云南某县艾滋病及其他脆弱家庭中儿童身心健康现况调查

目的了解中国政府／联合国儿童基金会艾滋病预防关怀项目县艾滋病及其他脆弱家庭中心儿童的身心健康现况,为项目提供基线资料。方法通过随机抽样,在云南省某项目县选取250名0-17岁来自受艾滋病、吸毒和贫困影响家庭的儿童,测量身高,并对其中154名6岁以上儿童进行心理问卷调查。结果来自三种家庭的儿童的身高没有显著性差异,心理状况有显著性差异。近68％的受艾滋病影响儿童不能处理生活中的困难,对生活中的事也不能决定怎么办;58％的受艾滋病影响的儿童害怕别人不和他（她）玩;67％的受艾滋病影响的儿童比较自信,但仍低于受吸毒影响的儿童（89％）。结论受艾滋病影响家庭的儿童与其他脆弱家庭儿童的心理状况不同,社区关怀项目应考虑之间的区别。     

受艾滋病影响儿童关爱救助政策落实情况的实证分析

目的分析受艾滋病影响儿童相关政策的落实情况。方法采用问卷调查、个案访谈、深入访谈等方法,获得我国艾滋病流行较为严重的四个省份的相关数据,通过定量、定性分析相结合的方法分析。结果共得到有效抚养人问卷149份,涉及受艾滋病影响儿童323名;有效多部门工作人员问卷23份,多部门深入访谈35次。其中县/市级深入访谈30次(含多部门研讨会7次),省级深入访谈5次(含多部门研讨会3次)。调查家庭中有57.7%的家庭儿童获得了生活救助,20.1%的家庭儿童获得了教育救助,5.4%的家庭儿童获得了医疗救助,17.6%的家庭儿童参加过心理关怀活动。但现有政策在执行过程中,仍面临缺乏资金和人员等保障条件、信息收集和共享困难等问题。结论国家及地方都出台了一系列针对受艾滋病影响儿童的关怀救助政策,为减轻艾滋病对儿童的影响发挥了积极作用,但政策落实尚不均衡,阻碍政策有效实施的因素仍然存在。     

中原部分农村地区受AIDS影响儿童生活质量的现况

目的了解中原部分农村地区受艾滋病(AIDS)影响儿童主观生活质量的现况,为进一步开展关怀和干预提供依据。方法使用《儿少主观生活质量量表》,对中原地区3个县117名受AIDS影响儿童进行调查。结果49%的儿童对目前的生活状况不满意;22%的儿童认知成分低于一般水平;情感成分极不满意和不太满意的儿童占39%;在情感成分和一些维度水平上受AIDS影响儿童低于一般农村儿童;受AIDS影响儿童的主观生活质量在不同的地区和年龄组之间存在一些差异。结论在社区、学校、家庭对受AIDS影响儿童的支持中,以儿童为中心,了解儿童的需求,关注儿童的心理健康,重视青春期教育和职业培训,尊重儿童的意见,提高儿童参与社会事务的程度,使受AIDS影响儿童生活质量得到全面的提高。     

我国小额贷款在受艾滋病影响家庭中的应用

受艾滋病影响的家庭通常受到经济困难和社会歧视的双重打击。小额贷款作为一种特殊形式的生产自救,有助于改善感染者家庭的经济状况,提高生活质量并重返社会。文章综述了小额贷款的分类及实施模式,在受艾滋病影响人群中的应用,对其和家庭产生的影响,存在的问题,并对进一步实施小额贷款提出了建议,对受艾滋病影响人群开展关怀救助具有重要意义。     

