The Impact of AIDS on Intergenerational Relationships in Africa

Abstract

This paper describes die impact of AIDS on intergenerational relationships in Africa (especially Sub-Saharan Africa). The AIDS infection in Sub-Saharan Africa has expanded astronomically with up to 18.5 million living with the disease. Young adults between the ages of 14 and 49 are most likely to be infected. In the countries of Sub-Saharan Africa, three levels of HIV/AIDS infection among adults can be identified-hardest hit, high, and moderate. This ranges from 3.6% for moderate level to 35.8% for the hardest hit. The situation has changed the youth population profile and has numerous quality of life implications for young people, older adults, and a multi-dimensional impact on community life.

With the adverse socioeconomic and psychological effect of AIDS, interactions between members of the different generations are made difficult-relationships are becoming more of a burden than a mutual source of satisfaction. Children and young adults are losing their parents and mentors, and sometimes have to take care of their infected and dying parents at a very early stage in life. The older population is now losing its social and economic support, which hitherto, they have drawn from their adult children, and at the same time, they are assuming a new caregiving role to either their infected and affected children or grandchildren, or both.

Hope exists if the trend is checked by AIDS prevention efforts with examples drawn from countries like Uganda, Senegal, and Nigeria. But since there are some victims already, efforts should be made to help them cope with the stress and adverse effects of the disease. Governmental policies should also aim at assisting victims and volunteers financially. As part of the strategy, intergenerational relationships at family, organizational and community levels should be strengthened. Reinforcing the value of being one's “brother's keeper” both as individuals and groups/organizations is crucial at this time of crisis.     

Intergenerational Practices and Possibilities Related to the HIV/AIDS Pandemic in Botswana and Nigeria

Abstract

The future of Botswana and Nigeria hangs precariously on the balance of life and death. In recent years, the latter seems to be winning as both countries face the devastation of their middle generation due to the HIV/AIDS pandemic. Neither country can afford to simply watch their populations be depleted at such an alarming rate. This paper seeks to propose how an intergenerational framework might be applied to this situation with the hope that intergenerational policies and approaches might ameliorate this social crisis.     

Analysis of HIV Caregivers in South Africa: A South African Depression and Anxiety Group

ABSTRACT

The severity of the HIV/AIDS epidemic in South Africa is well documented. However, little is known regarding the well-being of caregivers of persons with HIV/AIDS in South Africa. This study sought to evaluate characteristics, similarities and differences between groups of HIV caregivers in rural, semi-rural, and urban areas of South Africa. Interesting trends were noticed in the areas of suicidality, alcohol abuse, and intimate trauma. Findings indicate a substantial need for further study in the area of suicidality, denial of or lack of desire to know HIV status and the accompanying diagnostic stigma, and the need for a support network within lay caregivers.     

HIV Prevention Programs in the Black Church: A Viable Health Promotion Resource for African American Women?

ABSTRACT

Nearly 40 million people worldwide are living with the human immunodeficiency virus (HIV). The Centers for Disease Control report that women account for more than 50% of the existing 40 million HIV/AIDS cases to date. Moreover, African-American women are infected with HIV/AIDS 25 times more often than white women and four times more often than Hispanic women, making HIV/AIDS the leading cause of death for black women ages 25–34. Given the increasing rate of transmission with this population, the purpose of this article was to review the existing literature to investigate the risk factors associated with African-American women with HIV/AIDS and identify an effective method of HIV prevention for them. A discussion of religion and African-Americans in terms of the Black church and its health promotion efforts was also included. The article concludes with a discussion of program elements of HIV prevention programs in the Black church and possible challenges faced for the programs.     

Stigma,AIDS, and HIV Prevention in Africa: Reports from Community Organizations Providing Prevention Services

ABSTRACT

The AIDS epidemic in Africa remains a serious health crisis. Nongovernmental organizations (NGOs) in Africa play a critical role in the delivery of HIV prevention services. An important barrier to their HIV prevention efforts is stigma directed at persons living with HIV/AIDS. In order to understand how stigma affects HIV prevention programming, we conducted in-depth qualitative interviews with NGO directors in 29 African countries. Qualitative analytic approaches were used to identify key themes. Substantial discrimination and stigmatization of HIV-positive persons was reported. HIV-positive women were particularly likely to suffer negative social and economic consequences. The stigma associated with HIV interfered with disclosure of HIV status, risk-reduction behaviors, and HIV testing, creating significant barriers to HIV prevention efforts.

