter who was the care-giver?

Parenting in Adversity: Effects of Older Caregivers, Biological Carers and Troubled Carers on Child Outcomes in High HIV-Affected Communities

Caregiving by older adults is a common phenomenon, enhanced in the era of HIV infection. This longitudinal study was set up to examine the effect of caregiver age, relationship and mental wellbeing on child (4-13 years) outcomes (psychosocial and cognitive) in a sample of 808 caregiver- child dyads in South Africa and Malawi. Respondents were drawn from consecutive attenders at Community Based Organisations (CBOs) and interviewed with standardised inventories at baseline and followed up 12-15 months later. Analysis focused on three separate aspects of the caregiver; age, relationship to the child, and mental wellbeing, results are stratified with regard to these factors. Results showed that compared to younger caregivers, over 50 years were carrying a heavy load of childcare, but caregiver age for the most part was not associated with child outcomes. Being biologically related to the child (such as biological grandparenting) was also not a significant factor in child outcomes measured. However, irrespective of age and relationship, caregiver mental health was associated with differences in child outcome - those children of caregivers with a greater mental health burden were found to report experiencing more physical and psychologically violent discipline. Over time, the use of violent discipline was found to reduce. These data suggest that older caregivers and grandparents are providing comparable care to younger caregivers, for young children in the face of the HIV epidemic and that interventions should focus on mental health support for all caregivers, irrespective of age or relationship to the child.

Intervention Model for Orphan’s Emotional and Behavioral Problems: A Scoping Review

BACKGROUND: As many as, 45% of orphaned children and adolescents living in orphanages experience behavioral and emotional problems. Several literature reviews on the intervention of emotional and behavioral problems in orphan children and adolescents have been widely conducted. However, there is paucity in the reviews of emotional and behavioral problem interventions in the orphan group based on the type of group approach used in published articles. AIM: This study aimed to synthesize the results on the interventions of emotional and behavioral problems in orphan children and adolescents aged 7–20 years who live in institutions or orphanages. METHODS: This research was a scoping review. This review used three databases comprising PubMed, Science Direct, and Wiley Library Online. The inclusion criteria were experimental research designs and cohort studies, published in the 2009–2019, discussed emotional and behavioral problem’s intervention in orphan, and written in English. The exclusion criteria were that the research subjects had severe mental and psychosocial disorders such as autism, mental retardation, and mental disorders. The authors used three categories of keywords; the first keyword and its synonym were “intervention, treatment.” The second keyword focused on behavioral problems, which was “behavioral difficulties,” and the third keyword focuses on population and place, “orphan, institutions orphans, orphanages.” The article selection stage is described in detail in the flow diagram of Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The critical appraisal stage used the checklist from Joanna Briggs Institute. RESULTS: Ten articles were found and selected for review. The main emotional and behavioral problems experienced by orphan children and adolescents include depression, anxiety, and low self-esteem, feelings of anger, and trauma. Other problems related, functional disorders, life satisfaction, the probability of suicide, and early (prodromal) symptoms of psychosis, also arise. There were six types of interventions given to overcome emotional and behavioral problems in orphan children and adolescents, but the interventions that are most often given are cognitive therapy, educational support, complementary, and alternative medicine. The approaches in groups that are often used in this review are the support group and the teaching-learning group. The combination of two or more approaches in one intervention can increase the success or effectiveness in overcoming emotional and behavioral problems. CONCLUSIONS: Depression, anxiety, low self-esteem, feeling anger, and trauma are main problems for orphans. To address these emotional and behavior problems, it is necessary to combine several interventions and a combination of group-based approaches.

A physical symptom-based measure of quality of care for children affected by HIV/AIDS

Based on cross-sectional data of 1,625 children aged 6-18 years who were affected by parental HIV/AIDS in central rural China, we evaluated a physical symptom based measure of quality of care (QOC_PS) for these children. The QOC_PS has acceptable reliability estimates for children of both genders, at different age, and by orphanhood status. Known-group validation and construct validity analysis demonstrated a good validity of QOC_PS indicator. The QOC_PS score was significantly associated with psychosocial well-being measures among children. The physical symptom based measure provides a psychometrically appropriate indicator of quality of care for children affected by HIV/AIDS in China. It could be used as an alternative measure to assess quality of care in resource-poor settings where other objective measurements are not available or feasible. Future research is needed to further validate the scale among children in different living environments across various cultural settings.

Why Tell Children: A Synthesis of the Global Literature on Reasons for Disclosing or Not Disclosing an HIV Diagnosis to Children 12 and under

While the psychological and health benefits of knowing one's HIV diagnosis have been documented for adults and adolescents, practice is still in development for younger children. Moderating conditions for whether or not to tell a child he/she has HIV vary by region and local context. They include accessibility of treatment, consideration of HIV as a stigmatizing condition, prevalence of HIV, and an accompanying presumption that any illness is HIV-related, parent or caregiver concerns about child reactions, child's worsening health, assumptions about childhood and child readiness to know a diagnosis, and lack of policies such as those that would prevent bullying of affected children in schools. In this systematic review of the global literature, we summarize the reasons caregivers give for telling or not telling children 12 and under their HIV diagnosis. We also include articles in which children reflect on their desires for being told. While a broad number of reasons are given for telling a child - e.g., to aid in prevention, adaptation to illness (e.g., primarily to promote treatment adherence), understanding social reactions, and maintaining the child-adult relationship - a narrower range of reasons, often related to immediate child or caregiver well-being or discomfort, are given for not telling. Recommendations are made to improve the context for disclosure by providing supports before, during, and after disclosure and to advance the research agenda by broadening samples and refining approaches.

