- Open Access
An introduction to family-centred services for children affected by HIV and AIDS
© Richter; licensee BioMed Central Ltd. 2010
- Published: 23 June 2010
Family-centred services in the context of HIV/AIDS acknowledge a broad view of a "family system" and ideally include comprehensive treatment and care, community agencies and coordinated case management. The importance of family-centred care for children affected by HIV/AIDS has been recognized for some time. There is a clear confluence of changing social realities and the needs of children in families affected by HIV and AIDS, but a change of paradigm in rendering services to children through families, in both high-prevalence and concentrated epidemic settings, has been slow to emerge.
Despite a wide variety of model approaches, interventions, whether medical or psychosocial, still tend to target individuals rather than families. It has become clear that an individualistic approach to children affected by HIV and AIDS leads to confusion and misdirection of the global, national and local response. The almost exclusive focus on orphans, defined initially as a child who had lost one or both parents to AIDS, has occluded appreciation of the broader impact on children exposed to risk in other ways and the impact of the epidemic on families, communities and services for children. In addition, it led to narrowly focused, small-scale social welfare and case management approaches with little impact on government action, global and national policy, integration with health and education interventions, and increased funding.
National social protection programmes that strengthen families are now established in several countries hard hit by AIDS, and large-scale pilots are underway in others. These efforts are supported by international and national development agencies, increasingly by governments and, more recently, by UNAIDS and the global AIDS community.
There is no doubt that this is the beginning of a road and that there is still a long way to go, including basic research on families, family interventions, and effectiveness and costs of family-centred approaches. It is also clear that many of the institutions that are intended to serve families sometimes fail and frequently even combat non-traditional families.
The idea that health and social services for children should be family centred is not new, but it has yet to take hold in the area of greatest need for millions of children worldwide - those affected by HIV and AIDS and related risk factors, whether these be poverty and migration or injecting drug use.
Family-centred services for children, rooted in the consumer-led movements of the 1960s, emerged towards the end of the twentieth century, initially in the fields of paediatric and geriatric care. For example, research on the adverse effects of separating young children from their caregivers led to policies that welcomed family members to be with their children during hospitalization and to participate in their children's care, especially if the clinical regime depended on continued active engagement of the family in the children's treatment and rehabilitation. As awareness of the embeddedness of the wellbeing of all individuals in social relationships and networks grew, family-centred services began to be accepted as a model for intervention .
Advocates of family-centred services for children point out that the family is the basic unit of care for children, with primary responsibility for the delivery of services to children and the greatest influence on a child's health and wellbeing prior to, during and subsequent to interventions by health and social welfare professionals. These convictions have driven fundamental changes in health legislation and practice in both the United States and elsewhere, according rights to families to be fully involved in the health and wellbeing of children [1, 2].
Families are constant in the lives of children (and adults) while interventions through programmes and services are intermittent and generally short lived.
Families must be variously and inclusively defined.
Family-centred approaches are comprehensive and integrated.
Love and care within families, when recognized and reinforced, promote improved coping and wellness among children and adults.
Initial resistance by health professionals to the involvement of families in treatment were countered by evidence that revealed few, if any, ill effects of involving families, even in intensive care environments , as well as the many benefits of family participation. These include support for improved adherence, sensitive monitoring of changes in patient state, and extension of treatment and other services beyond the health facility [1, 5].
Extensive experience of family-centred services has been gained, amongst others, in the care of children with chronic conditions , disabilities , child welfare , neonatology , and early interventions to promote the development of young children at risk .
The importance of family-centred care for children affected by HIV/AIDS has long been recognized in the United States [1, 11–15]. Twenty years ago, Carol Levine observed, "AIDS threatens the intimacy and acceptance that ideally undergird family relationships, while at the same time making them all the more powerful and necessary" . Family-centred services in the context of HIV/AIDS acknowledge a broad view of a "family system" and ideally include comprehensive medical treatment, community agencies and coordinated case management .
Levine  speaks of family members as "individuals who by birth, adoption, marriage, or declared commitment share deep, personal connections and are mutually entitled to receive and obligated to provide support of various kinds to the extent possible, especially in times of need". The Task Force on AIDS and the Family concluded, "Families should be broadly defined to include, besides the traditional biological relationships, those committed relationships between individuals which fulfil the function of family" . And, in 1994, the Global Programme on AIDS marked World AIDS Day under the banner, "AIDS and the Family".
