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。     

项目县6～14岁艾滋病致孤儿童社会心理问题浅析

目的了解项目县6~14岁艾滋病致孤儿童社会心理问题,探讨适宜的支持对策。方法对5个项目县251名6~14岁艾滋病致孤儿童进行问卷调查和个人访谈。结果部分儿童丧失生活希望,感觉生活很不好,原因有父母久病、失去父母、经济困难、比别人差、被歧视、家务多等。仅10.8%儿童因得到亲人和社会支持而感觉生活很好。父母病重和死亡使儿童处于长期的负面情绪,如担心、恐惧、痛苦、悲伤、绝望和害怕;因父母去世而痛苦巨大。父/母去世后恢复时间很长。一些儿童出现情绪-行为问题,如入睡困难、做恶梦、老想哭、爱发呆、想发火、不想与人交往、不能集中注意力等。1/3儿童父母患病、去世后社会交往减少,原因是担心别人不愿和自己交往、怕人欺负等。结论父母生病去世给儿童带来了诸多社会心理问题,急需建立和完善相应的社会支持系统,给予儿童持续的社会心理支持。     

艾滋病致孤儿童在“阳光家园”安置模式下的心理状况调查

目的深人了解河南省阳光家园中艾滋病致孤儿童的心理状况。方法用调查问卷和深度访谈的方式，对河南三处阳光家园中的100名艾滋病致孤儿童进行调查。结果有效问卷91份。91名艾滋病致孤儿童对自己的日常生活总体而言感到幸福，但仍有不满意的地方；他们对伙伴关系非常重视，但对陌生人交往的态度不积极，也缺乏足够的长辈性质的关怀；近7成的孩子的个性特征中包含了内向的因素，有的孩子对管理人员和资助者缺乏感恩的心。     

卧龙区全球基金TB/HIV双重感染防治项目一期效果评价

目的分析卧龙区结核病/艾滋病病毒(TB/HIV)双重感染防治项目一期(2007-2008年)的执行效果。方法对2007-2008年项目执行情况资料进行汇总分析。结果2007-2008年共确诊结核病人916例,检测HIV抗体847例,检测率92.47%;筛查HIV感染者、艾滋病病人368人、1790人次,筛查率94.36%;发现活动性结核合并艾滋病病人55例,其中新发涂阳患者3例。经抗结核治疗后,新发涂阳治愈率66.7%,症状改善病灶明显吸收37例,症状缓解率70.0%。结论卧龙区TB/HIV双重感染防治项目取得满意效果,各项指标均达到项目要求,为二期项目的实施提供了宝贵经验。     

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。     

中原地区受AIDS影响的儿童心理健康水平的现况研究

目的 评定中原地区受艾滋病(AIDS)影响的儿童心理健康水平,为改善他们的心理状况提供客观依据.方法 选用SCL-90量表进行问卷调查,应用SAS 8.0进行统计分析.结果 共调查受艾滋病影响的初中生120人,其中双孤儿童33人,单孤儿童43人,受AIDS影响的双亲儿童44人.AIDS致双孤儿童的SCL-90总分(161.36±41.17)分,明显高于AIDS致单孤儿童的(137.37±33.32)分和受AIDS影响的双亲儿童的(141.82±39.36)分.AIDS单孤儿童中女孩的总分(147.07±34.75)明显高于男孩(119.27±21.50).结论 受AIDS影响的儿童心理问题比较严重,在为其提供心理支持的过程中,应根据不同类型、不同性别的特点,进行有针对性地干预.     

中国艾滋病致孤儿童生长发育与营养水平及心理健康研究

目的调研中国艾滋病致孤儿童生长发育、营养水平与心理健康状况,为政策制定提供依据。方法按性别、年龄1：1匹配,调查96对艾滋病致孤儿童与非孤儿的身心健康水平,并进行差异比较。结果孤儿组BMIz评分与肩胛下皮褶厚度显著低于非孤儿（P〈0．01）,消瘦明显。孤儿组自尊量表（SES）总分更低,而抑郁问卷（BDI）总分更高（P〈0．05）。男性孤儿身心健康弱势明显,女性组间未见显著性差异。结论中国艾滋病致孤儿童的身心健康脆弱性显著,需探索可持续性更强的孤儿抚养策略,并进行以心理支持为核心的综合健康干预,而且对男性孤儿应给予更多关注。     

