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.     

Older people as resources in South Africa: Mpumalanga households

The extended family used to be relied upon to provide subsistence and care for older people in sub-Saharan Africa. However, recently South Africa has seen a reversal of roles, where older people now provide subsistence and care to younger generations; this role reversal is being accelerated by HIV/AIDS deaths among young adults. In most rural households, the non-contributory old age pension (OAP) that is means-tested is an important factor in making older people breadwinners. Using data from the 2004 Mpumalanga Older People's Survey, we examined the changing role of older people, which has been influenced mainly by changes in household structure and old age pension. Findings show that in 63% of matrifocal, multigenerational households, 76% of older people are the sole providers of household necessities, caring for the sick and grandchildren in increasingly skip-generation households.     

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 Networks,Migration, and Care in Tanzania

This paper explores the impacts of the HIV/AIDS epidemic on children and families in northern Tanzania using the concept of social resilience.1 1. This paper is based on a presentation entitled, “Social Networks, Migration and Care in Tanzania: Supporting Women, Children and Young People's Resilience,” prepared for the 2nd African Conference on the Social Aspects of HIV/AIDS Research, International Convention Centre, Cape Town, May 9–12, 2004, organized by the Human Sciences Research Council, South Africa (see: www.sahara.org.za). View all notes The study is based on the findings of child-focused research with street children and children and families from HIV/AIDS-affected households. The paper illustrates the coping strategies that children and young people, and parents and caregivers adopt at the household level. In particular, it examines how the burden of care affects different generations of women and highlights their resilience, together with the importance of social networks and the fluidity of movement between rural and urban areas. The research suggests that migrating to urban areas to seek a living in the informal sector represents a survival strategy adopted by some children and young people orphaned by AIDS when their families and communities are unable or unwilling to support them. The paper concludes by exploring parents’, caregivers’, children's, and young people's views on the forms of social support that would promote their resilience and thereby help to mitigate the impacts of the epidemic at the household level.     

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.     

Internet Use Among People with HIV/AIDS

ABSTRACT

The Internet offers people with HIV/AIDS timely information about treatment advances and supportive social contacts for this stigmatized disease, yet little is known about Internet use patterns among people with HIV/AIDS. This study of 120 persons with HIV/AIDS in the U.S. found approximately 19% used the Internet for HIV/AIDS-related purposes, much lower than the rate for general Internet use among the U.S. population. Lower incomes were associated with lower rates of use, echoing the “digital divide” found in the general population. Access from home was most common and information sought was primarily on medical treatments and medications. Possible reasons for low access rates, strategies for increasing access, and implications for other client groups are discussed.     

Strengthening the Capacity of Grandparents in Providing Care to Young Children Affected by HIV/AIDS

Abstract

Action for Children (AFC) is a non-governmental organization founded and registered with the government of Uganda in 1998 to rescue children from immediate danger and to advocate for their rights. AFC is working on a three-year pilot project entitled the Grandparents Action Support Project (GAS), designed and implemented to strengthen the capacity of grandparents providing care to HIV/AIDS orphans and vulnerable children under the age of eight, and to improve the overall welfare of the families taking care of these children. After only seven months, an interim program evaluation revealed that several effective innovative and pragmatic community-based strategies have been developed and implemented by participants. The Project has had a multiplier effect in participating communities in that ‘non-Project’ families are copying and learning from GAS Project homes. Challenges and future expansion of the Project are described.     

Keynote 3. Living in the Valley of Death

Abstract

In 2003 alone, HIV/AIDS killed more than three million people, of which between 2.2 and 2.4 million were from Sub-Saharan Africa. This disease is having a devastating effect on the previously firm foundations of intergenerational relationships in affected countries. For many nations in Africa, Asia and South America, life has become a mirage, a paradox in which almost everything is overshadowed by the pangs of death. Poverty, HIV/AIDS and, surprisingly, compassion are the combined common causes of death. Consequently, social, ecological, economic, political and educational systems are almost entirely dislocated. Traditions demand that the young ones should outlive their elders. So there is a deliberate effort on the part of the elderly to embrace death in attempting to be compassionate. This paper is an attempt to explore this scenario with the aim of articulating the linkage between poverty and HIV/AIDS, and proposing ways of reducing their impact through intergenerational programming.     