The World AIDS Day Newsletter  pointed out that "any group of people linked by feelings of trust, mutual support and common destiny may be seen as a family. The concept need not be limited to ties of blood, marriage, sexual partnership or adoption. In this light, religious congregations, workers' associations, support groups of people with HIV/AIDS, gangs of street children, circles of drug injectors, collectives of sex workers ... may all be regarded as families".
Such definitions both respect traditional notions of family, as well as recognizing non-traditional forms of commitment arising from changes in reproductive biology, laws governing interpersonal obligations, acceptance of same-sex relationships, and deep association based on shared experience. In this sense, AIDS is a catalyst in expanding definitions of "family" to reflect the reality of contemporary life. More and more people live in non-traditional families, or "families of choice" , made up of some traditional family members, partners and friends .
There is a clear confluence of changing social realities and the needs of children in families affected by HIV and AIDS, but a change of paradigm in rendering services to children through families, in both high-prevalence and concentrated epidemic settings, has been slow to emerge. Rotheram et al  argue that the history of HIV, particularly in the United States, led to an individualistic focus that is proving hard to shift . Despite a wide variety of model approaches, interventions, whether medical or psychosocial, tend to target individuals, not families [23–25].
Yet, when an individual is affected by HIV/AIDS, their family is inevitably affected [26, 27]. Risk for infection is shared, as is apprehension about disclosure, stigmatization, ill-health and suffering, the costs and burdens of treatment, loss of income, and need for care and support. AIDS throws families into crisis, causing anxiety and stress wherever it occurs [28, 29]. The full impact of HIV and AIDS, including its social and economic effects, is only appreciated when the family, and not only the individual, is the unit of analysis .
Early into the new millennium, it became clear that an individualistic approach to children affected by HIV and AIDS was leading to confusion, and misdirecting, rather than amplifying, the global, national and local response . There was an almost exclusive focus on orphans, defined initially as a child who had lost one or both parents to AIDS, to draw attention to the large number of children being made vulnerable by AIDS . But this definition, with its focus on parental death, occluded appreciation of the broader impact on children exposed to risk in other ways and the impact of the epidemic on families, communities and services for children . In addition, it led to narrowly focused, small-scale social welfare and case management approaches with little impact on government action, global and national policy, integration with health and education interventions, and increased funding.
It was under these conditions that the Joint Learning Initiative on Children and AIDS (JLICA) was launched in 2006. The JLICA was modelled on the Joint Learning Initiative on Human Resources for Health , as an independent, collaborative, cross-sectoral and multidisciplinary initiative with a finite goal . The aim of the JLICA was to gather evidence, including about best practices, stimulate innovative thinking, and facilitate communication across disciplines and stakeholders in order to generate a set of high-level recommendations for the global community, governments, and international and local organizations. JLICA organized its work under four learning groups directed at topics suggested by the widely endorsed Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS : Strengthening Families; Community Action; Expanding Services and Protecting Human Rights; and Social and Economic Policies.
Spanning two years, the learning groups worked in a wide variety of ways, including by commissioning papers and through meetings, live and electronic debates, and a learning collaborative. The JLICA's final report was hailed as setting a new agenda for children , calling attention to the importance of families and family strengthening through family-centred services, economic assistance and social protection, and community support. Apart from reports generated by JLICA http://www.jlica.org, these arguments are set out in detail in Richter , Richter and Sherr , and Richter et al .
The death of a parent is an unspeakable loss for any child, an experience exacerbated by illness and suffering, potential loss of economic support, dislocation and separation from siblings. Adult deaths from AIDS continue to increase in the absence of antiretroviral treatment. But to focus only on orphans is to miss the bigger picture: 88% of so-called "orphaned" children have a surviving parent , and more than 90% of "orphans" live with close family [41, 42]. Families were the first to respond to children affected by AIDS, both in the USA and in southern Africa [43, 44], and have continued to be the vanguard of care and support for affected children.
Despite this, pitifully few resources and services are directed at bolstering and protecting this front line. Fewer than 15% of families caring for orphans and vulnerable children in 2007 were estimated to have received any assistance from external agencies . It has taken equally long to recognize the role that communities play and the importance of strengthening these systems of care .