艾滋病对婚姻和家庭结构的影响

目的对比、分析艾滋病对婚姻和家庭结构影响的主要表现特征。方法通过问卷调查的方法 ,收集了我国艾滋病流行较为严重的5个省份中,931户感染者家庭和995户非感染者家庭的数据。通过对比的方法 ,比较和分析被访者在婚姻、家庭结构等方面的差异特征。结果艾滋病病毒(HIV)感染者未婚、离异、丧偶和再婚的比例均明显高于非感染者;感染者家庭的平均人口数为4.0人,明显低于非感染者家庭的4.4人;41.1%的感染者家庭是主干家庭,高于非感染者家庭(33.4%);感染者家庭中儿童就学率明显低于非感染者家庭,而老年人的劳动参与率则明显高于非感染者家庭。结论艾滋病破坏了感染者正常的婚姻状态,导致主干家庭的比例增加,改变了家庭结构,使得感染者家庭中的儿童和老人受到极大的影响,这些都意味着家庭功能的削弱甚至是丧失。     

认知行为疗法改善受艾滋病影响儿童自我意识水平的个案研究

正受艾滋病影响儿童更容易产生消极的社会心理和认知结果[1],迫切需要在对这些儿童的物质救助基础上进一步开展心理干预[2]。本研究拟对一名凉山州自我意识水平较低的受艾滋病影响儿童使用认知行为疗法进行心理咨询,目的是探究认知行为疗法对受艾滋病影响儿童自我意识水平的改善作用及其可行性,为受艾滋病影响儿童心理健康提供有效的干预方法。     

艾滋病的迅速蔓延及对儿童的影响

1 全球儿童状况 迄今,全球已有1400万人死于艾滋病,其中1100万例发生在非洲,大约25％的受害者系儿童。在10个受艾滋病影响严重的非洲国家,预计2000～2005年,5岁以下儿童的死亡率将由科特迪瓦的17％达到博茨瓦纳的64％之高;预计中国届时将有1400名0～14岁的儿童感染艾滋病病毒。这个数字与1994～1997年相比增长了4倍。越南亦如此。这些数字表明艾滋病的控制工作在亚洲国家已迫在眉睫。     

艾滋病与艾滋病家庭研究进展

艾滋病影响的不仅仅是艾滋病病人本人,而是整个家庭以及家庭系统,而家庭在病人应对生理和心理压力的过程中起到了重要的支持性作用。文章从艾滋病对家庭及家庭系统的影响,家庭对艾滋病病人的影响,以及艾滋病家庭的压力应对三个方面回顾和总结了艾滋病家庭的相关研究。国家政府以及相关研究者可以关注作为整体的艾滋病家庭,丰富艾滋病家庭压力的应对方式,从而提高艾滋病家庭的生活水平,维护社会和谐。     

受艾滋病影响儿童的心理安全感及社交焦虑

目的了解受艾滋病影响儿童心理安全感和社交焦虑的现状及关系,为制定帮扶政策及干预提供参考。方法采用问卷法,调查232名受艾滋病影响儿童和1 640名普通儿童,使用t检验、Pearson相关和多元回归分析等方法比较组间差异、分析社交焦虑对心理安全感的影响。结果受艾滋病影响儿童心理安全感显著低于普通儿童(t=6.61,P0.01),社交焦虑显著高于普通儿童(t=-22.29,P0.01);女童的社交焦虑得分(26.58±2.61)分,显著高于男童(18.91±2.35)分,(t=-23.51,P0.01);女童的心理安全感得分(28.83±11.08)分,显著低于男童(57.68±15.74)分,(t=16.14,P0.01);相关分析表明,受艾滋病影响儿童的心理安全感及各维度与社交焦虑各维度呈显著负相关(r=-0.637～-0.695,P0.01);受艾滋病影响女童和社交回避及苦恼状况负向预测心理安全感及其各维度,同学关系差可以正向预测心理安全感及其各维度,R~2值在54%～56%之间(P0.01)。结论受艾滋病影响儿童社交焦虑偏高、心理安全感水平偏低,降低社交焦虑能有效改善他们的心理安全感。     

受HIV/AIDS影响儿童面临的问题及应对策略

受艾滋病病毒伎滋病（HIV／AIDS）影响儿童分为四类：（1）感染了HIV的儿童；（2）AIDS致孤儿童；（3）与HIV感染者或AIDS患者共同生活的儿童；（4）AIDS高发区中的儿童。受AIDS影响儿童面临许多问题，主要包括：家庭困难、社会歧视、教育问题、心理问题等。给予受艾滋病影响儿童生理、心理上的关怀是十分重要的，对儿童的成长发育起着积极作用。     

