艾滋病致孤儿童的心理健康问题研究及相关对策建议

目的了解艾滋病致孤儿童的心理健康问题,提出相关对策和建议。方法采用访谈、追踪调查和心理干预相结合的方法,对受艾滋病影响儿童的心理发展进行了5年的系列研究。结果共追踪调查1 625名儿童,其中孤儿755名,非孤儿童466名,对照儿童404名。发现艾滋孤儿存在着严重的心理问题,艾滋孤儿具有仇恨的心理,封闭、自卑和孤独心理严重,未来发展压力大,悲伤情绪异常严重,双孤和单孤的心理健康状况都很差。在心理干预和3年追踪研究的基础上,提出了相关对策和建议。结论时间解决不了艾滋孤儿的心理健康问题,要重视对艾滋孤儿的心理救助。     

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。     

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。     

艾滋病对中国儿童影响的研究

目的了解和认识艾滋病对中国儿童的影响。方法利用方差分析等方法,提出一个多层次的分析框架,设计以儿童成长为核心的家庭调查表及儿童访谈提纲,并进行实地调查。结果受艾滋病影响儿童的家庭人均生产收入减少;救助活动对改善艾滋病孤儿家庭的经济状况起到了一定的作用;父母存活的受艾滋病影响儿童的缺课率最高;受艾滋病影响儿童感受到心理压力和忧伤。结论艾滋病对儿童的影响主要反映在儿童的生活环境、生存状况和身心健康三个层面。在这三个层面,受艾滋病影响儿童与非艾滋病家庭的儿童存在明显的差异。     

受艾滋病影响儿童心理健康干预方法探索

目的探索能够有效促进受艾滋病影响儿童心理健康的干预策略。方法选取河南省某县受艾滋病影响的10～15岁儿童45名,进行为期10个月的综合心理支持,干预前后进行问卷调查测量干预效果。结果干预前有焦虑不安等负性心理体验的儿童占44.4%(20/45),干预后下降到20.0%(9/45);症状自评量表SCL-90测量的强迫症状、人际关系敏感、抑郁、焦虑以及偏执等各个因子,干预之后均显著改善。结论综合心理支持对于促进受艾滋病影响儿童的心理健康具有积极意义。     

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。     

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。     

彝族受艾滋病影响儿童共情感恩与亲社会行为的关系

目的 探讨受艾滋病影响儿童中共情反应、感恩水平和亲社会行为之间的关系,分析感恩在共情和亲社会行为之间的中介作用.方法 在四川省凉山彝族自治州一所中学通过整群抽样选取350名受艾滋病影响的中学生作为研究对象,采用人际反应指数量表、中文版感恩问卷和亲社会行为倾向量表进行问卷调查.结果 受艾滋病影响儿童的共情对亲社会行为具有...     

四川省凉山州受艾滋病影响儿童焦虑情况及影响因素分析

目的 了解凉山州彝族受艾滋病影响儿童(简称受艾影响儿童)焦虑现状及其影响因素.方法 采用问卷调查法对凉山州某两所学校223名受艾影响儿童的焦虑情绪现状进行调查并分析其影响因素.结果 223名受艾影响儿童平均年龄为(15.24±2.79)岁,其中男童120名(53.8％),女童103名(46.2％),使用儿童焦虑性情绪障...     

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。     

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.     

The impact of HIV/AIDS on children's educational outcome: a critical review of global literature

The number of children losing one or both parents to HIV/AIDS has continued to rise in the past decade, with most of them being school-aged children. This study reviews global literature on the effects of HIV/AIDS (e.g., parental HIV-related illness or death) on children's schooling. Systematic review procedures generated 23 studies for examination. Existing studies show educational disadvantages among children affected by AIDS in various educational outcomes, including school enrollment and attendance, school behavior and performance, school completion, and educational attainment. A number of individual and contextual factors potentially moderate or mediate the effect of HIV/AIDS on children's education. These factors include gender of child, pattern of parental loss (maternal vs. paternal vs. dual), living arrangement (relationship with caregivers, gender of the household head), and household poverty. Current literature indicates limitations in number and scope of existing studies and in educational outcome measurements. There is a lack of studies with longitudinal design and data collection from multiple sources (e.g., students, teachers, caregivers), and a lack of studies on the relationship between psychosocial well-being of children affected by AIDS and their educational outcomes. Future studies need to employ more rigorous methodology and incorporate both individual and contextual factors for children affected by AIDS in various regions. More efforts are needed to design and implement culturally appropriate and context-specific approaches to improve the educational outcomes of children affected by AIDS.     