Interventions to reduce AIDS-related stigma in Africa are urgently needed. Reducing the burden of stigma is critical to fighting the epidemic in Africa and could play an important role in global HIV reduction.     

Social Protection in a Context of HIV/AIDS: A Closer Look at South Africa

Abstract

South Africa is unusual in that it is experiencing high levels of AIDS morbidity and mortality, but is also able to afford a relatively developed system of social assistance. However, HIV/AIDS is affecting poverty in some unique ways and compounding other challenges such as unemployment. Its nature is such that it demands immediate action, balanced with a focus on long-term development. This is requiring a conceptual shift from ‘social security’ to ‘social protection’, since social assistance is not managing to address all dimensions of poverty and is also creating perverse incentives for people not to maximise their health. In South Africa, household studies comprise the most useful evidence to explore the particular challenges posed by HIV/AIDS. They indicate a need to review policies in all the social sectors and to focus on the issue of human capital.     

Eastern and Southern Africa

This article reviews the literature on migration and the spread of HIV/AIDS in Eastern and Southern Africa. It includes Angola, Botswana, Burundi, Djibouti, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The literature focuses separately on AIDS or migration. HIV/AIDS is widespread and prevalent in these regions. The major concern is that migrants are at risk due to their migration and HIV infection is spread after a return to their home countries. Populations at risk include rural-to-urban migrants, displaced persons in the Sudan and in the Horn of Africa, refugees crossing borders, and pastoralists moving within rural areas. In 1997, there were an estimated 1.3 million refugees in east African countries and 5 million internally displaced due to conflicts in Angola, Mozambique, and South Africa. Risk factors among migrant groups include high rates of partner change, unprotected sexual intercourse, nonuse of condoms, prior sexually transmitted diseases, IV drug use, and residence in a high HIV-prevalence community. Confounding factors may be age, gender, occupation, and mobility. Health services for migrants vary between countries. There are successful models for prevention of HIV. 13 targeted interventions are identified.     

Permanency Planning for HIV/AIDS Affected Children

Abstract

As thousands of women are added to the surveillance data each year, the AIDS epidemic continues to be far reaching. And, as the number of infected women increase, there is an increase in the number of children affected by HIV. This article reviews the existing literature of AIDS affected children who have experienced or will experience the death of one or both parents as a result of HIV/AIDS. Approaches to culturally relevant, alternative permanency planning are examined which seek to serve as a guide for HIV-infected parents and human service providers.     

Why do People Disclose their HIV Status? Qualitative Evidence from a Group of Activist Women in Khayelitsha

Abstract

This study explores the bio-psychosocial context of HIV/AIDS in which eleven HIV-positive activist women from Khayelitsha negotiated the process of disclosing their HIV-positive status to significant others, specifically biological household members. The study is based on the narratives of a group of HIV-positive peer-educators in Cape Town, South Africa. The results suggest that community perceptions of HIV/AIDS are shaped by a wide variety of factors particular to the socio-cultural and political context of HIV/AIDS in South Africa. The process and outcomes of disclosure to others occurs within this shifting web of meanings, and in turn, reshapes them as people respond to the person who has just disclosed. Eight out of the eleven women disclosed to a close biological household member as these significant-others provided, or had the potential to provide, the appropriate support. Six of the eleven participants disclosed during the symptomatic phases of HIV/AIDS, while five were asymptomatic at the time. Four of the five who disclosed when asymptomatic were diagnosed while pregnant and had never experienced severe opportunistic infections. Additionally, these same four disclosed some time after diagnosis (nine months > t < two years). Of the six who disclosed in a state of ill-health, five disclosed immediately after diagnosis in order to access health-related social support. At this time, concerns regarding health and mortality superseded fears of rejection and discrimination due to AIDS-related stigma. The perceived potential benefits (social and health-related support) outweighed the perceived risks (stigmatisation and discrimination). When participants had never experienced serious illness, they disclosed in order to educate loved-ones, gain emotional support or challenge false popular perceptions of HIV/AIDS.     