Household displacement and health risk behaviors among HIV/AIDS-affected children in rural China

When parents die of or are infected with HIV, children might have to leave their own household and be displaced to other living arrangements and some may even be displaced multiple times. The objective of this study is to examine the association between household displacement and health risk behaviors among AIDS orphans (children who have lost one or both of their parents to HIV/AIDS) and vulnerable children (children living with HIV-infected parents) in rural China. The sample consisted of 1015 children (549 AIDS orphans, 466 vulnerable children) in family-based care. The children were assigned to three displacement groups according to the number of household displacement (i.e., none, once, at least twice) after their parents became ill or died of HIV/AIDS. Cigarette smoking, alcohol use, violence, public property destruction, suicidal ideation, and suicide attempt were used to assess the health risk behaviors of these children. Both bivariate and multivariate tests were used to assess the differences in health risk behaviors among displacement groups. The findings indicated that children who were displaced at least twice were more likely to report a higher frequency of public property destruction and suicide ideation than those who were never displaced or displaced once. Multivariate analysis revealed that public property destruction, suicide ideation and suicide attempt were significantly associated with the household displacement among these children, controlling for gender, age, child status (AIDS orphans vs. vulnerable children), and the duration of household displacement. Results in the current study suggest that a stable living environment was important for both AIDS orphans and vulnerable children in communities with a high prevalence of HIV/AIDS. The government, community, and other agencies need to make efforts to avoid frequent household displacement among these children after the HIV-related infection or death of their parents.     

HIV/AIDS and family support systems: A situation analysis of people living with HIV/AIDS in Lagos State

Current statistics about the HIV/AIDS epidemic in Nigeria do not reveal the broader social and economic impacts of the disease on the family. The study therefore primarily aimed to address the socio-economic effects of HIV infection on individuals and their families. The study was carried out in Lagos State. In-depth interviews were employed to collect information from 188 people living with HIV/AIDS through support groups in the state, while four focus group discussions were conducted to elicit information from people affected by AIDS about the socio-economic impacts of HIV/AIDS on families in Nigeria. From the survey, among people living with HIV/AIDS, 66% of females and males were in the age group 21–40 years, while 10% were older people above 60 years of age. Findings revealed that as HIV/AIDS strikes at parents, grand parents are assuming responsibility for bringing up the children of the infected persons and the orphans of those killed by the virus. It was striking that some of the older caregivers could not meet the requirement of these children. They are often forced to work more than they would have, or borrow in order to cope with the needs of these extra mouths. Some of the infected people have sold their properties to enable them to cope with the economic effects of the virus, while their children have had to drop out of school, since they could not afford the school fees and other related expenses. It was suggested that PLWHA should be economically empowered with adequate medical treatment, in order to reduce the impact of the disease on the family.     

Stigma Against Children Affected by AIDS (SACAA): Psychometric Evaluation of a Brief Measurement Scale

The current study was designed to develop and evaluate a brief scale measuring perceived public stigma against children affected by HIV/AIDS. The participants include 755 children who have lost one or both parents to HIV/AIDS (AIDS orphans), 466 children facing the potential of losing their parents to HIV/AIDS (vulnerable children), and 404 comparison children who did not have HIV-related illness or death in their families. The data in this study demonstrated that the SACAA scale provides a psychometrically sound measure of perceived stigma against children affected by AIDS in China. The SACAA scale is a reliable measure for children of both genders, at different developmental stages, and for both children affected by HIV/AIDS and comparison children. Known-group validation and correlation analysis demonstrate excellent construct validity of this brief SACAA scale. The SACAA score was positively associated with psychopathological symptoms and negatively associated with psychosocial well-being among participating children.     

