A systematic review on the meaning of the concept 'AIDS Orphan': Confusion over definitions and implications for care

Royal Free and University College Medical School, London, UK.
AIDS Care (Impact Factor: 1.6). 06/2008; 20(5):527-36. DOI: 10.1080/09540120701867248
Source: PubMed


Global publications on the international AIDS epidemic report on the existence of an ever-increasing number of orphans and vulnerable children. It has been suggested that by the end of this decade there will be in excess of 25 million AIDS orphans globally, an issue which will require understanding and organisation of long-term medical, psychological and social support. This study provides a systematic review to examine the use, overuse and misuse of the term orphan and explores the benefits and limitations of this approach. It then summarises the knowledge on orphans to date. Using a search strategy of published studies and recent conference abstracts, 383 papers were identified where the concept of AIDS and Orphan was raised. The papers were systematically coded and reviewed to understand when and how a child is labelled an orphan, and to summarise the effect of orphanhood on outcome measures, most notably psychologically and physically. All controlled studies published prior to 2006 were reviewed. A consistent picture of negative effects of parental death (however defined) on a wide range of physical, socioeconomic and psychological outcomes were recorded. Seventeen studies met criteria for in-depth review (empirical, fully published, control group). The majority of studies are cross-sectional (two are longitudinal) and employ a very wide array of measures - both standardised and study specific. This detailed analysis shows a mixed picture on outcome. Although most studies report some negative effects, there are often no differences and some evidence of protective effects from quality of subsequent care and economic assistance. The lack of consistent measures and the blurring of definitions are stumbling blocks in this area.

