Consequences of HIV for children: avoidable or inevitable?
FXB Center for Health and Human Rights, HSPH, Harvard University, 651 Huntington Avenue, Boston, MA 02115, USA
(Received 13 January 2009; final version received 10 May 2009)
The HIV/AIDS epidemic has many serious consequences for children. These consequences are, however, rarely
inevitable. Families can provide a protective barrier that deflects blows, or minimises their impact and a
supportive nurturing environment that can help children recover from harm. If strong enough, and with sufficient
access to quality services and support from communities, families can reduce the impacts of HIV/AIDS on
children to negligible levels in most areas of impact. It is apparent that the impacts felt by children are not simply
unfortunate, inevitable consequences of this epidemic. A strong and supported family with good access to quality
services can deflect almost all of the impact. It is as a result of an interaction of the context of poverty, which
weakens families, and a failure to adequately respond, that impacts are felt by children.
Keywords: HIV; children
The Joint Learning Initiative on Children and AIDS
is based on the premise that HIV/AIDS has negative
implications for children and that actions can reduce
these impacts. The first part is easy to accept, and the
second is, to an extent, similarly easy to accept. No
doubt HIV/AIDS has negative implications and that
actions can reduce these, the question is to what
extent can they be reduced and by what actions? This
paper seeks to speak to this question by discussing
what impacts on children are avoidable and which are
Families can provide a protective barrier that
deflects blows, or minimises their impact and a
supportive nurturing environment that can help
children recover from harm. If strong enough, and
with sufficient access to quality services and support
from communities, families can reduce the impacts of
HIV/AIDS on children to negligible levels in most
areas of impact. While the potential exists for the
family to protect children, they often lack material
resources, receive limited outside support and have
poor access to appropriate, quality services leading to
serious consequences for children.
The impacts of HIV/AIDS on children are well
documented in this issue and elsewhere (such as
Foster & Williamson, 2000; Hunter & Williamson,
2000, 2004; Richter, Manegold, & Pather, 2004;
Sherr, 2008; Subbarao & Coury, 2004; USAID,
2004). A detailed description of these impacts will
not be repeated; rather what this paper seeks to do is
examine the pathways to impact and to question their
inevitability by drawing on insights from previous
work. By extracting from existing work, a conceptual
framework will be developed. This will be followed by
an examination of the pathways to an impact that
will be undertaken by drawing on this framework.
The examinations will consider two areas of impact.
? Child infection and
? Adult illness and death.
For each of these it is obvious that, if the infections of
parents, caregivers and other adults whom children
rely on, or interact with, had been prevented there
would not be an impact on children. More than this,
the paper will argue that even when adult prevention
has failed, the impacts on children are, in almost all
instances, not inevitable.
The conceptualisation of the problem plays an
important role in shaping perceptions of what the
required response is. Rather than examining the child
in isolation, the framework on which the paper is
based considers the child within the family context. It
is suggested below that there are six components to
family care that are important here. These six interact
to determine the extent to which the needs of children
are met and can be summarised in Figure 1.
Without intentions to care for the child, no care
will be provided. Intentions may be affected by the
gender of the child, their age and their relatedness
and may thus play a role in shaping discrimination.
Vol. 21, No. S1, August 2009, 98?104
ISSN 0954-0121 print/ISSN 1360-0451 online
# 2009 Taylor & Francis
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