The impact of parental HIV/AIDS on children's cognitive ability in rural China

This study examined the impact of parental HIV/AIDS on children's cognitive ability. Cross-sectional data were collected from 1625 children aged 6–18 years, including 755 AIDS orphans, 466 vulnerable children, and 404 comparison children in rural China. Participants completed measures of demographic information and the assessment of cognitive ability (verbal comprehension ability and perceptual reasoning ability). Results showed that the cognitive ability was lower among children affected by HIV/AIDS than comparison children. Double orphans living in kinship care performed better on verbal comprehension ability than children living in orphanage or group home, but not on perceptual reasoning ability. Older children (≥15 years old) scored higher on verbal comprehension ability and younger children (≤11 years old) scored higher on perceptual reasoning ability. Boys scored higher than girls on perceptual reasoning ability but not on verbal comprehension ability. Future studies should explore factors that may hinder the development of cognitive ability of children affected by HIV/AIDS and provide appropriate intervention in this regard.     

Impact of Parental HIV/AIDS on Children’s Psychological Well-Being: A Systematic Review of Global Literature

This review examines the global literature regarding the impact of parental HIV/AIDS on children’s psychological well-being. Fifty one articles reporting quantitative data from a total of 30 studies were retrieved and reviewed. Findings were mixed but tended to show that AIDS orphans and vulnerable children had poorer psychological well-being in comparison with children from HIV-free families or children orphaned by other causes. Limited longitudinal studies suggested a negative effect of parental HIV on children’s psychological well-being in an early stage of parental HIV-related illness and such effects persisted through the course of parental illness and after parental death. HIV-related stressful life events, stigma, and poverty were risk factors that might aggravate the negative impact of parental HIV/AIDS on children. Individual coping skills, trusting relationship with caregivers and social support were suggested to protect children against the negative effects of parental HIV/AIDS. This review underlines the vulnerability of children affected by HIV/AIDS. Culturally and developmentally appropriate evidence-based interventions are urgently needed to promote the psychological well-being of children affected by HIV/AIDS.     

Targeting AIDS orphans and child-headed households? A perspective from national surveys in South Africa, 1995-2005

In the HIV and AIDS sphere, children remain on the margins with respect to advocacy, prevention, treatment and care. Moreover, concern is generally limited to specific categories of children, most especially children living with HIV, orphaned children and child-headed households. Excluded from view are the very large numbers of children affected by generalized HIV/AIDS epidemics, now in advanced stages, in already impoverished countries in southern Africa. In this paper, we use information from comparable national household surveys in South Africa, in five waves between 1995 and 2005, to examine the impact of HIV and AIDS on children and on the structure of the households in which they find themselves. The question posed is whether it is appropriate to target orphans and child-headed households in this context. The data indicate that orphaning, particularly loss of a mother, tripled during this period, as is to be expected from rising adult mortality. Though they remain a small proportion, child-only households also rose markedly during this time. However, difficult as their situation is, neither orphans nor child-only households appear to be the worst-off children, at least from the point of view of reported sources of financial support and per capita monthly expenditure. Households headed by single adults and young adults are economically vulnerable groups not yet included in efforts to support affected children and families. Poverty is a pitiless backdrop to the AIDS epidemic and needs to be at the heart of strategies to address the needs of all vulnerable children in hard-hit communities.     

An enumeration of orphans and analysis of the problems and wishes of orphans: the case of Kariba,Zimbabwe

In southern Africa, HIV and AIDS accounts for the largest proportion of orphans. Very often the orphaned children become destitute, and young girls in particular become more vulnerable to HIV and AIDS as they try to fend for the rest of the family. This paper reports on the number of orphans in Kariba, Zimbabwe, describing their problems, coping strategies and wishes. The study was carried out in Nyamhunga and Mahombekombe high-density residential areas of Kariba, Zimbabwe. All households in the study area were visited, and a semi-structured questionnaire aimed at enumerating orphans and obtaining information regarding general problems of orphans was administered to heads of households present. In addition, information on the plight, coping strategies and survival wishes of orphans were collected through 15 focus group discussions held with orphans, care givers, community leaders and stakeholders. The prevalence of orphans in Kariba, based on a sample of 3 976 households, was found to be very high (56%) with most of the orphans in the age group 6 – 12 years. The majority of the orphans were paternal and under maternal care. Over 30% of the orphans of schoolgoing age were not in school, and some young girl orphans became involved in commercial sex work. The survival wish list of the orphans included school fees, accommodation, health care provision, adequate food and income-generating projects. However, suggestions on orphan care and needs given by community members were somewhat divergent from the orphans' wish list, indicating that community interventions may not be sensitive to the wishes of those affected. Although the study did not categorise orphans according to cause of death of parents, there are indications that most of the orphans are accounted for by HIV and AIDS.     

