Children Living in HIV Families

Human Immunodeficiency Virus-1 (HIV) is an infectious agent that infects and damages specific blood cells in the human immune system (specifically, CD4 "T-cells"). As result of this, the capacity of that individual breaks down and hence, he or she is no more able to defend subsequent diseases. The likelihood of opportunistic infection increases when the virus replicates uncontrolled and damages the individual's cellular immunologic response system and ultimately may cause death of that infected person.

HIV influences the families of those affected, in addition to the catastrophic impact of the virus on individuals. Children affected by HIV infection with HIV-infected parents or siblings are among the most susceptible "silent victims" of the HIV epidemic.

Parenting Issues in Children

In a recent study of women's parenting behaviors, HIV-infected mothers reported lower mother-child connection quality and less supervision of their children's activities than non-infected mothers, possibly indicating that maternal HIV infection may interfere with successful parenting. Physical limitations caused by a significant chronic disease may be one cause of the disrupted parenting behaviors.

Not unexpectedly, when people proceed from "asymptomatic HIV infection" to "symptomatic HN infection" and, eventually, to an AIDS diagnosis, their physical condition deteriorates. Poor physical health has been recognized as a risk factor for impaired parenting techniques in many populations. The prevalence of maternal depressive symptoms is another possible reason for the link between HIV infection and poor parenting abilities.

Adults with HIV have been shown to have increased depressive symptoms. Parents who are depressed frequently struggle to face the rigors of a child's upbringing. This may be especially true for HIV-positive parents, whom demographic groups with poorer incomes and higher environmental stress overrepresent. A lack of proper social support may contribute to the constellation of pressures experienced by HIV-affected families.

This may also influence family relationships since parents who lack social support are more likely to have poor parenting abilities. According to studies, mothers with HIV and their children reported receiving less social assistance than non-infected women and their children. Multiple studies have linked perceived parental social support to better psychosocial outcomes in children of HIV-infected mothers and dads.

Child Behavior Problems

Non-infected children of HIV-positive parents are more likely to experience behavioral and adjustment issues for various reasons. Children of HIV-positive mothers have a higher risk of depressive symptoms, externalizing disorders, and academic challenges. In contrast, children of males with hemophilia and HIV infection have a higher chance of harmful parent-child interactions.

These adjustment issues may result from degraded parental behaviors, decreased social support, or uncertainty about the parent's health status. In one study, kid medical confusion about the parent's disease was more significantly connected to child adjustment issues than objective markers of the parent's illness.

Disruptions in available coping resources due to parental sickness might potentially create child behavior difficulties. In one research of families afflicted by father HIV infection and hemophilia, the severity of the illness predicted increases in disruptions of parent-child interactions. Parent-child relationship issues predicted an increase in the child's use of avoidant coping methods, connected with an increase in the child's internalizing problems. Furthermore, the employment of avoidant coping techniques by HIV-infected parents and spouses has been linked to increased behavioral difficulties in their children.

Child Bereavement

Although breakthroughs in the medical care of the condition have resulted in adults and children with HIV enjoying longer and better lives, there is presently no cure for AIDS. As a result, children of HIV-positive parents and siblings of HIV-positive children will undoubtedly lose a loved one far sooner than is deemed "normal."

Although child mourning is seldom easy, children who lose loved ones to HIV/AIDS may face additional challenges due to the condition's nature. For example, in families where the sickness has not been disclosed, children must decide what to tell support persons about the cause of their loved one's death.

The stigma associated with HIV may limit the sympathy and assistance that surviving family members may provide. Furthermore, children may be hesitant to announce their parent's death for fear that people would believe the survivor(s) are also HIV positive.

Finally, in households where the HIV status of a parent or sibling has not been disclosed to other family members, survivors may discover the loved one's HIV status while grieving the death of the loved one. These obstacles may influence the child's post-grieving recovery and should be addressed in supportive and therapeutic partnerships.

Emerging Issues

Following are the major emerging issues −

Permanency Planning

Several difficulties affecting children of HIV-positive parents have lately been investigated in the scientific literature. Given the projected number of "AIDS orphans" shortly, problems about custody arrangements for children following the death or incapacity of their parents must be addressed. Discussions of "permanency planning" are rare among HIV-positive parents in the United States and overseas. As a result, orphaned children may undergo unneeded changes in the period immediately after the loss of their parents. Several programs have been established to assist families in making plans for their children's current and future care. A cohesive and feasible plan for the child's custody and care is essential in the event of a parent's incapacity or death. The kid's participation in these dialogues is essentially determined by the child (e.g., developmental level, disclosure status, preference).

Disclosure

The disclosure of HIV status to direct family members is related to the problem. Most children (ages 5-15) in numerous studies of HIV-positive moms were allegedly uninformed of their mother's HIV status. When children were informed of their parent's illness, the parent generally broke the news. Not surprisingly, no consistent evidence evaluating the benefits or hazards of child disclosure has been documented. Instead, the decision to notify family members of what and when appears profoundly personal. Factors to consider include

• The patient's attitude towards the illness (e.g., acceptance vs. Shame)

• The child's developmental level

• The child's ability to distinguish between public and private information

• The child's available coping strategies and social support

The following issues and the HIV-infected child's right to privacy must be considered before disclosing a child's disease to his or her siblings.

Need for Psychosocial Services 

Given the difficulties that HIV-infected families confront, it seems to reason that psychological services should be offered. It is uncertain if such programs are available to most HIV-affected children and families. The demographic characteristics of children whose parent(s) are HIV-infected imply that proactive mental health therapies are out of reach for many. Recent needs assessment surveys, however, indicate that many parents recognize a need for such programs to reinforce their parenting skills, address their children's fears about sickness, and give guidance during the disclosure process.

Conclusion

HIV impacts the families of those affected, with HIV-infected mothers reporting lower mother-child connection quality and less supervision of their children's activities than non-infected mothers. Physical limitations and the mother's depressive symptoms may contribute to the link between HIV infection and poor parenting abilities.

Perceived parental social support has been linked to better psychosocial outcomes in children of HIV-infected mothers and dads. Child behavior problems, disruptions in available coping resources, and avoidant coping techniques have been linked to increased behavioral difficulties. Child bereavement is complicated due to the stigma associated with HIV/AIDS.