Surviving parents and families who take in children of relatives experience the stresses of increased dependency and, across the world, become poorer [47, 48]. The death of working-age adults means the loss of jobs, livelihoods and skills, and additional care exacts heavy costs. The poorest families respond by cutting consumption: eating less and spending less on education and healthcare for other members of the family. All this critically affects the wellbeing of children [41, 49].
The assumption that families are collapsing has led to a burgeoning of orphanages and other forms of institutional care drawing resources, even those intended to assist children affected by AIDS, away from families into expensive alternatives with known adverse effects on children's health and development . While there is no question that families are under considerable strain, families are intimate social networks evolved for human care. As such, they continue to form, adapt and reconfigure, both throughout the family lifecycle and in response to external stressors [51, 52]. Belsey  attests that it is the loss of family capital, in terms of resources, networks and reserves, that mediates the impact of HIV and AIDS on children and on the wider society. By his estimates, close to 60% of families in high-prevalence environments are directly affected by AIDS.
At its heart, AIDS can be thought of as a family disease. In high-prevalence environments, transmission occurs mainly in the family, between parents and children  and between partners and spouses . Families are also on the front line of prevention , providing education and reinforcing risk reduction, especially among young people .
Levine  argues that the impact of AIDS on families, and the potential of families to be at the forefront of prevention, treatment and care, has not been fully appreciated, partly because people in high-risk groups, such as men who have sex with men, injecting drug users, sex workers, migrants and refugees, are inaccurately assumed to be isolated from family life. In concentrated epidemics, transmission from men who have sex with men (MSM), injecting drug users (IDUs) and sex workers spreads into families through concurrent heterosexual sex and sex with regular partners and spouses, and vertical transmission .
Among these extremely marginalized groups, families are also inevitably affected, whether in their roles as parents, spouses, partners, siblings, children or intimate others . Despite the lack of attention to family factors in these populations, many MSM and IDUs are married , and most female sex workers have children and regular partners, in addition to clients. Families of these groups have been identified to be important for, among other things, prevention [60, 61], disclosure [62, 63], support , and treatment adherence .
The JLICA made strong recommendations regarding strengthening families through social protection and income transfers, on the one hand, and family strengthening through family-centred services on the other.
Social protection for families affected by HIV/AIDS is part of a groundswell of provision and demand for increased protection against destitution and improved social security, including for the poorest families in the poorest parts of the world [38, 39, 49, 66]. National programmes are established in several countries hard hit by AIDS, including South Africa, Botswana, Mozambique, Namibia and Lesotho, and large-scale pilots are underway in, among others, Malawi, Zambia and Kenya. These efforts are supported by international and national development agencies, increasingly by governments  and, more recently, by UNAIDS and the global AIDS community .
The second prong of the response - family strengthening through family-centred services for children affected by HIV and AIDS - has yet to receive similar levels of endorsement and commitment. In response, the Coalition on Children Affected by AIDS (see http://www.ccaba.org), a network of child-focused foundations advised by researchers and advocates, started The Road to Vienna, an initiative to explore the nature of family-centred services, evidence for their feasibility and effectiveness, barriers to their expansion, and their relevance to especially marginalized populations. The initiative began with a meeting in Nairobi in late September 2009, piggy backed onto the first African Conference on "Promoting Family-Based Care for Children in Africa", organized by the African Network for the Prevention and Protection against Child Abuse and Neglect and its partners. Ten presentations were made on various aspects of familycentred services, including applications to prevention of mother to child transmission, antiretroviral (ARV) treatment for children, early child development services, and depression; five of these presentations appear as papers in this special issue (Bentancourt et al, Leeper et al, Bhana et al, Tomlinson, and Hosegood and Madhavan).
A second meeting was convened in Geneva in February 2010, in partnership with the International AIDS Society, to consider family-centred services for children and families of people in especially marginalized groups (MSM, IDUs, sex workers, and people currently or recently incarcerated). Seven presentations were made, together with a panel discussion, with strong participation from people representing affected groups. Three of these presentations appear as papers in this special issue (Beard et al, Solomon et al, and Sherr). What became clear from this meeting is the almost complete lack of research in this area, and a strong desire by people in marginalized groups to receive services to support their families and legal reform to help them to be good parents.
The rationale and available evidence for family-centred services for children affected by AIDS has not been brought together before. While there are very few clinical trials on family-centred services, DeGennaro and Weitz  make the point that individual components of family-centred services have been shown to be effective. These include home-based models of HIV voluntary counselling and testing , risk reduction following couple's counselling and testing , response to ARV treatment and adherence [71, 72], prevention of mother to child transmission (PMTCT) , and child nutrition and education benefits of adult ARV programmes .
