Search

HIV stigma contributes to risks for poor health; these risks are exacerbated by additional stigmas of race, gender, sexual orientation, and substance abuse history. As women continue to be infected by HIV and as people with HIV are living longer, their children, most of whom are not HIV infected, are affected by their parent’s HIV status. Children may feel stigma as acutely as their HIV-positive (HIV+) parents, contributing to the children’s vulnerability. Children of HIV+ mothers have more emotional problems, disrupted relationships, and poor school outcomes than those whose mothers are not living with HIV. As we learn about stigma’s impact beyond the individual, we are compelled to respond systemically within families to reduce future generations’ vulnerability to HIV and other risks. Based on a line of inquiry with HIV-affected teens about their stigma experiences, our multidisciplinary team discovered stigma’s impact on our ability, not only to study stigma, but to engage parents and especially their children in services and research. We draw on these findings and the literature on community-based participation to contend that participatory methods have value, not only for research and program development, but in reducing the impact of stigma with our HIV-affected partners. The participatory process is as important to stigma reduction as knowledge and service development outcomes. Participatory methods can expand our potential for breaking the cycle of intergenerational vulnerability by strengthening family skills and capacity and enhancing self-worth so those affected by HIV are empowered to overcome stigma’s impact.

This narrative review examines the effects on children of stigma by association with an HIV-positive parent. It expands on previous reviews by including all HIV-affected children, whether orphaned or living with a parent with HIV, and considers the broad effects of stigma-by-association (SBA), including but not limited to the psychological impact. Studies met the following criteria - sample included children, ages 6-19 years old, who were not HIV-positive but were currently living with or had lived with a parent who was HIV-positive (i.e., AIDS orphans). Study findings included children's perspectives on stigma and were available in English. Studies for inclusion were identified by searches in Psychinfo, Proquest, and PubMed from 1996 through 2016. This review substantiates that children across countries and cultures experience HIV SBA. SBA is associated with psychological or emotional problems, disrupted peer and adult relationships, and poor school outcomes for children. Orphans were more likely than children living with positive parents to experience negative outcomes, which can have a long-term impact. Felt stigma was as prevalent as enacted stigma and may become the focus of intervention as HIV disease increasingly becomes a concealable disease. The review findings also point to the complexity of relationships between SBA and variables such as poverty and mental health and the bi-directional relationship between SBA and depression. We adapt a stigma framework developed for people living with HIV (PLWHIV) to structure the results of this review. With these findings, we can develop interventions that support stigma reduction with children and their parents, responding to the wide range of stigma consequences and customized to the children's family and cultural context.

We hear it all the time and know it to be true—HIV does not discriminate based on age, race or ethnicity, gender, sexual orientation, or socioeconomic status. This issue explores living with HIV th...

Over the last decade, Comprehensive Family Assessment (CFA) has become a best practice in child welfare. Comprehensive Family Assessments go beyond risk assessment to develop a full picture of the child's and family's situation. When appropriately synthesized, assessment information can lead to a clear articulation of the patterns of child or family functioning which are related to child abuse and maltreatment or which can be strengthened to facilitate change. This study defines and provides concrete examples of dimensions of quality in child welfare assessment reports that are consistent with the CFA guidelines and best practices embraced by child welfare agencies, courts, and other key stakeholders. Leveraging a random assignment design, the study compares the quality of reports written by a caseworker alone versus those written by a caseworker paired with a licensed Integrated Assessment (IA) screener. Findings are discussed in the context of the dual professional model and factors contributing to the timely completion of high quality assessment reports.

Stigma affects not only the person living with HIV, but also, by association, their family members. Stigma-by-association may contribute to adverse outcomes for children of parents living with HIV. We interviewed 27 African-American adolescents, 13–18 years old, who were not HIV-positive but whose mothers were living with HIV. As part of a broader study, adolescents responded to four open-ended questions regarding their experience of HIV stigma-by-association. Their responses were analyzed using ATLAS.ti to identify themes. About half of the teens had not told anyone their mother’s HIV status but had heard peers make fun of or insult people with HIV. Anticipating stigma, teens used a range of strategies from being silent and vigilant to brushing off insults as ignorance and refusing to feel shame. In some instances, these strategies strained peer interactions and reinforced the mother/teen connection. With guidance, mothers may be well positioned to coach children and teens to identify stigma situations, ...

