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

Rachel E Goldberg,Susan E Short

doi:10.1080/09540121.2016.1176684

Rachel E Goldberg, Susan E Short

Open Access

https://doi.org/10.1080/09540121.2016.1176684

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Abstract

ABSTRACTMillions 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.

Highlights

The umbrella terms “Orphans and Vulnerable Children” (OVC) and “HIV-affected children” are deliberately inclusive. They recognize the vulnerability of a broad range of children, among them children living in Sub-Saharan Africa (SSA) whose lives are disrupted by the HIV/AIDS epidemic, including through pediatric HIV/AIDS, the illness and/or death of family and household members, and impacts on communities (Bryant & Beard, 2016; Sherr et al, 2008, 2014)
Demographic and Health Survey (DHS) eligibility for testing and testing rates vary across settings, shaping these figures; these studies suggest that millions of children are living in households with HIV-infected parents in high-prevalence countries
Short and Goldberg (2015) report on variation by kinship, finding that most children co-residing with tested, HIV-infected adults live with parents, often mothers, who are infected, in some countries a substantial minority live with infected non-parental adults

Summary

Introduction

The umbrella terms “Orphans and Vulnerable Children” (OVC) and “HIV-affected children” are deliberately inclusive They recognize the vulnerability of a broad range of children, among them children living in Sub-Saharan Africa (SSA) whose lives are disrupted by the HIV/AIDS epidemic, including through pediatric HIV/AIDS, the illness and/or death of family and household members, and impacts on communities (Bryant & Beard, 2016; Sherr et al, 2008, 2014). One group of HIV-affected children with distinct vulnerabilities are those living with HIV-infected or AIDSill adults 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 (Foster, 2006; Sherr et al, 2014).

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