There are also clear costs for not adopting familycentred approaches to children affected by HIV and AIDS. These are especially evident in PMTCT programmes. For example, partner participation in programmes has been found to be associated with higher acceptance of post-test counselling, increased couple communication about HIV prevention, and increased use of ARVs . Narrow pharmacological approaches are a lost opportunity for PMTCT to be the gateway to family-based prevention, care and treatment .
A piecemeal approach, tackling only one aspect of a complex multifaceted problem, also has the disadvantage that early successes may be reversed because later stage factors were not considered . For example, eliminating HIV transmission to children is critical, but it does not eliminate risks to the mortality, morbidity and developmental progress of exposed but uninfected children [77, 78].
There are many different kinds of families, facing different kinds of challenges, and they will require different kinds of support. For example, Levine points out, "Because non-traditional families are more commonly socially and psychologically similar to the patient, having been deliberately formed around shared interests, they may be better equipped to respond to external pressures such as stigma, but not to the dependency and level of care occasioned by illness" . But what seems unquestionable is that a family lens would significantly move forward our ability to understand contextual influences on HIV and AIDS prevention, treatment and care to ensure access by more people to services with better outcomes, and balance available resources across services, families and communities to achieve comprehensive and integrated care.
There is no doubt that this is the beginning of a road and that there is much to be done, including basic research on families, family interventions, and effectiveness and costs of family-centred approaches. It is also clear that many of the institutions that are intended to serve families (law, health care, social security and welfare, housing, work) sometimes fail and, importantly, frequently even combat non-traditional families. The latter may, at worst, be prosecuted for their lifestyle and lose custody of their children and, at least, be excluded from decisions about treatment, and be excluded from insurance benefits and/or home tenancy when a partner dies.
LMR co-chaired Learning Group 1: Strengthening Families in the Joint Learning Initiative on Children and AIDS (JLICA) and is a member on the Committee of the Coalition on Children Affected by AIDS (CCABA). Executive Director, Child, Youth, Family and Social Development, Human Sciences Research Council, South Africa; Honorary Professor, Department of Psychology, University of KwaZulu-Natal, South Africa; Honorary Professor, Department of Paediatrics and Child Health, University of Witwatersrand, South Africa; Honorary Research Associate, University of Oxford, United Kingdom; Visiting Scholar, Harvard, University, United States.
The author would like to thank Julia de Kadt for assistance with checking and formatting references.
This article has been published as part of Journal of the International AIDS Society Volume 13 Supplement 2, 2010: Family-centred services for children affected by HIV and AIDS. The full contents of the supplement are available online at http://www.jiasociety.org/supplements/13/S2
- Johnson B: Family-centered care: Four decades of progress. Families, Systems and Health. 2000, 18: 137-156. 10.1037/h0091843.View ArticleGoogle Scholar
- Brewer E, McPherson M, Magrab P, Hutchins P: Family-centered, community based, coordinated care for children with special health care needs. Pediatrics. 1989, 83: 1055-1060.PubMedGoogle Scholar
- Shelton T: Family-centered care for children with special health-care needs. 1987, Washington DC, Association for the Care of Children's HealthGoogle Scholar