Potential Roles of Black Churches in HIV/AIDS Prevention

Abstract

This study examines the role of Black churches in AIDS/HIV prevention. This is a pilot survey study design administered to 11 churches represented by 11 ministers and one church member. The analysis is both qualitative and quantitative. The results showed that most of the ministers had spoken with their congregation on HIV/AIDS. A few ministers had previously sponsored or taken part in HIV/AIDS workshops and disseminated HIV/AIDS educational material in the African American community. None of the churches had an established HIV/AIDS prevention program. Most of the ministers were receptive to implementing an HIV/AIDS prevention program, provided that it did not violate the church doctrines. The findings in this study suggest that Black churches represent an important potential resource for HIV/AIDS prevention. For success, the initial strategy should involve the minister in the early planning stage. Future research should focus on expanding the scope of this study and improving communication between the church, community-based organizations, and health professionals.     

Children orphaned by HIV and AIDS in middle childhood in Potchefstroom,Northwest: The role of a social worker

ABSTRACT

The effects of HIV and AIDS have devastated families and communities in South Africa. The scourge has also left many children orphaned in the country. Given the vulnerability of orphaned children, social workers are in the forefront of ensuring that these children are cared for and protected from any harm. Hence, the purpose of this paper was to explore the role of a social worker in issues related to children orphaned by AIDS in their middle childhood. This study was situated within a qualitative research paradigm utilizing purposive, non-probability sampling of 10 participants recruited from Potchefstroom in the Northwest Province of South Africa. A semi-structured interview schedule was employed as a research tool, and in-depth one-on-one interviews were adopted as the method of data collection. A thematic content analysis was used to analyze the data collected during the interviews. The main findings point towards the need to educate children about HIV and AIDS and to empower their caregivers. The primary conclusion drawn from this study is that social workers play various key roles which contribute towards the well-being of orphaned children. Recommendations are posed in relation to social work service providers, government interventions, and future research.     

Social Security in Africa

Abstract

Africa is the poorest region of the world and has the youngest and least developed social security programs. Most Africans are not covered by social security programs. The high prevalence of HIV/AIDS in some sub-Saharan countries and internal armed conflicts in others have created difficult problems in some countries for social security programs. As a result, some countries do not have functioning social security programs. The social security programs that do exist in Africa are influenced by their colonial heritage, with the programs in English-speaking Africa differing from those in French-speaking Africa. Six different patterns of social security provision can be identified.     

HIV/AIDS Orphans' Education in Uganda

Abstract

The HIV/AIDS epidemic in most sub-Saharan African countries has created a crisis in the African family structure. In Uganda, older people's roles have been reversed from being provided for to providers. Older people, who are already poor, face the loss of economic support from their adult children and unexpected social, psychological and economic burden due to the care-giving role they assume. In this study, we used cross-sectional data from Kayunga district in Central Uganda to examine the impact of HIV/AIDS on the role of older persons. We found that there were HIV/AIDS related deaths in 82.3% of the surveyed households. In almost 34% of the households, the care-givers of HIV/AIDS orphans were older people over 50 years old. Almost all households headed by older people (97.8%) had on average three school-going orphaned children living in the household.     

Preventing HIV/AIDS Among Trinidad and Tobago Teens Using a Family-Based Program

Summary

This paper describes a family-based HIV/AIDS prevention project currently underway in Trinidad and Tobago—an English speaking twin-island nation in the Caribbean. The project involves a partnership between U.S.-based researchers and a social service agency on the Islands. It describes the development and adaptation of the intervention and reports preliminary outcomes from a pilot intervention (n= 32). Findings indicate high participant retention; statistically significant pre to posttest changes in HIV/AIDS knowledge and awareness; parent/youth discussions at home; condom self-efficacy; and parental monitoring. Findings are discussed within the context of collaborative HIV/AIDS prevention research.     

