Author: Victoria Wilmarth

Gender differentials in the impact of parental death: Adolescent’s sexual behaviour and risk of HIV infection in rural South Africa

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Title: Gender differentials in the impact of parental death: Adolescent’s sexual behaviour and risk of HIV infection in rural South Africa.

Authors: Makandwe Nyirenda, Nuala McGrath, Marie-Louise Newell

Date: October 2010

Abstract: Using data from a longitudinal surveillance study from rural South Africa, we investigated the odds of sexual debut, pregnancy and HIV infection of 15- to 19-year-old adolescents by parental survival. Using descriptive statistics and logistic regressions, we examine the relative risk of orphans compared with non-orphans to have ever had sex, being pregnant and being HIV infected, adjusting for age, sex, socio-economic status, education, being employed and residency. Of 8274 adolescents, 42% were orphaned (one or both parents died). Over 80% of adolescents remained in school, but orphans were significantly more likely to lag behind in grade for age. Female adolescent maternal (aOR 1.32, 95% CI 1.07-1.62), paternal (aOR 1.26, 95% CI 1.06-1.49) and dual (aOR 1.37, 95% CI 1.05-1.78) orphans were significantly more likely than non-orphaned females to have ever had sex; among males it was only paternal (aOR 1.27, 95% CI 1.05-1.53) orphans. Maternal (aOR 1.49, 95% CI 1.03-2.15) and dual (aOR 1.74, 95% CI 1.11-2.73) female orphans relative to non-orphaned females were significantly more likely to be HIV infected; male paternal (aOR 3.41, 95% CI 1.37-8.46) and dual (aOR 3.54, 95% CI 1.06-11.86) orphans had over three-fold the odds of being infected. There was strong evidence that death of mother for girls was associated with increased vulnerability to earlier sexual debut and HIV infection, while fathers appeared to play a significant role in both their son’s and daughter’s lives.

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Knowing kids dying of HIV: a traumatic event for AIDS orphans

Written by Victoria Wilmarth on . Posted in OVC and HIV/AIDS, Psychological Effects of Orphanhood. Leave a Comment

Title: Knowing kids dying of HIV: a traumatic event for AIDS orphans

Authors: Qun Zhao, Xiaoming Li, Xiuyun Lin, Xiaoyi Fang, Guoxiang Zhao, Junfeng Zhao

Date: 2009

Abstract: Data from 755 AIDS orphans living in a rural area of China with high rates of HIV infection were used to examine the association between a child’s trauma symptoms and knowing a peer with HIV infection or one who had died of HIV. Trauma symptoms were measured by the Traumatic Symptoms Checklist for Children-Chinese Version (TSCC-CV). About 47% of participants reported they knew a child with HIV or one who had died of HIV. More orphans living in family-based care reported such knowledge, and trauma symptoms were significantly higher in children who reported such knowledge. Multivariate analysis showed that such knowledge was significantly associated with traumatic symptoms, controlling for gender, age, family socioeconomic status, orphan status (double vs. single), and care arrangement (family-based vs. institutional care). The results underscored the importance of psychosocial support and counseling to orphans in communities with high levels of HIV-related mortality.

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Contraception in HIV-positive female adolescents

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Title: Contraception in HIV-positive female adolescents

Authors: Nadia T Kancheva Landolt, Sudrak Lakhonphon, Jintanat Ananworanich

Date: 2011

Abstract:

Sexual behavior of HIV-positive youths, whether infected perinatally, through risky behavior or other ways, is not substantially different from that of HIV-uninfected peers. Because of highly active antiretroviral therapy, increasing number of children, infected perinatally, are surviving into adolescence and are becoming sexually active and need reproductive health services. The objective of this article is to review the methods of contraception appropriate for HIV-positive adolescents with a special focus on hormonal contraceptives. Delaying the start of sexual life and the use of two methods thereafter, one of which is the male condom and the other a highly effective contraceptive method such as hormonal contraception or an intrauterine device, is currently the most effective option for those who desire simultaneous protection from both pregnancy and sexually transmitted diseases. Health care providers should be aware of the possible pharmacokinetic interactions between hormonal contraception and antiretrovirals. There is an urgent need for more information regarding metabolic outcomes of hormonal contraceptives, especially the effect of injectable progestins on bone metabolism, in HIV-positive adolescent girls.

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The influence of maternal HIV serostatus on mother-daughter sexual risk communication and adolescent engagement in HIV risk behaviors

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Title: The influence of maternal HIV serostatus on mother-daughter sexual risk communication and adolescent engagement in HIV risk behaviors

Author: Julie A Cederbaum

Date: January 1, 2009

Abstract:

Objective . There is a growing body of literature that demonstrates positive parental influences on adolescents’ sexual initiation and sexual risk behaviors; little is known about how these processes operate when mom is HIV-positive. Youth of HIV-positive women are an extremely vulnerable population. They are often exposed to the same factors that placed their mothers at risk; many live in low-income, high seroprevalence inner-city areas. As these children come of age, we have the opportunity to understand parent-child sexual risk communication (PTSRC) and monitoring among HIV infected mothers, and how these behaviors may influence their child’s sexual decision-making.