2005～2007年我国7省艾滋病综合治疗和关怀工作的比较分析

目的描述2005~2007年第四轮中国全球基金艾滋病项目(GF4)覆盖的7省项目县艾滋病综合治疗和关怀工作的季度变化趋势和地区间差异。方法对7省艾滋病治疗和关怀工作报表及相关资料进行质量评价,描述针对HIV感染者/艾滋病患者(PLWHA)的抗病毒治疗、抗机会性感染和关怀/支持工作的开展情况,评估并分析其变化趋势和地区差异。结果截至2007年6月,7省接受联合抗逆转录病毒治疗的艾滋病患者共5018人,抗病毒治疗率中位数为87.66%,其中贵州、新疆较低,江西较高(P<0.05);7省接受抗机会性感染治疗的PLWHA共13 349人,抗机会性感染治疗率中位数为100%;7省接受关怀/支持服务的PLWHA共13780人,关怀/支持服务覆盖率中位数为59.09%,其中湖南、江西较高,广西较低(P<0.05);抗病毒治疗率、抗机会性感染治疗率和关怀/支持服务覆盖率均呈现出随时间增长,但增长速度逐渐减慢的特征(P<0.05)。结论 2005~2007年GF4项目7省针对PLWHA的各项治疗、关怀/支持工作进展迅速,覆盖人数及比例不断提高,其中目标人群抗病毒治疗率和抗机会性感染治疗率较高,取得了重要成效,但各项目地区存在关...     

凉山州4县10乡预防艾滋病母婴传播乡镇试点项目进展及效果

中国性病艾滋病防治协会于2018年至今在四川省凉山州昭觉、布拖、美姑、越西4县10乡镇实施凉山州预防艾滋病母婴传播项目,支持乡村工作队伍进村入户,开展健康教育、提供HIV咨询检测转介服务,发现并转介孕妇,促进HIV阳性孕产妇孕情早发现。2020年1-9月居家育龄妇女健康教育服务覆盖率达到95%。居家普通育龄妇女接受孕检服务覆盖率达99%,居家普通育龄妇女获取HIV检测服务覆盖率99%。艾滋病病毒(HIV)阳性孕产妇孕早期纳入预防艾滋病母婴传播(PMTCT)管理比例达到98.8%。通过探索和完善乡村PMTCT队伍管理机制,项目为促进PMTCT服务落实,打通服务最后一公里提供了有益经验。     

中国部分省份参与艾滋病防治工作的民间组织状况分析

目的 了解部分省(自治区、直辖市,下同)开展艾滋病防治工作的民间组织状况,为更好地动员和支持民间组织参与艾滋病防治工作提供建议.方法 利用第六轮中国全球基金艾滋病项目作为平台,通过网络招募、邮件组、深入访谈等形式收集相关信息.结果 开展艾滋病防治工作的民间组织在不同省份的发展状况很不平衡,其中55%为未注册的机构,基本都具有艾滋病防治工作经验.所有专门从事男男性行为人群干预的机构均未注册,且分布在城市;专门从事吸毒和暗娼人群干预的民间组织为数不多,为感染者和受艾滋病影响儿童提供关怀和支持的机构,则与感染者的分布及是否有项目支持相关.结论 要进一步加强对非政府组织参与艾滋病防治工作的支持力度,加强对民间组织开展工作的统一规划、指导和管理,强化和支持国际非政府组织的技术支持作用,同时鼓励民间组织加强自身能力建设.     

Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe

OBJECTIVE: To describe patterns of association between different groups of young orphans and vulnerable children (OVC) and their nutritional and health outcomes; and to develop a theoretical framework to analyse the determinants of child malnutrition and ill-health, and identify the different mechanisms which contribute to these outcomes in such children. METHODS: We developed and tested a theoretical framework to explain why orphans and vulnerable children experience more ill-health and malnutrition based on statistical analysis of data on 31 672 children aged 0-17 years (6753 aged under 5 years) selected from the Zimbabwe OVC Baseline Survey 2004. RESULTS: 28% of children aged 0-4 years at last birthday were either orphans or vulnerable children. They were more likely than non-vulnerable children to have suffered recently from diarrhoeal illness (age- and sex-adjusted odds ratio, AOR, 1.27; 95% CI 1.09-1.48) and acute respiratory infection (1.27; 1.01-1.59) and to be stunted (1.24; 1.09-1.41) and underweight (1.18; 1.02-1.36). After further adjustment for exposure to extreme poverty, OVC remained at greater risk of diarrhoeal disease (AOR 1.25; 1.07-1.46) and chronic malnutrition (1.21; 1.07-1.38). In 0-17-year-olds, OVC with acute respiratory infection were more likely not to have received any treatment even after adjusting for poverty (AOR 1.29; 95% CI 1.16-1.43). CONCLUSION: Differences in exposure to extreme poverty among young children by OVC status were relatively small and did not explain the greater malnutrition and ill-health seen in OVC.     

The extent of community and public support available to families caring for orphans in Malawi

There are an estimated 15 million AIDS orphans worldwide. Families play an important role in safeguarding orphans, but they may be increasingly compromised by the HIV/AIDS epidemic. The international aid community has recognized the need to help families continue caring for orphaned children by strengthening their safety nets. Before we build new structures, however, we need to know the extent to which community and public safety nets already provide support to families with orphans. To address this gap, we analyzed nationally representative data from 27,495 children in the 2004-2005 Malawi Integrated Household Survey. We found that communities commonly assisted orphan households through private transfers; organized responses to the orphan crisis were far less frequent. Friends and relatives provided assistance to over 75% of orphan households through private gifts, but the value of such support was relatively low. Over 40% of orphans lived in a community with support groups for the chronically ill and approximately a third of these communities provided services specifically for orphans and other vulnerable children. Public programs, which form a final safety net for vulnerable households, were more widespread. Free/subsidized agricultural inputs and food were the most commonly used public safety nets by children's households in the past year (44 and 13%, respectively), and households with orphans were more likely to be beneficiaries. Malawi is poised to drastically expand safety nets to orphans and their families, and these findings provide an important foundation for this process.     

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.     

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.     

Childcare in poor urban settlements in Swaziland in an era of HIV/AIDS

This paper explores the role of the family in caring for orphans and other children in poor urban communities having some of the highest levels of HIV/AIDS prevalence in the world. A range of family forms in Swaziland was found to be caring for orphans. Child-headed households and lone-elderly carers were not the most common; maternal kin played a more important role in orphan care than did paternal kin, indicating both stresses due to AIDS and the dynamic nature of the family. Women of all ages were bearing the brunt of the extra care responsibilities caused by the epidemic. There was limited involvement in children's well-being by agencies of any kind and orphan care remained largely situated within kin structures. The AIDS epidemic was impacting on families in a variety of ways, with a corresponding increase in poverty and vulnerability. Carers did not perceive orphans as a separate category of children requiring assistance over and above any other vulnerable child. Families require assistance at the household, community and national level. Meanwhile, community-based initiatives were poorly developed. Welfare sector policies should strengthen the family model of childcare by increasing support to the poorest families rather than treating orphans as a separate category of vulnerable children and thereby excluding other needy children.     

Epidemiology of health and vulnerability among children orphaned and made vulnerable by HIV/AIDS in sub-Saharan Africa

The HIV/AIDS epidemic in sub-Saharan Africa has already orphaned a generation of children, and it is projected that by 2010, 18 million African children under the age of 18 are likely to be orphans from this single cause (UNICEF, 2005, The state of the Worlds Children: Childhood under threat. New York: UNICEF). Results from a Kellogg funded OVC project (Skinner et al., 2004, Definition of orphaned and vulnerable children. Cape Town: HSRC) supported the construct that the loss of either or both parents would indicate a situation of likely vulnerability of children. A key problem in the literature on the impact of orphanhood on the well-being of children, families and communities, is that the focus of assertions and predictions is often on the negative impact on 'AIDS orphans', or households. There are hardly any studies that compare the experiences of orphans with non-orphans. This paper thus attempts to fill that gap. It uses epidemiological data to explore the epidemiology of health and vulnerability of children within the context of AIDS in sub-Saharan Africa. Because of data limitations, only the following aspects are examined: (i) orphan status; (ii) household structure (in particular, grandparent headedness and female-headedness); (iii) illness of parents; (iv) poverty; and (v) access to services, especially schooling, health, social services. While recognizing the limitations of the analysis, data presented in this paper indicates that orphans in sub-Saharan Africa are more vulnerable than non-orphans. The authors conclude with some suggestions for policy makers and programme implementers, highlighting the importance of focusing on interventions that will have maximum impact on the health and well-being of children.     