- Lee M, Friedenberg A, Mukpo D, Conray K, Palmisciano A, Levy M: Visiting hours policies in New England intensive care units: Strategies for improvement. Critical Care Medicine. 2007, 35: 497-501. 10.1097/01.CCM.0000254338.87182.AC.View ArticlePubMedGoogle Scholar
- Dunst C, Trivette C: Meta-Analytic Structural Equation Modeling of the Influences of Family-Centered Care on Parent and Child Psychological Health. International Journal of Pediatrics. 2009, 2009: 1-9. 10.1155/2009/576840.View ArticleGoogle Scholar
- Stone B, Murphy N, Mundorff M, Parker H, Peterson P, Srivastava R: Children with chronic complex medical illnesses: Is inpatient care family-centered?. Journal of Pediatric Rehabilitation Medicine. 2008, 1: 237-243.PubMed CentralPubMedGoogle Scholar
- Mahoney G, O'Sullivan P: Early intervention practices with families of children with handicaps. Mental Retardation. 1990, 28: 169-176.PubMedGoogle Scholar
- Frankel H: Family-centered, home-based services in child protection: A review of the research. Social Services Review. 1988, 62: 137-157. 10.1086/603665.View ArticleGoogle Scholar
- Als H, Gilkerson L: The role of relationship-based developmentally supportive newborn intensive care in strengthening outcomes of preterm children. Seminars in Perinatology. 1997, 21: 178-189. 10.1016/S0146-0005(97)80062-6.View ArticlePubMedGoogle Scholar
- Gonzalez-Mena J: Child, family and community: Family-centered early child care and education. 2008, New York: Prentice HallGoogle Scholar
- Anderson E: Implications for public policy: Towards a pro-family AIDS social policy. Marriage and Family Review. 1989, 13: 187-228. 10.1300/J002v13n01_06.View ArticleGoogle Scholar
- Brown L, Lourie K: Children and adolescents living with HIV and AIDS: A review. Journal of Child Psychology and Psychiatry. 2000, 41: 81-96. 10.1017/S0021963099004977.View ArticlePubMedGoogle Scholar
- Mellins C, Erhardt A: Families affected by pediatric AIDS: Sources of stress and coping. Developmental and Behavioral Pediatrics. 1994, 15: S54-S60. 10.1097/00004703-199406001-00010.View ArticleGoogle Scholar
- Pequegnat W, Sazapocnik J: Working with families in the era of HIV/AIDS. 2000, Thousand Oaks, CA: Sage PublicationsGoogle Scholar
- Rotheram-Borus MJ, Flannery D, Rice E, Lester P: Families living with HIV. AIDS Care. 2005, 17: 978-987. 10.1080/09540120500101690.View ArticlePubMedGoogle Scholar
- Levine C: AIDS and changing concepts of family. The Milbank Quarterly. 1990, 68: 33-58. 10.2307/3350175.View ArticlePubMedGoogle Scholar
- Boland M, Czarniecki L, Haiken H: Coordinated care for children with HIV infection. Children and AIDS: Clinical practice No. 19. Edited by: Struber M. 1992, Washington DC: American Psychiatric Press, 165-181.Google Scholar
- Anderson E: AIDS public policy: Implications for families. New England Journal of Public Policy. 1988, 4: 411-427.PubMedGoogle Scholar
- Global Program on AIDS WHO: World AIDS Day Newsletter. 1994, Geneva, World Health OrganizationGoogle Scholar
- Nord D: The impact of multiple AIDS-related loss on families of origin and families of choice. American Journal of Family Therapy. 1996, 24: 129-144. 10.1080/01926189608251026.View ArticleGoogle Scholar
- Bor R, du Plessis P: The impact of HIV/AIDS on families: An overview of recent research. Families, Systems and Health. 1997, 15: 413-427. 10.1037/h0089837.View ArticleGoogle Scholar
- Bor R, Miller R, Goldman E: HIV/AIDS and the family: A review of research in the first decade. Journal of Family Therapy. 1993, 15: 187-204. 10.1111/j.1467-6427.1993.00753.x.View ArticleGoogle Scholar
- Families living with drugs and HIV: Intervention and treatment strategies. 1993, New York: Guilford PressGoogle Scholar
- Boyd-Franklin N: Children, families and HIV/AIDS: Psychosocial and therapeutic issues. 1995, New York: Guilford PressGoogle Scholar
- Fullilove RE, Green L, Fullilove M: The Family to Family program: A structural intervention with implications for the prevention of HIV/AIDS and other community epidemics. AIDS. 2000, 14: S63-S67. 10.1097/00002030-200006001-00010.View ArticlePubMedGoogle Scholar