Methods . Guided by a family-expansion of the Theory of Planned Behavior, this study employed a sequential mixed methods design to understand impact of maternal HIV status on maternal sexual risk communication and monitoring and in turn, how these behaviors effect daughters’ beliefs and behaviors. Phase one included 7 focus groups; this information was used to inform the development the survey instrument. Phase II was a self-administered survey completed by 110 mother-daughter dyads.

Results . Maternal HIV status was not a predictor of PTSRC or monitoring. Predictors of PTSRC included behavioral beliefs about PTSRC; relationship satisfaction was a predictor of parental monitoring. Maternal HIV status did significantly and positively influence daughters’ behavioral beliefs about the negative outcomes of sex and hedonistic beliefs about condoms. Further, maternal HIV status predicted daughters’ intentions to abstain. Child age, and normative and control beliefs also significantly predicted adolescent intention to have sex.

Conclusion . This study is one of few to explore the impact of maternal HIV status on adolescent risk behaviors. Knowledge of mother’s HIV status was predictive of behavioral beliefs; however, daughters of HIV-positive women were more likely to report ever having had sex. This shows that there is a disconnect between knowing and doing; it is this juncture that future HIV intervention must target. Important to include in future clinical and research interventions are: attention to structural factors in both physical and social community; helping families build healthy and satisfying relationships; and finding ways to create and influence community norms around abstinence and safer sex behaviors.

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Growing up with HIV/AIDS: a study on adolescents with HIV/AIDS and their family caregivers

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Title: Growing up with HIV/AIDS: a study on adolescents with HIV/AIDS and their family caregivers

Authors: Ana Amélia Antunes Lima, Eva Néri Rubim Pedro

Date: 2008

Abstract: This is an exploratory study with a qualitative approach, which looks at the adolescent process with HIV/AIDS. The purpose is to identify how the adolescent process occurs, from the perspective of these teenagers and their family caregivers. The investigation was performed in Porto Alegre, RS between May and July 2005, and the subjects were four adolescents and three caregivers. Data were collected by means of interviews, which were subject to the content analysis technique. The study revealed that both teenagers and family caregivers did not show concern with the changes typical of the period, especially regarding sexuality questions. Yet, the underlying diagnosis and coping with HIV remain in the family core in order to protect these agents against the stigma of the disease.

 

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Correlates of poor health among orphans and abandoned children in less wealthy countries: the importance of caregiver health

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Title:  Correlates of Poor Health among Orphans and Abandoned Children in Less Wealthy Countries: The Importance of Caregiver Health

Authors:  Nathan Thielman, Jan Ostermann, Kathryn Whetten, Rachel Whetten, Karen O’Donnell, the Positive Outcomes for orphans (POFO) Research Team

Date: June 13, 2012

Abstract:

Background

More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregiver, and household characteristics among randomly selected OAC in five countries.

Methodology

Using a two-stage random sampling strategy in 6 study areas in Cambodia, Ethiopia, India, Kenya, and Tanzania, the Positive Outcomes for Orphans (POFO) study identified 1,480 community-living OAC ages 6 to 12. Detailed interviews were conducted with 1,305 primary caregivers at baseline and after 6 and 12 months. Multivariable logistic regression models describe associations between the characteristics of children, caregivers, and households and child health outcomes: fair or poor child health; fever, cough, or diarrhea within the past two weeks; illness in the past 6 months; and fair or poor health on at least two assessments.

Principle Findings

Across the six study areas, 23% of OAC were reported to be in fair or poor health; 19%, 18%, and 2% had fever, cough, or diarrhea, respectively, within the past two weeks; 55% had illnesses within the past 6 months; and 23% were in fair or poor health on at least two assessments. Female gender, suspected HIV infection, experiences of potentially traumatic events, including the loss of both parents, urban residence, eating fewer than 3 meals per day, and low caregiver involvement were associated with poorer child health outcomes. Particularly strong associations were observed between child health measures and the health of their primary caregivers.

 

Conclusions

Poor caregiver health is a strong signal for poor health of OAC. Strategies to support OAC should target the caregiver-child dyad. Steps to ensure food security, foster gender equality, and prevent and treat traumatic events are needed.

 

 

 

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Factors impacting on antiretroviral therapy compliance in HIV positive adolescents

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Title: Factors impacting on antiretroviral therapy compliance in HIV positive adolescents

Author(s): Trocomé, N, Vaudre, G, Dolfus C and G Leverger

Date: September 6, 2002

Abstract:

Is poor treatment observance frequently observed in HIV positive adolescent population, due to the adolescent developmental process, their experience of living with HIV, or lack of information on the disease or treatment?

Methods. – We interviewed the 29 HIV positive adolescents followed up in one pediatric reference center. Confidential interviews were performed according to a standard questionnaire by psychologist and research nurse.

