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HIVAN/ECI March 2006 HIV/AIDS Journal Club
Jo-Ann Du Plessis. HIVAN Networking Unit. March 2006.
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Jacqui Hadingham and Deseree Archary from the UKZN Medical School presented the dismal truth about how vulnerable HIV-exposed but uninfected children are. For various reasons covered in their talk, not least of all because an HIV-infected caregiver cannot care as well for the child as he or she could if healthy, there are socio-economic, psychological and developmental implications for the child.
Research done by Marie-Louise Newell suggests that globally 2.8 million children are born to HIV-infected women. But it is difficult to get figures on children who are not HIV-affected but who are not HIV-positive nor orphans.
Medically, the impact of HIV on the child in utero leads to a compromised immune system which has the potential to result in numerous medical problems. In addition to this effect, however, the socio-economic, developmental and psychological impacts of the disease on the HIV-exposed child are huge. In their paper, the authors used the UN Convention on the Rights of the Child as a framework for looking at the ways in which these children are vulnerable, and the most relevant articles were selected from those listed in the Convention. Thus Jacqui and Derseree covered eight topics in their presentation, each of which (especially in the context of HIV/AIDS) interact and impact collectively:
- Stigma
- Guidance and development
- Harm and abuse
- Access to healthcare
- Standard of living - Family economics
- Access to education
- Right to play
- Exploitation and employment
Stigma:As with HIV-infected children, children who are exposed to the virus are discriminated against due to the presence of HIV in their household. Stigmatisation is usually a coping mechanism, as being HIV-positive is seen as ?“not respectable?” in many communities, and HIV-uninfected people may discriminate against an HIV infected person as a way of maintaining their own respectability or self-esteem.
Guidance and development:
Losing a caregiver or parent to HIV means that for many children the guidance that that significant person would offer the child is lost. This has the potential to lead to a myriad of problems, for example, and importantly in the context of HIV, to misconceptions about sexuality. Without the support and protective guidance of the parent, the child is also more vulnerable to abuse, sexual and otherwise.
Harm and abuse:
As mentioned, the HIV-exposed child may be more vulnerable to abuse after losing their caregiver. Children in these situations also have to take on heavy domestic chores which tax them physically and emotionally. They are needed in the home, therefore drop out of school, and this impacts on their future employment prospects. In addition, their new guardian may show anger at having to look after yet another child in a resource-constrained setting, and this can translate into verbal or physical violence or abuse. There is minimal support available for children as their parents are no longer alive to protect and care for them.
Access to healthcare:
Especially in developing countries, national healthcare systems are overburdened and the health care is costly (financially, and in terms of time and opportunity cost). The health needs of the HIV-exposed child may become secondary to the health needs of the ill parent or household member. Resources for healthcare go to the ill person and therefore immunising and treating the child is less likely. Some reports have shown that healthcare personnel discriminate against HIV-affected children, perhaps because the child is seen as possibly HIV-positive themselves or because the family is viewed as being immoral.
Standard of living ?– family economics:
According to estimates, 25 million people in Sub-Saharan Africa live with HIV/AIDS. Food insecurity in this area is especially severe. This is exacerbated by the fact that people leave their jobs in order to care for the sick household member, leading to more stress and strain on already constrained households. When ill members are sick or die, financial resources are diverted to cover treatment and funeral expenses, leading to indebtedness and more financial problems in the future. In a study by Brahmbhatt et al, children of HIV-positive mothers living in polygynous households (i.e. more than one female head), were more likely to have household resources diverted away from them.
Access to education:
From 2003 onwards, school enrolment rates in Africa have been less than 50%. This drop has been for various reasons, among them the fact that there is an increased proportion of vulnerable children (i.e. orphans and girl children) who have restricted access to education and because teachers are succumbing to AIDS. A government report has shown that in KwaZulu-Natal alone, 70 000 more teachers will be needed by 2010 to make up for the educators being lost to AIDS. That figure matches the number of teachers currently in the provincial education system in 2006.
The right to play:
The right to play is taken from the child as he or she is catapulted into adult roles of caring for sick household members, earning money and so on. There are significant and dire psychological effects of living in an HIV-affected household, which are not quantifiable and have not been widely and comprehensively researched to date.
Exploitation and employment:Derseree explained that not only in terms of survival sex (sex for money to buy basic necessities) being undertaken by girl children, there is an increased trend in the ?“sugar daddy?” syndrome in many poorer areas. Some reports have shown that as long as adolescents have access to the three C?’s ?– cash, clothing and cell phones ?– they appear to be content. In war affected areas exploitation of children is severe.
In this presentation to the Journal Club, the presenters showed by means of their literature trawl that the effect of HIV on non-infected children cannot be underestimated, and that the world would be wise to notice and care for these children to the same extent that attention is given to those who are HIV-infected.
They ended their presentation with a quote from Woodrow Wilson, 28th President of the United States: ?“You are not here merely to make a living. You are here in order to enable the world to live more amply, with greater vision, with a finer spirit of hope and achievement. You are here to enrich the world, and you impoverish yourself if you forget that errand."
The full report and biosketches on the presenters can be accessed on the righthand side of this page.
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