What do we know about children living with HIV-infected or AIDS-ill adults in Sub-Saharan Africa? A systematic review of the literature

Abstract

Millions of children in Sub-Saharan Africa live with adults, often parents, who are HIV-infected or ill due to AIDS. These children experience social, emotional, and health vulnerabilities that overlap with, but are not necessarily the same as, those of orphans or other vulnerable children. Despite their distinctive vulnerabilities, research aimed at understanding the situation of these children has been limited until very recently. This review summarizes the state of knowledge based on a systematic search of PubMed and Web of Science that identified 47 empirical research articles that examined either the population prevalence of children living with HIV-infected or AIDS-sick adults, or the consequences of adult HIV infection or AIDS illness for child well-being. This review confirms that this population of children is substantial in size, and that the vulnerabilities they experience are multi-faceted, spanning physical and emotional health and schooling. Mechanisms were examined empirically in only a small number of studies, but encompass poverty, transmission of opportunistic infections, care for unwell adults, adult distress, AIDS stigma, lack of social support, maternal breastfeeding issues, and vertical HIV transmission. Some evidence is provided that infants, adolescents, children with infected or ill mothers, and children living with severely ill adults are particularly vulnerable. Future research would benefit from more attention to causal inference and further characterization of processes and circumstances related to vulnerability and resilience. It would also benefit from further study of variation in observed associations between adult HIV/AIDS and child well-being based on characteristics such as age, sex, kinship, severity of illness, TB co-infection, disclosure, and serostatus awareness. Almost one-quarter of the studies reviewed did not investigate variation based on any of these factors. More nuanced understanding of the short- and long-term effects of adult HIV on children’s needs and circumstances will be important to ongoing discussions about equity in policies and interventions.

New Directions for the Consideration of HIV: Heterogeneity and the Cognition of Time

“…Third, when broad generalizations are emphasized, higher level variables wash out important lower level details and differences. For example, categories found to be important for education in other studies, such as the sex of the deceased or infected parent (Goldberg & Short, 2016), are completely overshadowed. How do we know which variables are important and where?…”

Decreased consumption of common weaning foods is associated with poor linear growth among HIV‐exposed infants participating in the Kigali antiretroviral and breastfeeding assessment for the elimination of HIV (Kabeho) study

“…The weaning diet may affect weight immediately and later in life (Ong, Emmett, Noble, Ness, & Dunger, ; Pearce & Langley‐evans, ; Scaglioni et al, ; Tang & Krebs, ). Early stunting (low length‐for‐age) predicts increased morbidity and mortality, reduced cognitive and behavioral skills, and poor long‐term health (Black et al, ; De Onis & Branca, ; Dewey & Begum, ; Goldberg & Short, ; Prendergast et al, ). Individuals with faster linear growth and weight gain in the first 2 years of life tend to complete more years of schooling and have a lower risk of school failure in low‐ and middle‐income countries (Martorell et al, ).…”

“…HEU infants may be particularly vulnerable to poor developmental outcomes due to a unique set of harmful exposures. They experience increased risk of maternal illness and death, deleterious socioeconomic factors that co‐vary with HIV infection, and exposure to HIV and antiretroviral drugs (Brennan et al, ; Evans, Jones, & Prendergast, ; Filteau, ; Goldberg & Short, ; Pierre, Fulford, Lewis, Palmer, & Walters, ; Slogrove, ). There is some indication that HEU infants may have metabolic differences from their unexposed counterparts, thereby modifying the relationship between diet and growth in this unique population (Jao & Abrams, ; Jao et al, ).…”

Mitigating depression among orphaned and vulnerable adolescents: a randomized controlled trial of interpersonal psychotherapy for groups in South Africa

“…In high‐income countries, selectively targeted prevention programs have focused on individuals with risk factors including poverty, parental divorce, and bereavement (Cardemil, Reivich, Beevers, Seligman, & James, ; Sandler et al., ; Wolchik et al., ). The elevated risks for mental health problems faced by orphans and HIV‐affected children in generalized epidemic settings (Cluver & Gardner, ; Goldberg & Short, ) suggests that this may also be an appropriate target group. Accordingly, this study investigates the impact of IPTG on depression symptoms among orphaned and vulnerable adolescents in South Africa – home to the world's largest HIV epidemic (UNICEF, ).…”