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Available from: Joanne M Mueller, Oct 26, 2015
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    • "A review of 60 nationally representative household surveys from 36 different countries found that children living in households with low income were most at risk of poor psychosocial and/or material outcomes [13]. Similarly, another review [14] asserted that controlled studies point to a much more complex picture on AIDS orphan children, with data suggesting negative effects or no differences alongside some evidence of protective effects due to the quality of care and economic assistance after the death of parent(s). In terms of the latter, it is worthwhile to note the commonness of caregiving roles adopted by those other than the biological parents in the context of a long history of economic migrancy in southern Africa, including South Africa "
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    ABSTRACT: Background Recent studies have questioned whether orphanhood is primarily associated with key dimensions of psycho-social wellbeing in children living in circumstances of material deprivation and high prevalence of HIV and AIDS. Methods This study uses cross-sectional data from a longitudinal study conducted between 2004-2007 to examine the psychosocial well-being of orphans and non-orphans in the Amajuba District of KwaZulu-Natal, South Africa. Psychosocial wellbeing included an assessment of orphans’ and non orphans’ level of anxiety and depression, affability and resilience. Stratified cluster sampling, based on both school and age, was used to construct a cohort of recent orphans and non-orphans and their households, randomly selected from schools. Results Levels of anxiety and depression, affability and resilience did not differ significantly between orphans and non-orphans, nor did salient household, poverty and caregiver characteristics vary substantially amongst orphans and non-orphans. Multivariate analyses indicated that children’s psychosocial outcomes, when controlling for orphan status and related demographic variables were more strongly influenced by household composition/size, living above or below the poverty threshold and factors associated with the caregiver-child relationship and caregiver health. Conclusions The results muster additional evidence for moving beyond narrow definitions of vulnerability associated exclusively with orphanhood to consider the multitude of material, social and relational factors affecting the psycho-social well-being of children in general who are living in circumstances of poverty and HIV and AIDS.
    Full-text · Article · Jun 2014 · BMC Public Health
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    • "Children orphaned due to HIV/AIDS (COA) and those orphaned because of reasons other than HIV/AIDS (COO) aged 12 to 16 years were sampled for this study. An orphan child was defined as a child who had lost one or both parents, and therefore included maternal, paternal and double orphans [28,29]. A scoping exercise was undertaken during November 2011 in and around Hyderabad to identify functional orphanages from where recruitment of children could be done, and to obtain characteristics of orphans housed in these orphanages to assist with sampling (number of orphaned children by age and sex, type of orphan (AIDS or non-AIDS), average duration of stay, predominant language spoken and appropriate time to contact). "
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    ABSTRACT: Systematic data on mental health issues among orphaned children are not readily available in India. This study explored depression and its associated risk factors among orphaned children in Hyderabad city in south India. 400 orphaned children drawn equally from AIDS and non-AIDS orphan groups aged 12-16 years residing in orphanages in and around Hyderabad city in southern India were recruited to assess depression and associated risk factors using the Center for Epidemiologic Studies-Depression Scale (CES-DC). Variation in the intensity of depression was assessed using multiple classification analysis (MCA). 397 (99%) orphans provided complete interviews in the study of whom 306 (76.5%) were aged 12 to 14 years, and 206 (51.8%) were paternal orphans. Children orphaned by AIDS were significantly more likely to report being bullied by friends or relatives (50.3%) and report experiencing discrimination (12.6%) than those orphaned due to other reasons (p < 0.001). The overall prevalence of depression score >15 with CES-DC was 74.1% (95% CI 69.7-78.4) with this being significantly higher for children orphaned by AIDS (84.4%, 95% CI 79.4 - 89.5) than those due to other reasons (63.6%, 95% CI 56.9 - 70.4). Mean depression score was significantly higher for children orphaned by AIDS (34.6) than the other group (20.6; p < 0.001). Among the children orphaned by AIDS, the bulk of depression score was clustered in 12-14 years age groups whereas in the children orphaned by other reasons it was clustered in the 15-16 years age group (p = 0.001). MCA analysis showed being a child orphaned by AIDS had the highest effect on the intensity of depression (Beta = 0.473). Children orphaned by AIDS had significantly higher depressive symptoms than the other orphaned children. These findings could be used for further planning of mental health interventions to meet the mental health needs of orphaned children, that could include preventive, diagnostic and treatment services.
    Full-text · Article · Apr 2014 · International Journal of Mental Health Systems
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    • "This is because the situation of orphans in this category is exacerbated by the loss of both parents, and hence the need for special attention and care. The conflation between these two sets of children is analytically incorrect and the social ramifications of such a skewed focus will not help but rather hinder programming for children (Meintjes and Geise 2006, Sherr et al. 2008). Therefore the aim of this paper was to examine the impact of the diminishing family support system on the education of orphans in Lesotho using the experiences of the orphans themselves, caregivers, teachers, social workers and community leaders. "
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    ABSTRACT: This paper examines the impact of the weakening of the extended family on the education of double orphans in Lesotho through in-depth interviews with participants from 3 of the 10 districts in Lesotho. The findings reveal that in Lesotho the extended family has not yet disintegrated as the literature suggests. However, it shows signs of rupturing, as many orphans reported that they are being taken into extended family households, the incentive for these households being, presumably, the financial and other material assistance that they receive from the government and non-governmental organisations (NGOs) which supplements household income and material wellbeing. The findings show that financial and other assistance given by the government and NGOs have resulted in conflict between the orphans and caregivers. This has also prompted many extended families to shift responsibilities to the government and NGOs. Most of the extended households provided the orphans with poor living conditions, such as unhygienic houses, poor nutrition, and little or no provision of school materials, which has had a negative impact on the education of the orphans. The combined effects of economic crisis and HIV and AIDS have resulted in extended families not being able to care for the needs of the orphans adequately, whilst continuing to accept them into their households. It is recommended that although extended families are still accepting orphans, the government should strengthen and recognise the important role played by families and the communities in caring for these vulnerable children. The government should also introduce social grants for orphans and other vulnerable children and review the current meagre public assistance (R100) it provides for orphans and vulnerable children in Lesotho. Other stakeholders should concentrate on strengthening the capacity of families and communities through programmes and projects which could be more sustainable than the current handouts given by many NGOs.
    Full-text · Article · Sep 2013 · African Journal of AIDS Research
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