Assessing the health status of young AIDS and other orphans in Kampala, Uganda

The huge number of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) orphans is an important feature of the epidemic in sub-Saharan Africa. There are few and conflicting data on the effects of being orphaned on health and nutrition in the highly affected HIV endemic areas of Africa. This study reports findings from a cross-sectional survey on associations between orphan status and health and nutrition parameters in young children of urban Uganda. A high prevalence of orphans was reported from a central Kampala community, with 41% being attributed to HIV/AIDS. Although there was a higher prevalence of self-reported morbidity in orphans than non-orphans, there were no differences in reported treatment seeking behaviour and measured anthropometric parameters. Hence it seems that the extended family system still manages to care for young orphans. Paying school fees for older children should be the primary target for HIV/AIDS impact mitigation programs in urban Uganda.     

Experiences of families caring for an HIV-infected child in KwaZulu-Natal, South Africa: an exploratory study

In South Africa, 2.5% of children are living with HIV. KwaZulu-Natal is the province most affected by the epidemic and has the highest number of pregnant women living with HIV. This study reports on a qualitative study to assess the views and experiences of those involved in caring for a child with HIV/AIDS. In-depth interviews were conducted in KwaZulu-Natal with 13 women who were the primary caregivers of a child with HIV/AIDS and 12 key informants who worked with children and families living with HIV/AIDS. The combination of widespread poverty and HIV-related stigma was perceived to compromise the health of a child with HIV/AIDS. Caregivers' primary focus was on economic survival and there was little income to meet basic human needs including the child's. Stigmatizing attitudes caused some caregivers to keep their child's sickness a secret and symptoms were sometimes ignored or treatment delayed. Little material and emotional support was available to caregivers who were overwhelmed by multiple stresses in this context. Support group interventions for caregivers of children with HIV/AIDS can be a useful resource provided that they jointly address the economic and psychological needs of caregivers. A stronger commitment at the national level to reduce poverty and HIV-related stigma is needed to strengthen the capacity of families who are caring for children with HIV/AIDS.     

The Plight of Older Persons as Caregivers to People Infected/Affected by HIV/AIDS: Evidence from Uganda

This paper describes the challenges faced by elderly persons (50 years and above) in Uganda, as parents and/or relatives of persons infected by HIV and as caregivers of the infected relatives and their uninfected children. Little is known regarding these indirect impacts of HIV/AIDS on the elderly in sub-Saharan Africa. Yet, the elderly are most often the main caregivers of HIV-infected persons and their families. Data used in this study were obtained from focus group discussions and in-depth interviews conducted among elderly respondents in 10 rural and urban communities within two Ugandan districts, Luwero and Kamuli. Findings indicate that the elderly do provide care to patients with AIDS at the terminal stage of the illness-when patients most need constant care. In most cases, the challenge of caring for the sick patients is compounded by the responsibility to care for the children affected by HIV/AIDS, which also starts when their parents are still living, not when the children become orphans. This demanding work was reported to negatively affect the elderly in various dimensions (economic, emotional, physical, and nutritional), all of which impacts their health and well-being. The responsibility for day-to-day patient care is borne primarily by elderly females, who reported a higher rate of physical ailments than male respondents-perhaps an indication of their disproportionate contribution to the care responsibilities. Most of the elderly respondents interviewed have a lot of anxiety about their future health and well-being, which they attributed in most part to the HIV/AIDS epidemic. These challenges do appear to exacerbate the aging process of the elderly whose health and well-being are already affected by the poor resource base and weak health infrastructure in this setting.