Caring for HIV-positive orphans in the context of HIV and AIDS: perspectives of Botswana grandmothers

BACKGROUND

Botswana has a human immunodeficiency virus (HIV) prevalence of 18.6% and an estimated 137 805 orphans in a population of approximately two million people. Many of these orphans are cared for by their grandmothers, who struggle with caring for orphans suffering from a disease they know very little about.

METHODS

The purpose of this exploratory qualitative study was to explore experiences of grandmothers caring for HIV-positive orphan grandchildren.

RESULTS

The ages of the grandmothers interviewed ranged from 60 to 80 years, while the number of orphans under their care ranged from one to nine. The themes that emerged included the following: challenges of HIV treatment, HIV-related stigma, disclosure of HIV status, communication of sexuality issues and the adolescent pregnancies. Cultural beliefs prevented them from talking about sexuality and in some cases, accepting HIV as the cause of death.

CONCLUSIONS

Grandmothers were challenged by HIV treatment of orphans and their supportive role as caregivers. The lack of knowledge of the disease must be addressed to improve adherence and communication about HIV. HIV programs need to address older persons' dynamic and diverse needs as individuals. Community home-based care nurses need to support grandmothers caring for HIV-positive grandchildren and refer them to relevant professionals who can assist with the care responsibilities.

IMPLICATIONS FOR PRACTICE

Nurses working with older people caring for HIV positive orphans need to develop culturally sensitive HIV education programs that address needs specific to.

Orphanhood by AIDS-Related Causes and Child Mental Health: A Developmental Psychopathology Approach

While the number of new HIV infections has declined, the number of orphans as a result of AIDS-related deaths continues to increase. The aim of this paper was to systematically review empirical research on the mental health of children affected by HIV/AIDS in the developing world, specifically with an eye on developing a theoretical framework to guide intervention and research. Articles for review were gathered by following the Preferred Reporting Items for Systemic Reviews and Meta Analyses (PRISMA standards), reviewed and then organized and synthesized with a Developmental Psychopathology framework. Results showed that the immediate and longterm effects of AIDS orphanhood are moderated by a number of important risk and protective factors that may serve as strategic targets for intervention. Research and clinical implications are discussed.

The role of perceived social support in loneliness and self-esteem among children affected by HIV/AIDS: a longitudinal multilevel analysis in rural China

OBJECTIVES

To delineate the trajectories of loneliness and self-esteem over time among children affected by parental HIV and AIDS, and to examine how their perceived social support (PSS) influenced initial scores and change rates of these two psychological outcomes.

DESIGN

We collected longitudinal data from children affected by parental HIV/AIDS in rural central China. Children 6-18 years of age at baseline were eligible to participate in the study and were assessed annually for 3 years.

METHODS

Multilevel regression models for change were used to assess the effect of baseline PSS on the trajectories of loneliness and self-esteem over time. We employed maximum likelihood estimates to fit multilevel models and specified the between-individual covariance matrix as 'unstructured' to allow correlation among the different sources of variance. Statistics including -2 Log Likelihood, Akaike Information Criterion and Bayesian Information Criterion were used in evaluating the model fit.

RESULTS

The results of multilevel analyses indicated that loneliness scores significantly declined over time. Controlling for demographic characteristics, children with higher PSS reported significantly lower baseline loneliness score and experienced a slower rate of decline in loneliness over time. Children with higher PSS were more likely to report higher self-esteem scores at baseline. However, the self-esteem scores remained stable over time controlling for baseline PSS and all the other variables.

CONCLUSIONS

The positive effect of PSS on psychological adjustment may imply a promising approach for future intervention among children affected by HIV/AIDS, in which efforts to promote psychosocial well being could focus on children and families with lower social support. We also call for a greater understanding of children's psychological adjustment process in various contexts of social support and appropriate adaptations of evidence-based interventions to meet their diverse needs.

Domestic chores workload and depressive symptoms among children affected by HIV/AIDS in China

Limited data are available regarding the effects of domestic chores workload on psychological problems among children affected by HIV/AIDS in China. The current study aims to examine association between children's depressive symptoms and the domestic chores workload (i.e., the frequency and the amount of time doing domestic chores). Data were derived from the baseline survey of a longitudinal study which investigated the impact of parental HIV/AIDS on psychological problems of children. A total of 1449 children in family-based care were included in the analysis: 579 orphaned children who lost one or both parents due to AIDS, 466 vulnerable children living with one or both parents being infected with HIV, and 404 comparison children who did not have HIV/AIDS-infected family members in their families. Results showed differences on domestic chores workload between children affected by HIV/AIDS (orphans and vulnerable children) and the comparison children. Children affected by HIV/AIDS worked more frequently and worked longer time on domestic chores than the comparison children. Multivariate linear regression analysis showed that domestic chores workload was positively associated with depressive symptoms. The data suggest that children affected by HIV/AIDS may face increasing burden of domestic chores and it is necessary to reduce the excessive workload of domestic chores among children affected by HIV/AIDS through increasing community-based social support for children in the families affected by HIV/AIDS.