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Maternal well-being, childcare and child adjustment in the context of HIV/AIDS: What does the psychological literature say?1

CSSR Working Paper No. 135

René Brandt

Centre for Social Science Research (CSSR)

November 2005

SARPN acknowledges permission from the Centre for Social Science Research (CSSR) to post this document - www.cssr.uct.ac.za
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Abstract

This paper outlines the findings of the psychosocial and psychological literature on the impact of mothers and primary caregivers’ HIV infection on maternal well-being, childcare and child adjustment. Drawing on an ecological approach, the paper outlines a model that both demonstrates the link between parental HIV/AIDS and child outcome, and examines the pathways that account for this relationship. These include personal, familial and environmental factors. Some of the key findings that emerge from the literature are that children of HIV positive mothers are at greater risk for emotional and psychological problems than children of uninfected mothers, especially internalising problems such as depression. However, children in poor, affected communities also experience detrimental developmental effects, indicating that HIV/AIDS typically serves as an added stressor in already at-risk communities. Further, disruptions to parental monitoring and the quality of the parent-child relationship are a key pathway whereby these impacts are felt, and are more likely where maternal HIV infection has progressed to AIDS. It is recommended that policy responses take cognisance of children’s contexts and the pathways to child outcomes when attempting to respond to the HIV/AIDS epidemic.

Introduction

This paper attempts to come to terms with the literature that considers the question of the impact of maternal HIV/AIDS on uninfected children. The review aims to assist in conceptualising an area of increased importance in the field of HIV/AIDS due to the marked increase in numbers of HIV-infected women and mothers, particularly in the developing world (Aberg, 2005; UNAIDS, 2004b; 2004c), and with this the impact of the disease on children and families (Campbell, 1999). With the decrease in perinatally transmitted HIV, an even narrower, but large, group of affected/uninfected children has emerged as important in addressing the crisis, both at the present moment and in terms of later sequelae (Lewis, 2001). While fewer children may be infected (by their mothers), large numbers of children are affected by virtue of the prevalence of HIV/AIDS in the homes and communities in which they live. Further, a major risk to the child’s socio-emotional and cognitive development is posed by the HIV positive mother or caregiver whose capacity to provide emotionally responsive care to the child may be reduced by his/her illness.

The paper provides an up to date review that extends work produced in recent years. Most notable amongst these are: Foster and Williamson’s (2000) review of the impact of HIV/AIDS on children in sub-Saharan Africa, including coping mechanisms and the impact of HIV on children; and Wild’s (2001) review of empirical research and clinical evidence regarding the impact of parental AIDS and orphanhood on child adjustment. Also relevant, but more tangential, are Hunter and Williamson’s (2002) demographic portrait of children affected by HIV/AIDS in 23 countries, and Richter, Manegold and Pather’s (2004) review of family and community interventions for children affected by AIDS, as well as several other policy documents that have addressed some of the same issues, although in broader terms. In contrast with the aforementioned articles, this paper focuses specifically on children still living with infected parents (whether asymptomatic or with full-blown AIDS). It is not intended to focus on children already orphaned. Further, the paper will provide a critical review of the psychological and psychosocial literature in order to develop a model of the relationships between HIV positive mothers’ well-being, childcare and children’s psychosocial adjustment. The model aims to move beyond the simple linking of parental illness and child adjustment to examine family process and other relevant variables (Wild, 2001). The paper will therefore delineate the critical conceptual issues and evaluate and discuss the empirical evidence. It is hoped that such a framing of the literature will be useful for considering the relevance of research findings for the conceptualisation, planning and implementation of programmes for infected mothers and their children, as well as their households and broader networks.


Footnotes:
  1. I would like to thank Lauren Wild and Nicoli Nattrass for their useful comments on this paper.


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