HIV/AIDS Projects with and for Gay Men in Northern Thailand

Abstract

In this paper I look at three HIV/AIDS projects which were run by and for gay men, transsexuals and men who have sex with men (MSM) in northern Thailand in the early 1990s. These three projects were very different in format and in context, ranging from a rural village AIDS association to an urban drag beauty contest. The projects were located in settings as different as gay bars and cruising areas, shopping malls and rural villages. Aspects of the three Thai projects have important implications for those working in HIV/AIDS prevention and in the care and support of people living with HIV/AIDS (PLWHAs) across cultures, particularly in relation to education, outreach and counselling programs.     

Family-Based HIV Preventive Intervention

Summary

Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youth's exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smith, & Henry, 2003). This often translates into three concrete programmatic features: (1) Contextual relevance; (2) Developmental-groundedness; and (3) Systemic Delivery. Because families are considered to be urban youth's best hope to grow up and survive multiple dangers in urban neighborhoods (Pequegnat& Szapocznik, 2000), centering prevention within families may ensure that youth receive ongoing support, education, and messages that can increase their capacity to negotiate peer situations involving sex. This paper will present preliminary data from an HIV/AIDS prevention program that is contextually relevant, developmentally grounded and systematically-delivered. The collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP) is aimed at decreasing HIV/AIDS risk exposure among a sample of African American youth living in a poverty-stricken, inner-city community in Chicago. This study describes results from this family-based HIV preventive intervention and involves 88 African American pre-adolescents and their primary caregivers. We present results for the intervention group at baseline and post intervention. We compare post test results to a community comparison group of youth. Suggestions for future research are provided.     

Determinants Influencing Male Condom use Among University Students in Portugal

ABSTRACT. A self-administered questionnaire was carried out among university students in Portugal, with the aim to examine determinants influencing male condom use, according to the information–motivation–behavioral skills model (J. Fisher & Fisher, 1992). Students’ levels of information, motivation, and behavioral skills regarding preventive sexual behavior (male condom use) were ascertained and were used to determine their association with condom use among 880 male and 1,807 female students aged 18 to 35 years old. Although 86.9% of respondents indicated that they used a condom during their first sexual intercourse, only 32.8% used a condom always during sexual intercourse in the last 12 months. Most young people, especially women, had a good level of information regarding HIV/AIDS transmission/prevention. They also showed reasonable positive attitudes and had positive subjective norms and intentions toward HIV/AIDS preventive behaviors. Men presented a higher perceived difficulty and a lower perceived effectiveness of HIV/AIDS preventive behavior, therefore reporting higher risk acceptance. A path analysis revealed that preventive sexual behavior did not depend directly on information level but on motivation and behavioral skills (especially among men). Information about HIV prevention/transmission was not significantly associated with condom use. The finding that motivation and behavioral skills were the strongest determinants of condom use suggested that these may be important factors in effective sexually transmitted infection-prevention programs.     

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.     

Kin and Youths in the Social Networks of Youth‐Headed Households in Namibia

In settings highly affected by HIV/AIDS, households headed by children may result from strained family relations, poverty, and stigma associated with the disease. Understanding local systems and dynamics of support is essential to planning comprehensive models of care. This study measured size and composition of the support and conflict networks of 27 children and youth heads of household in northern Namibia and documented their perceptions of adequacy. Results showed a strong presence of and satisfaction with kin and peers as supporters, which challenges the assumptions that these households have few functional ties to family and that adults are the sole providers of support. Assistance to children without parental supervision should build on existing local strategies and children's resources.     

Gendered Economic,Social, and Cultural Challenges to HIV/AIDS Prevention and Intervention for Chinese Women

ABSTRACT

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services for testing and treatment of HIV, and eradicate gender-based discrimination and violence. There is also an urgent need to further develop various public health infrastructure in China, especially in remote and rural areas. The pool of gender experts in China should also be expanded to conduct a thorough gender analysis and design a national response to address the evolving HIV/AIDS epidemic in Chinese women.     