- Shang X: Supporting HIV/AIDS affected families and children: The case of four Chinese counties. International Jounral of Social Welfare. 2009, 18: 202-212. 10.1111/j.1468-2397.2008.00595.x.View ArticleGoogle Scholar
- Schuster MA, Kanouse DE, Morton SC, Bozzette SA, Miu A, Scott GB, Shapiro MF: HIV-infected parents and their children in the United States. American Journal of Public Health. 2000, 90: 1074-1081. 10.2105/AJPH.90.7.1074.PubMed CentralView ArticlePubMedGoogle Scholar
- Li L, Wu Z, Wu S, Jia M, Lieber E, Lu Y: Impacts of HIV/AIDS stigma on family identity and interactions in China. Families, Systems and Health. 2008, 26: 431-442. 10.1037/1091-75184.108.40.2061.PubMed CentralView ArticlePubMedGoogle Scholar
- Williams R, Stafford W: Silent casualties: Partners, families and spouses of persons with AIDS. Journal of Counselling and Development. 1991, 69: 423-427.View ArticleGoogle Scholar
- Bonuck K: AIDS and families: Cultural, social and functional impacts. Social Work in Health Care. 1993, 19: 75-89. 10.1300/J010v18n02_05.View ArticleGoogle Scholar
- Richter L, Foster G, Sherr L: Where the heart is: Meeting the psychosocial needs of young children in the context of HIV/AIDS. 2006, The HagueGoogle Scholar
- Hunter S: Orphans as a window on the AIDS epidemic in sub-Saharan Africa: Initial results and implications of a study in Uganda. Social Science and Medicine. 1990, 31: 681-690. 10.1016/0277-9536(90)90250-V.View ArticlePubMedGoogle Scholar
- Foster G, Levine C, Williamson J: A generation at risk: The global impact of HIV/AIDS on orphans and vulnerable children. 2005, New York: Cambridge University PressView ArticleGoogle Scholar
- Joint Learning Initiative: Human resources for health: Overcoming the crisis. Cambridge, MA. 2004Google Scholar
- Bell P, Bingwayo A: The Joint Learning Initiative on Children and AIDS. The Lancet. 2006, 368: 1850-1851. 10.1016/S0140-6736(06)69753-5.View ArticleGoogle Scholar
- UNICEF: The framework for the protection, care and support of orphans and vulnerable children living in a world with HIV and AIDS. New York. 2004Google Scholar
- The Lancet editorial: A new agenda for children affected by HIV/AIDS. The Lancet. 2009, 373: 517-10.1016/S0140-6736(09)60174-4.View ArticleGoogle Scholar
- Richter L: No small issue: Children and families. Universal Action Now. Plenary Presentation at the XVIIth International AIDS Conference, "Universal Action Now", Mexico City, 6 August 2008. 2008, The Hague, NetherlandsGoogle Scholar
- Richter L, Sherr L: Strengthening families: a key recommendation of the Joint Learning Initiative on Children and AIDS (JLICA). AIDS Care. 2009, 21: 1-2. 10.1080/09540120903131138.PubMed CentralView ArticlePubMedGoogle Scholar
- Richter L, Sherr L, Adato M, Belsey M, Chandan U, Desmond C, Drimie S, Haour-Knipe M, Hosegood V, Kimou J, et al: Strengthening families to support children affected by HIV and AIDS. AIDS Care. 2009, 21: 3-12. 10.1080/09540120902923121.PubMed CentralView ArticlePubMedGoogle Scholar
- Heymann J, Earle A, Rajaraman D, Miller C, Bogen K: Extended family caring for children orphaned by AIDS: Balancing essential work and caregiving in a high HIV prevalence nations. AIDS Care. 2007, 19: 337-345. 10.1080/09540120600763225.View ArticlePubMedGoogle Scholar
- Phiri S, Tolfree D: Family and community-based care for children affected by HIV/AIDS: Strengthening the frontline response. A generation at risk: The global impact of HIV/AIDS on orphans and vulnerable children. Edited by: Foster G, Levine C, Williamson J. 2005, New York: Cambridge University Press, 11-36.View ArticleGoogle Scholar
- Frierson RL, Lippmann SB, Johnson J: AIDS: Psychological stresses on the family. Psychosomatics. 1987, 28: 65-68.View ArticlePubMedGoogle Scholar
- Beer C, Rose A, Tout K: AIDS: The grandmothers' burden. The global impact of AIDS. Edited by: Fleming AF, Carballo M, FitzSimons DW, Bailey MR, Mann J. 1988, New York: Liss Inc, 171-174.Google Scholar
- United Nations Secretary General: Declaration of commitment on HIV/AIDS. Five Years Later. New York. 2006Google Scholar