AIDS,travel and migration: legal and human rights aspects

This article discusses the legal and human rights aspects of AIDS, travel, and migration in Africa. Restrictions upon migration and travel in the context of HIV/AIDS have directed attention on the jeopardy of free international movement and the need to uphold it. International travel and migration have been blamed for introducing HIV and restrictions imposed to prevent the import of such disease. Contemporary legal and administrative barriers to free movement of people across national borders are similar to the physical barriers imposed to prevent the spread of diseases in past centuries. However, physical barriers failed to prevent the international spread of diseases and legal and administrative barriers have been proven ineffective. Meanwhile, responses to HIV/AIDS set patterns for other health-related issues and to affect the entire legal framework of international travel and migration. Based on previous studies, data on migratory flows and numbers of travelers and migrants are scarce in Africa. Migrants represent more or less 10% of the population of sub-Saharan Africa or 35 million persons, including some 60 million refugees.     

A Model Program for Increasing Treatment Access for African American Women Who Use Crack Cocaine and Are at Risk of Contracting HIV

ABSTRACT

In the United States, the threat of HIV/AIDS to African-American women's health has become the focus of much concern. This article describes a federally funded community-based program that provides services to African-American women at risk for HIV/AIDS in Nashville, TN. This program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important to the continued development of culturally relevant interventions that are vital to stemming the disproportionate rates of HIV/AIDS within the African-American community by ensuring treatment access to all populations.     

Intergenerational Impact of the AIDS Pandemic in Nigeria

ABSTRACT

This paper articulates and assesses the intergenerational impact of the AIDS pandemic in Nigeria based on literature reviews and mailed surveys. The findings reveal that, with the advent of colonialism in the 19th century, the wave of modernization, and the new idea of nuclear family system, intergenerational bonds and relationships were weakened to an extent. But the arrival of the AIDS epidemic in the 1980s and its steady increase worsened the situation. Intergenerational relationships have been affected to the extent that bonds between generations are collapsing. The AIDS pandemic creates social isolation and stigmatization of the infected and affected population. Since the middle generation is mostly infected, the older and younger generations who depend on them suffer most of the consequences. Some efforts have been made by the government and non-governmental organizations to address the increasing rate of infection. But little has been done to mitigate the impact of the pandemic especially on intergenerational relationships. As a possible solution, this paper suggests some intergenerational programming and policy approaches to address the problem, and achieve better intergenerational relationships in Nigeria at this time of crisis.     

Transferring a University-Led HIV/AIDS Prevention Initiative to a Community Agency

Summary

Given the urgent need for HIV/AIDS interventions that will reverse current infection trends among urban minority youth, identifying effective and socially relevant approaches is of primary concern. HIV/AIDS prevention initiatives that are housed in, and led by, communities may address the limits of laboratory-based inquiry for this complex and socially-situated health issue. In this article, we describe the process of moving a researcherled, HIV/AIDS prevention research program—the Collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP)—from a university laboratory to a community mental health agency with the goal of strengthening program access, effectiveness, and sustainability over time. We outline the framework, timeline, and responsibilities involved in moving the program, research, and technology from its original university base to a local community agency. From the challenges faced and lessons learned during this complex transfer process, we hope to enhance understanding of ways in which we can narrow the gap between academic and community leadership of HIV/AIDS prevention research.     

Female Tourists, Casual Sex, and HIV Risk in Costa Rica

This paper describes the involvement of young female tourists who visit rural Costa Rica with gringueros (i.e., local men who actively seek relationships with foreign women), and explores the implications of these relations, which gringueros see as outlets for sexual adventure, for sexual behaviors that could contribute to the spread of HIV/AIDS. The findings highlight the need to use tourism-related locales to implement HIV/AIDS awareness strategies targeted at women tourists, gringueros, and other local youth.

Chapter 12. Families Caring for Persons with HIV/AIDS

SUMMARY

The extent to which family members are willing and able to assist with daily activities and provide emotional support can greatly affect the quality of life for persons with chronic illness. In the case of HIV/AIDS, the burdens of symptom management and medication are amplified by social stigma. This chapter provides a summary of the physical, psychological, social, and spiritual issues associated with HIV/AIDS along with approaches to assessment and treatment.