Results. – Seventy-nine percent had stopped at least once a time their treatment who was the major barrier to their sense of freedom behind their adolescence (one-third of them decided to stop it more than one month), although 75% knew the potential consequences and had a good information about their seeks. Fifty-five percent expressed feelings of loneliness or depression, yet 75% consider they had a pleasant life because they had a normal life. In fact, the secret and silence about HIV were the price for this normality.

Conclusion. – Being dependent upon a treatment is a major constraint on the lives of HIV positive adolescents. Although they are fully informed, the deliberate interruption of treatment could attest of their expressed need for autonomy and medical prescription have to be careful with this problem.

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New Study Finds Caregiver’s Health is Strong Predictor of Orphan Health

Written by Victoria Wilmarth on . Posted in Blog: News, Events and Opinion. 1 Comment

The health of a caregiver is the most important predictor of orphan health, according to a new study conducted by the Positive Outcomes for Orphans (POFO) Research Team. The study, conducted by an international research team, spans five culturally-and economically-diverse less-wealthy nations in Africa and Asia. More important than an orphan’s geographic location, living conditions, or past trauma, the study finds that an unhealthy caregiver likely means an unhealthy child.

The findings prompt researchers to call for international orphan policies to place greater attention on assessing and treating children and their caregiver’s health together, rather than focusing on children’s health in isolation.

Published in PLoS One today, the Duke University sponsored study of over 1300 randomly selected orphans and abandoned children from six diverse settings found that one in five was in fair or poor health and one in four had experienced symptoms of illness in the previous two weeks.  Forty-five percent of the caregivers reported their own health to be fair or poor, and one in four caregivers reported symptoms like fever, cough and/or diarrhea in the last two weeks. Strong and consistent associations were found between poorer child health and poorer health among their caregivers. Children whose caregivers were more involved in their lives and well-being were less likely to be sick or unhealthy.

“This study produces strong evidence to inform policy and resource allocation relevant to the health of this large vulnerable child population worldwide,” said Nathan Thielman, lead author and associate professor of medicine and global health at the Duke Global Health Institute. “Specifically, policies that promote orphan well-being should include health assessments and interventions that target the caregiver-child dyad. ”

Researchers say a lack of economic resources may be a contributor to poor child health. Orphans are often cared for in households headed by females or the elderly; these households may have less money and are less likely to cover medical expenses associated with caregiver illness, further limiting their ability to provide adequate nutrition and access to health care for the child.

Researchers argue the study provides strong support for establishing more family-based clinics in resource-poor settings that offer services and treatment to both children and their caregivers. They also suggest adding comprehensive caregiver health assessments to existing tools used to measure the well-being of orphans.

The multi-site study included community-dwelling orphans ages 6-12 and their caregivers from six culturally- and economically-diverse sites across five countries: Cambodia, Ethiopia, India, Kenya and Tanzania. All of the children in the study have survived the death of one parent or were abandoned by both parents. Of 153 million children orphaned worldwide, 145 million reside in less -wealthy nations where high rates of HIV/AIDS and other diseases like malaria and tuberculosis claim thousands of lives every day.

This research was supported by a wide range of international partner organizations, including: ACE Africa, Bungoma, Kenya; Homeland Meahto Phum Ko’Mah in

Battambang, Cambodia; KIWAKKUKI and TAWREF, Moshi, Tanzania; SaveLives Ethiopia and Save the Vulnerables Organization, Addis Ababa, Ethiopia; and Sahara Centre for Rehabilitation and Residential Care in Delhi, Hyderabad and Nagaland, India.

This work was supported by the National Institute of Child Health and Development (NICHD), grant No. 5R01HD046345-04. The Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health also supported this study.

 

XIX International AIDS Conference: “Turning the Tide Together”

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From July 22nd through the 27th,  more than 20,000 delegates from around the world will gather in Washington D.C. for the XIX International AIDS Conference. The conference is being organized by the International AIDS Society. AIDS 2012 describes itself as: “a chance to asses where we are, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward.”

The AIDS epidemic remains closely intertwined with the plight of millions of orphans and vulnerable children worldwide. As an event that brings together scientists, medical professionals, policy makers, and activists, AIDS 2012 is an opportunity for the international community to collaboratively share ideas, research, and policies to support OVC affected by HIV/AIDS.

 

19th Session of the African Committee of Experts on the Rights and Welfare of Children

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Eleven experts from across Africa met in Addis Ababa, Ethiopia at the end of March as a part of the 19th Ordinary Session of the African Committee of Experts on the Rights and Welfare of Children (ACERWC). The meeting focused on harmful traditional practices (HTP). Particular attention was paid to female genital mutilation (FGM), a practice that the ACERWC committee Chairperson cited as not only a health risk, but also a human rights violation. The committee also discussed a variety of topics connected to Day of the African Child 2012, which will take place on June 16 with the theme  “The Rights of Children with Disability: the Duty to Protect, to Respect, to Promote and to Fulfill.”

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