- Foster G: Supporting community efforts to assist orphans in Africa. New England Journal of Medicine. 2002, 346: 1907-1910. 10.1056/NEJMsb020718.View ArticlePubMedGoogle Scholar
- Whiteside A: Poverty and HIV/AIDS in Africa. Third World Quarterly. 2002, 23: 313-332. 10.1080/01436590220126667.View ArticleGoogle Scholar
- Franco L, Burkhalter B, de Wagt A, Jennings L, Gamble A, Hammink ME: Evidence base for children affected by HIV and AIDS in low prevalence and concentrated epidemic countries: Applicability to programming guidance from high prevalence countries. AIDS Care. 2009, 21: 59-10.1080/09540120902923089.View ArticleGoogle Scholar
- Adato M, Bassett L: Social protection to support vulnerable children and families: The potential of cash transfers to protect education, health and nutrition. AIDS Care. 2009, 21: 60-75. 10.1080/09540120903112351.PubMed CentralView ArticlePubMedGoogle Scholar
- Nelson C: A neurobiological perspective on early human deprivation. Child Development Perspectives. 2007, 1: 13-18. 10.1111/j.1750-8606.2007.00004.x.View ArticleGoogle Scholar
- Mathambo V, Gibbs A: Extended family childcare arrangements in a context of AIDS: Collapse or adaptation?. AIDS Care. 2009, 21: 22-27. 10.1080/09540120902942949.PubMed CentralView ArticlePubMedGoogle Scholar
- Hosegood V: The demographic impact of HIV and AIDS across the family and household life cycle: Implications for efforts to strengthen families in sub-Saharan Africa. AIDS Care. 2009, 21: 13-21. 10.1080/09540120902923063.PubMed CentralView ArticlePubMedGoogle Scholar
- Belsey M: AIDS and the family: policy options for a crisis in family capital. New York. 2005Google Scholar
- de Cock KM, Fowler MG, Mercier E, de Vincenzi I, Saba J, Hoff E, Alnwick DJ, Rogers M, Shaffer N: Prevention of mother-to-child transmission in resource-poor countries. Journal of the American Medical Association. 2000, 283: 1175-1182. 10.1001/jama.283.9.1175.View ArticlePubMedGoogle Scholar
- Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, Greenberg L, Allen S: New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data. The Lancet. 2008, 371: 2183-2191. 10.1016/S0140-6736(08)60953-8.View ArticleGoogle Scholar
- Murphy D, Marelich W, Herbeck D, Payne D: Family routines and parental monitoring as protective factors among early and middle adolescents affected by maternal HIV/AIDS. Child Development. 2009, 80: 1676-1691. 10.1111/j.1467-8624.2009.01361.x.PubMed CentralView ArticlePubMedGoogle Scholar
- Harawa N, Williams J, Ramamurthi H, Bingham T: Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: Implications for heterosexual transmission. Journal of Urban Health. 2006, 83: 682-694. 10.1007/s11524-006-9067-0.PubMed CentralView ArticlePubMedGoogle Scholar
- Pivnick A, Jacobson A, Erik K, Doll L, Drucker E: AIDS, HIV infection, and illicit drug use with inner-city families and social networks. American Journal of Public Health. 1994, 84: 271-274. 10.2105/AJPH.84.2.271.PubMed CentralView ArticlePubMedGoogle Scholar
- Go VF, Srikrishnan AK, Sivaram S, Murugavel GK, Galai N, Johnson SC, Sripaipan T, Solomon S, Celentano DD: High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India. Journal of Acquired Immune Deficiency Syndromes. 2004, 35: 314-319. 10.1097/00126334-200403010-00014.View ArticlePubMedGoogle Scholar
- Garofalo R, Mustanski B, Donenberg G: Parents know and parents matter: Is it time to develop family-based HIV prevention programs for young men who have sex with men?. Journal of Adolescent Health. 2008, 43: 201-204. 10.1016/j.jadohealth.2008.01.017.PubMed CentralView ArticlePubMedGoogle Scholar
- Panchanadeswaran S, Johnson SC, Sivaram S, Srikrishnan AK, Latkin C, Bentley ME, Solomon S, Go VF, Celentano D: Intimate partner violence is as important as client violence in increasing street-based female sex workers' vulnerability to HIV in India. International Journal of Drug Policy. 2008, 19: 106-112. 10.1016/j.drugpo.2007.11.013.PubMed CentralView ArticlePubMedGoogle Scholar