To understand the beneficial aspects of a psychoeducational group, parents living with HIV participated in two telephone interviews. Twelve parents answered open-ended questions about program processes, components, and activities. Study participants identified five processes: focused and motivated; learn from each other; share freely with people who understand; support and care about each other; respect each other's privacy; and protect each other. The identified knowledge areas—self-care, parenting, and goal-setting—were consistent with the program's focus. Components noted were those activities designed to develop comfort between participants, share ideas, and practice skills. Goal-setting and monitoring progress represented a primary task that brought focus to the group's endeavors and around which knowledge was shared and feedback and support were provided, strengthening the bonds between the participants. As people with HIV are living longer, programming can take a future orientation, supporting pare...

Addressing the needs of the most vulnerable children is a universal challenge, particularly in developing countries lacking infrastructure of social welfare services, adequately trained workforce and educational programs. This article describes training and utilization of para-social workers to the social service needs of children and families. These supervised para-professional community based staff and volunteers can fill gaps in serving the needs of children and families, particularly where social welfare systems are undeveloped or severely stretched. We present the development of one such program as a case study, the Social Work Partnership for Orphans and Vulnerable Children in Tanzania. A competency-based training model includes an introductory workshop, a six month-long supervised field component and subsequent training and technical assistance. The curriculum teaches practical skills to assist vulnerable children, especially those HIV affected, including assessing needs, implementing case management resource linkages, counseling, family support, and ongoing service coordination. Over 500 participants have begun the para-social work program in districts throughout the country. Participants report high satisfaction with the training, and knowledge scores consistently and significantly improve throughout the training. This partnership aims to create a sustainable para-professional workforce to address gaps of most vulnerable children in Tanzania and can serve as a model to apply social work principles and techniques in settings where professional and structural resources are highly limited.

Objectives: African American urban adolescents are one of the fastest growing groups of children affected by their mother’s HIV status. These children experience HIV stigma by association with their HIV-positive mothers. Stigma may contribute to adverse outcomes for these teens. Methods: The authors describe a multistage process of scale construction, cognitive interviewing, and pilot testing to develop a measure reflecting an African American adolescent’s experience of HIV stigma when mother has HIV. Results: The resulting measure has 23 items with good reliability. An additional item suggested by qualitative data will be added to the measure and used in further testing. Conclusions: Potential uses of the measure are discussed. Intervention approaches for reducing stigma’s impact among HIV-affected African American adolescents are briefly outlined.

Grandparents and other relatives increasingly assume the role of primary caregiver to minor children. This study interviewed family members caring for children whose parents were not available due to parental incarceration, other involvement in the criminal justice system, and substance abuse-related issues. Interviews with 25 African American women examined the impact of caregiving including stress and depression. Stress included caregiver issues related to finances, time allocation, care responsibilities, and concerns about the absent parent, as well as issues specific to the children related to school concerns, child behavior, and emotional problems. These stresses were examined along with caregiver depression scores using the Center for Epidemiological Studies Depression Scale, which indicated more depression related to caregiver illnesses, older caregivers, and care for older and a larger number of children. This study suggests that caring for these children is both challenging and stressful, and car...

As people with HIV are living longer, HIV-infected parents are raising children while managing the effects of chronic illness and stigma. Groups need to adapt to the changing needs of people with HIV/AIDS. The Making Positive Changes Program uses groups to enhance social support and to provide education on issues that affect families with HIV. Sessions focus on one of two major topics-self-care and parenting-with consumer involvement in planning and facilitation. Challenges included those typical to group work but also specific to HIV/AIDS, especially stigma. As the program develops, consumers will increasingly participate in and guide group implementation.

Custody planning programs for HIV-infected parents help families overcome the obstacles to making future plans for their children, in the event of the parent's debilitating illness or death. In order to understand the social work intervention, progress notes from the Family Options Project, a custody planning program, were analyzed for themes regarding: (1) methods used by the social workers and (2) the content discussed with birth parents. The social workers used problem-solving methods that helped parents examine and partialize problems and explore solutions. Content centered on planning options, parent mental and physical health, and family relationships, reflecting the complexities of planning with HIV-affected families. As people with HIV are living longer, custody planning and family preservation have become equally important outcomes for the program.