Disclosure of HIV Status and Adherence to Daily Drug Regimens Among HIV-infected Children in Uganda

Pediatric adherence to daily drug regimens has not been widely assessed in Africa where majority of HIV infected children live. Using in-depth interviews of 42 HIV-infected children taking ART and/or cotrimoxazole prophylaxis, and 42 primary caregivers, at a comprehensive HIV/AIDS clinic in Uganda, we evaluated their adherence experiences for purposes of program improvement. Daily drug regimens provided by the pediatric clinic included cotrimoxazole prophylaxis as well as ART and cotrimoxazole combined. Complete disclosure of HIV status by caregivers to children and strong parental relationships were related to good adherence. Structural factors including poverty and stigma were barriers to adherence even for children who had had complete disclosure and a supportive relationship with a parent. To ensure adherence to life-extending medications, our findings underscore the need for providers to support caregivers to disclose, provide on-going support and maintain open communication with HIV-infected children taking cotrimoxazole prophylaxis and ART.     

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.     

Willingness to care for children orphaned by HIV/AIDS: a study of foster and adoptive parents

There is substantial evidence to indicate that South Africa is facing the prospect of a large number of children, now and in the future, who will be orphaned as a result of the HIV/AIDS pandemic. Following the incapacitation and/or death of their parents, many of these children will be cared for by the safety net provided by members of their extended families. However, there is evidence to suggest that this safety net is fast becoming overwhelmed and possibly reaching saturation point. The ideal would be for as many of these children as possible to experience some type of family life in which to grow and mature into responsible adults. The present study explores adoptive and foster parents' (n = 175) willingness to care for a child orphaned by HIV/AIDS. Although some differences were noted depending on the HIV status of the child and whether the respondent was an adoptive or foster parent, results indicate an overall willingness in these populations to care for children orphaned by HIV/AIDS. The evidence also suggests that HIV-negative female orphans who are younger than 6 years, and who are family members, or from the same cultural background as the potential caregivers and do not have surviving relatives or siblings, have the best chance of being taken into foster or adoptive care.     

On the periphery of HIV and AIDS: Reflections on stress as experienced by caregivers in a child residential care facility in South Africa

Few researchers have investigated how female caregivers of institutionalised children, especially those affected by HIV and AIDS, experience stress. The role played by caregivers cannot be overemphasised; yet caregivers who work in institutions caring for orphaned and/or abandoned children affected by HIV and AIDS, are often marginalised and on the periphery of the HIV and AIDS pandemic. The implication is that insufficient attention or consideration is given to the importance of the role they play in these children’s lives. The objective of the study was to explore how female caregivers of institutionalised children affected by HIV and AIDS experience stress. A qualitative research project with a case study design was conducted. The purposively selected participants from a previously identified care facility were seven females in the age ranges of 35–59. Data was gathered during individual interviews and focus group discussions. Thematic content analysis of the data yielded the following themes: (1) contextualising caregiving as ‘work’; (2) stresses linked to caregiving; and (3) coping with stress. Findings from this study indicated that participants experienced caregiving in an institution as stressful, demotivating, and emotionally burdensome. Moreover, caregivers working in an environment of HIV and AIDS experienced additional stress related to organisational and management impediments, lack of emotional and practical support, inadequate training, discipline difficulties, and lack of respect and appreciation from the children in their care. It is recommended that training and management support as well as personal support and counselling for caregivers in the institutional context could help them to cope better, feel empowered and to potentially elevate their status as valued members of society.     

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.     

Self-reported physical health among older surrogate parents to children orphaned and affected by HIV disease

Around the globe, older relatives, largely grandparents, have become the surrogate parents to children and adolescents orphaned by parental death from HIV/AIDS and to those whose infected parents are too ill to serve as their primary caregivers. Largely invisible to research, programme and policy initiatives, these older surrogate parents face compounded stress and the risk of neglected and compromised health. An exploratory study of third- and fourth-generation relatives (n=20, mean of 59 years) found an average of 3.3 chronic health conditions. Fifty-five per cent rated their own health as "fair" or "poor" and 70% reported having insufficient time to attend to their own health. Supportive services are needed to address the health needs of these "hidden patients".     

Risk and protective factors for psychological well-being of children orphaned by AIDS in Cape Town: a qualitative study of children and caregivers' perspectives

By 2020, an estimated 2.3 million South African children will be orphaned by HIV/AIDS (Actuarial Society of South Africa, 2005), but little is known about risk and protective factors for their emotional and behavioural well-being. This qualitative study explores perspectives of affected families. Orphaned children (n = 60), caregivers of orphaned children (n = 42) and social care professionals (n = 20) completed semi-structured interviews and focus groups. Participants were recruited from schools, shelters and welfare services. Findings from multiple sources indicate potential risk and protective factors in a range of dimensions, including bereavement, family functioning, social support, poverty, access to education and perceived stigma. Many factors reflected international literature on children experiencing similar stressors (e.g. non HIV/AIDS-related bereavement). However, this study also identified factors which may be specific to this group, notably stigma, abuse and peer factors. Current research is quantitatively testing associations between these identified factors and psychological outcomes.