- Ko NY, Lee HC, Hsu ST, Wang WL, Huang MC, Ko WC: Differences in HIV disclosure by modes of transmission in Taiwanese families. AIDS Care. 2007, 19: 791-798. 10.1080/09540120601095718.View ArticlePubMedGoogle Scholar
- Serovich JM, Esbensen AJ, Mason TL: HIV disclosure by men who have sex with men to immediate family over time. AIDS Patient Care And Stds. 2005, 19: 506-517. 10.1089/apc.2005.19.506.PubMed CentralView ArticlePubMedGoogle Scholar
- Johnston D, Stall R, Smith K: Reliance by gay men and intravenous drug users on friends and family for AIDS-related care. AIDS Care. 1995, 7: 307-319. 10.1080/09540129550126533.View ArticlePubMedGoogle Scholar
- Knowlton AR, Arnsten JH, Gourevitch MN, Eldred L, Wilkinson JD, Rose CD, Buchanan A, Purcell DW: Microsocial environmental influences on highly active antiretroviral therapy outcomes among active injection drug users: The role of informal caregiving and household factors. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2007, 46: S110-S119. 10.1097/QAI.0b013e31815767f8.View ArticlePubMedGoogle Scholar
- Richter L: Social cash transfers, socioeconomic development and human rights. Vulnerable Children and Youth Studies.Google Scholar
- UNAIDS: Joint action for results: UNAIDS outcome framework 2009-2011. Geneva. 2009Google Scholar
- DeGennaro V, Zeitz P: Embracing a family-centred response to the HIV/AIDS epidemic for the elimination of pediatric. Global Public Health. 2009, 4: 386-401. 10.1080/17441690802638725.View ArticlePubMedGoogle Scholar
- Were W, Mermin J, Bunnell R, Ekwaru JP, Kaharuza F: Home-based model for HIV voluntary counseling and testing. The Lancet. 2003, 361: 1569-10.1016/S0140-6736(03)13212-6.View ArticleGoogle Scholar
- Roth D, Stewart K, Clay O, van der Straten A, Karita E, Allen S: Sexual practices of HIV discordant and concordant couples in Rwanda: Effects of a testing and counseling programme for men. International Journal of STD and AIDS. 2001, 12: 181-188. 10.1258/0956462011916992.View ArticlePubMedGoogle Scholar
- Marseille E, Kahn JG, Pitter C, Bunnell R, Epalatai W, Jawe E, Were W, Mermin J: The cost effectiveness of home-based provision of antiretroviral therapy in rural Uganda. Applied Health Economics and Health Policy. 2009, 7: 229-243.PubMed CentralView ArticlePubMedGoogle Scholar
- Mermin J, Were W, Ekwaru JP, Moore D, Downing R, Behumbiize P, Lule JR, Coutinho A, Tappero J, Bunnell R: Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study. The Lancet. 2008, 371: 752-759. 10.1016/S0140-6736(08)60345-1.View ArticleGoogle Scholar
- Abrams E, Myer L, Rosenfield A, El-Sadr W: Prevention of mother-to-child transmission services as a gateway to family-based human immunodeficiency virus care and treatment in resource-limited settings: Rationale and international experiences. American Journal of Obstetrics and Gynecology. 2007, 197: S101-S106. 10.1016/j.ajog.2007.03.068.View ArticlePubMedGoogle Scholar
- Zivin J, Thirumurthy H, Goldstein M: AIDS treatment and intrahousehold resource allocation: Children's nutrition and schooling in Kenya. Journal of Public Economics. 2009, 93: 1008-1015. 10.1016/j.jpubeco.2009.03.003.PubMed CentralView ArticlePubMedGoogle Scholar
- Desgrees-Du-Lou A, Brou H, Djohan G, Becquet R, Ekouevi D, Zanou B, Viho I, Allou G, Dabis F, Leroy V, et al: Beneficial Effects of Offering Prenatal HIV Counselling and Testing on Developing a HIV Preventive Attitude among Couples. Abidjan, 2002-2005. AIDS and Behavior. 2009, 13: 348-355. 10.1007/s10461-007-9316-6.View ArticlePubMedGoogle Scholar
- Claeson M, Waldman R: The evolution of child health programmes in developing countries: From targeting diseases to targeting people. Bulletin of the World Health Organization. 2000, 78: 1234-1245.PubMed CentralPubMedGoogle Scholar
- Filtreau S: The HIV-exposed, uninfected African child. Tropical Medicine & International Health. 2009, 14: 276-287. 10.1111/j.1365-3156.2009.02220.x.View ArticleGoogle Scholar
- Isanaka S, Duggan C, Fawzi WW: Patterns of postnatal growth in HIV-infected and HIV-exposed children. Nutrition. 2009, 67: 343-359.Google Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.