Constructing an alternative family unit: families living with HIV/AIDS redefine African traditional parenting patterns

This article is based on a study, conducted at Inanda, of caregivers who mainly take care of children that are infected and/or affected by HIV/AIDS. ¹ 1. The discussion of this article emanates from a three‐year‐long study that focused on the after‐effects of HIV/AIDS. Six participants from 15 in‐depth interviews are used for the focus of the article. Based on recurring similar characteristics, the other nine participants were excluded. All the participants of the study were Zulu speakers, one of the main languages of the country. I use fictitious names to conceal their identities. It explores the reality and experiences of the family members. The focus of the article is based on data analysed following interviews with the caregivers. Family parenting experience portrays HIV/AIDS caregiving as an intense, emotional and powerful experience, filled with pride and hope as well as exclusion. Findings of the study reflect a change in the definition and practice of parenting. Another finding is that HIV/AIDS is forcing a redefinition of the concept and practice of parenting beyond the traditional boundaries of age, sex and gender. One of the main findings of the study was that the respondents' parenting practices and coping strategies are largely influenced by a strong commitment to the wellbeing of the children. The study found that, in relation to some community members, the respondents have a different parenting style. Their commitment depicts their self‐sacrifice, an indication of some continuity in what is expected of African parenting practice. The thesis of this article is that the HIV/AIDS context is principally responsible for a shift in the understanding of the concept and practice of parenting within an African context.     

Perspectives on disclosure among children living with HIV in India

BackgroundFollowing the widespread uptake of anti-retroviral therapy (ART), young children living with HIV are entering adolescence and beyond, necessitating disclosure of HIV status. However, few studies have described children's experiences following disclosure.MethodsWe assessed disclosure status among children attending HIV clinics at two tertiary-care centers in southern India. Children who had disclosure were administered a pre-tested questionnaire assessing their knowledge about HIV, ART, experiences following disclosure, perceived stigma and ideas about their future. The association of the children's responses with social desirability bias was examined using a modified social desirability scale.ResultsTwenty-four caregiver-child dyads participated in this study. They constituted a subset of children who had been told of their HIV diagnosis from a larger study of 247 dyads. Mean age at disclosure was 10.9 ± 2.5 years. Medical personnel were responsible for disclosure to 14 children, parents/caregivers to 3 children, both medical and care personnel together to 4 children and other relatives to remaining 3 children. Disclosure was met with acceptance by one-third of the children. Despite disclosure, five children did not know how HIV spreads, and three were unaware about how infection could be prevented. Notwithstanding their positive status, 20 children felt that they were treated well at school and by their immediate relatives, although 11 children mentioned that they needed to hide while taking ART. Social desirability bias did not play a role in the responses given by these children.ConclusionsThe rate of disclosure of HIV status among children living with HIV in India was low, even among older children. Most children accepted their status, but knowledge about HIV and ART was inadequate. Disclosure was predominantly performed by medical personnel, rather than the primary caregiver. Incorporating disclosure into the care process for older children is likely to be beneficial, and should be recognized as an iterative process with a need for incorporating cultural sensitivities and a comprehensive approach to health education.     

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.     

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.     

Everyday Conflict and Stress Among Older African American Women

Abstract

Older African American women are at high risk for morbidity due to anger suppression and stress. Yet sources of everyday stress and conflict in the lives of older African American women have not been documented. Such information is essential for developing health promotion programs. A focus group study was conducted with older African American women on everyday stress and conflict. Everyday stress stemmed from worries about functional disability and about accessing transportation. Everyday conflicts occurred with adult children, teen-aged grandchildren, and older neighbors or peers. Conflicts with adult children centered on how the adult child was raising his/her children. Conflicts with grandchildren centered on social respect. Conflicts with neighbors/peers centered on perceived rudeness or past transgressions. Participant strategies for dealing with stress and conflict tended to be avoidant. A training program in constructive conflict strategies for older African American women is presented that draws on information gained in the focus groups.