Nutritional status, psychological well-being and the quality of life of AIDS orphans in rural Henan Province, China

OBJECTIVE: To assess the influence of orphanhood due to AIDS on children's nutritional status, psychological well-being and life quality, and to explore appropriate intervention strategies in China. METHODS: In 2005, 186 children aged 8-15 years (93 AIDS orphans and 93 non-orphans) from a rural area of Henan Province were surveyed in a cross-sectional and matched pairs study on nutritional status, psychological health and life quality. RESULTS: We found no compelling evidence for poorer nutritional status in orphans. The nutritional status of both orphans and non-orphans was extremely poor according to the prevalence of stunting, underweight, wasting and anaemia. Depression, low self-esteem and lower quality of life were more frequent in orphans. These differences mainly existed in boys' groups. No significant differences were found between paternal, maternal and double orphans, or orphans in orphanages or extended families. Regression analysis revealed that orphanhood leads to low self-esteem and more depression which contributes to lower quality of life and mediates the association between orphanhood and quality of life. CONCLUSION: The high prevalence of poor nutritional status indicates that basic material needs of children, including AIDS orphans, are not met in rural China. Psychological problems were prominent among orphans and had become the most important contributor of lower life quality. Boys were at least as vulnerable as girls. The living conditions of all children in rural China must be improved; school-based care and support are crucial and would be a cost-effective way to improve the overall life quality of AIDS orphans.     

Supporting orphans and vulnerable children affected by AIDS: using community-generated definitions to explore patterns of children's vulnerability in Zambia

This study explores how communities in Zambia characterize vulnerable children in the context of HIV; demonstrates how estimates of vulnerability vary depending on definitions; and discusses the implications of these estimates for program delivery. Baseline research conducted in 2005 included cross-sectional community-based household surveys at six locations using multi-stage random sampling (totalling 1,503 households, reporting on 5,009 children) and participatory qualitative research (focus group and in-depth interviews) with adults and youth at four locations. Between 14 and 27% of children in the sample had experienced a parental death (2-5% maternal orphans, 7-13% paternal orphans, 4-10% double orphans). In addition, other characteristics that communities associated with children's vulnerability were prevalent: 26-34% had been taken into another household, 15-27% were living in female-headed households, and 11-28% were living in a household with someone who is chronically ill. Overall, 58-73% of children had one or more community-defined characteristics of vulnerability. This study highlights the need to carefully consider the meaning of "vulnerability" when targeting programmes to support children affected by HIV and AIDS. Local community input is vital to inform context-specific criteria for distributing programme resources. If used, eligibility criteria should be context-specific yet flexible to evolving community realities. In settings such as rural Zambia where levels of HIV-related vulnerability are high, it may be more efficient to target at the level of communities rather than assess individual households.     

Constraints to educational opportunities of orphans: a community-based study from northern Uganda

The objective of this article is to assess constraints on educational opportunities of orphans cared for within the extended family system in Lira district, northern Uganda. The data were collected through: review of school census records; ethnographic fieldwork; in-depth interviews with 21 community leaders, 45 heads of households caring for orphans and 35 orphans. Focus group discussions were held with men and women caring for orphans, community leaders and orphans. A household survey was conducted in 402 households caring for orphans. We found that very poor widows living on less than half a dollar per day head 48% of the households caring for orphans. The elderly heads of households were 3 times more likely to have all the children in their household in schools than the younger ones. Furthermore, the widowed and single heads of households were more likely to have all orphans in school than the married, and households that received external support offered better educational opportunities. Poverty, as indicated by lack of food while at school and heavy involvement of orphans in domestic labour, were identified as major constraints on orphans' schooling. There is an urgent need to support orphans' education in northern Uganda beyond the current Universal Primary Education efforts. The most vulnerable households need to be targeted, and the communities need to be sensitized to child labour, school meals and sex abuse.