This study examined the mental health problems and service utilization patterns of kinship families who accessed services in an urban outpatient child psychiatry clinic. A random sample of children who completed the intake process during a calendar year yielded 47 children, or 19% of the sample, whose primary caregiver was a relative, other than a biological parent; approximately half of those families were involved with the child welfare system. Data from an administrative database and from medical records describe the diagnoses, identified problems, and services used by the kinship families. Academic or school-related problems emerged as an identified problem in approximately half of the kinship cases, but school intervention was not a primary target for clinicians. The kinship sample was also compared with a random stratified sample of children who were living with primary caregivers other than kin. Kinship families were more likely to be African-American, but few differences were found betwee...

This study investigated the needs of relative caregivers of children in the child welfare system whose parents had HIV. Families of children supported by the state child welfare agency were invited to participate in the study; 17 families reported that HIV affected them and 11 families did not identify HIV as an issue. The findings indicate that complex emotional and behavioral issues stressed the HIV-affected kin caregivers; these issues included the children's behavioral problems, HIV-related concerns, adolescent issues, emotional difficulties, and sexual abuse, HIV-affected caregivers had more concern about their health and multiple roles. Nonaffected caregivers were less likely to report severe parenting stress and more likely to report financial stress. HIV-affected caregivers require attention and intervention by social workers, child welfare workers, and case managers.

Older HIV-1-seropositive individuals largely have not been investigated with respect to their psychosocial characteristics. In this article, the authors review research reported to date regarding the psychosocial context of this growing subgroup of HIV-1-infected individuals. Specifically, the authors consider the characteristics of mood state, life stressor burden, social support network, and coping strategies that individuals older than 50 years are more likely to adopt in adjusting to HIV-1 infection. The authors also separately consider issues of caregiving burden. Data supporting a theoretically based stressor-support-coping model are presented and related to targeting psychotherapeutic interventions for this age group.

Using qualitative methods, university researchers enlisted the participation and collaboration of community residents to assess the service needs of HIV-affected families in an inner-city African-American community with a high seroprevalence of HIV/AIDS. Community members infected with and affected by HIV/AIDSparticipated in interviews and reviewed and refined the preliminary findings. The participants were concerned by the lack of HIV/AIDScommunity services that were family-sensitive, i.e., addressed the stresses and concerns of those people who provide support and care for a person with HIV. Participants identified community awareness and education as critical to serving those infected and affected. Denial and stigma in the community need to be addressed concurrently with the development of specific services for HIV-affected families.

SUMMARY As the number of HIV-infected women increases, providers and policy makers are faced with an additional challenge-the number of children who will be affected by a parent's death from HIV. This paper reports the findings of an exploratory study of the relationship between coping of mothers with AIDS and the status of their plans for the Future of their children. Nineteen women with an AIDS diagnosis and having regular contact with their children were interviewed. A chance health locus of control, the ability to cope with the death of others, availability of informal support, and a better health status were associated with more planning by mothers with AIDS. The findings suggest interventions for helping families plan and point to variables for future research.

The aim of wound management in hand burn injuries is to restore function and prevent problem scars, so a key consideration in wound healing is the removal of dressings without causing pain and further trauma as well as preserving function. Conventionally, wound dressings such as paraffin gauze were used for burn injuries, but this led to pain and trauma on removal, as well as drying out. This study looks at the use of Mepitel® One on hand burns; this dressing incorporates all the benefits of Mepitel, however, it only has Safetac technology on the wound contact side, allowing easy handling and application.

Women constitute one of the fastest growing groups of people infected with HIV. Women have always been affected by HIV as informal or formal caregivers. Despite this, HIV services and education have been directed almost exclusively towards men. Given that women comprise half of the workforce, the change in the face of the epidemic requires a reexamination of the EAP professional's approach to AIDS education and services. This article delineates HTV-related issues specific to women and their impact on the functions of the EAP. Suggestions are made for targeting AIDS workplace education and prevention to women. The implications of women's issues on early identification, counseling, and referral by EAP professionals are also explored. Consideration is given to the cultural and socioeconomic diversity of women affected by HIV.

Feminist health and holistic health movements predate and contribute to the current changes in women's health care. Recently, there has been a rivitalization of women's health centers reflecting three approaches to women's health: (1) centers with an exclusive focus on one health problem, e.g., breast cancer, chemical dependency (2) centers with a predominantly reproductive focus, and (3) centers with a holistic/feminist health care focus. Based on an exploratory survey of women's centers in a large city, this paper identifies differences among them and discusses the potential for misguidance that may occur with the current increase in women's health centers. It also discusses the implications of this growth for social work education and clinical practice.