A review of research literature

Existing studies

Existing studies on the impact of AIDS on households and children are of various types: demographic studies, epidemiological cohort studies, national survey analyses, census reports, etc. The principal studies including their contribution and limitations are shown in the following table.

Table 2 : Existing studies and surveys on children and families affected by HIV/AIDS carried out in sub-Saharan Africa.

(Source : Birdthistle, 2004 )

Refining research

As the family and the community constitute the first protective safety net for children, research studies must contribute more to the understanding of these networks and of these protective support mechanisms for children affected by HIV/AIDS.
On the contrary, according to Barnett and Whiteside, taking into account the impact of HIV/AIDS on households and communities is difficult for the following reasons:

• “Households are not homogeneous between cultures or even within them.
• Households change their size and constitution over time, in particular through processes of natural growth, decay, and dissolution.
• It is difficult to gain information concerning the internal distributional dynamics of households and thus to discern the gender-specific impact at this level.
• The impact of excess mortality and morbidity on households may be difficult to track as households are a dynamic entity (they can join or split, etc.) and geographically mobile” Barnett and Whiteside, 2001.

Despite these difficulties, studies at the household and community level are useful to carry out. According to Barnett and Whiteside:”Tracking AIDS-affected households will require a large sample over a relatively long period of time. Nonetheless, an important problem that should be borne in mind when considering such studies is that the earliest and most seriously affected households will disappear first—probably before the survey has been commissioned, let alone executed. Any survey of this type should be carefully designed to pick up traces of survivors or to pick up memories of households that have disappeared from communities or kinship networks. A study of the impact of HIV/AIDS at the household and community level is a study in its own right, and very few have been undertaken“ Barnett and Whiteside, 2001.
For further research, the following points must be taken into account:

Household or family: two different concepts

Most studies more frequently use the household concept than the family one. Unlike the family concept where kinship is essential, the household concept refers to the residential unit. It is made up of a group of kin or non-kin who acknowledge the authority of a single person (household head) and who are attached to a same residential unit Vanderwalle, 2001.

The concept of household was created to have an operational counting unit in order to count individuals just one time during a demographic data collection such as census or surveys, which are fundamentally opposed to family studies. However, according to H.Vandewalle, the initial purpose of this concept leads us to doubt of its validity regarding the understanding of the complexity of family structures and of family change. Thus, these concepts must be refined and attention must be paid regarding their use and the consequences on study results Vanderwalle, 2001.

Measure the impact of AIDS on communities:

No study was found that measured the impact of AIDS on communities. How can we assess the impact of the growing number of orphans on whole communities beyond the household and individual level? In what way can we assess community capacity to cope with the orphan crisis? Birdthistle, 2004

Further understanding of the adaptation and survival strategies of vulnerable children:

In order further understand coping and support strategies, researchers must reach and identify the most vulnerable by:

• Following interviewees who have migrated out of original study areas, because affected children are more likely than others to migrate in relation with the support mechanisms within the extended family.
• Tracking members of “dissolved and reconstructed“households. In fact, households affected by HIV/AIDS are more likely to dissolve than other households.
• Creating large and more representative samples composed of youths living in institutions or on the street, and of adolescent-headed-households to highlight the proportion of orphans and vulnerable children affected by AIDS Birdthistle, 2004.

Promote comparative research in order to better consider different contexts

Research must build an understanding of the impact of HIV/AIDS on children in different contexts (for example urban versus rural settings) both by promoting studies across countries and settings and by linking qualitative and quantitative studies. This type or study remains limited despite the growing necessity to analyse the consequences and needs in specific contexts Birdthistle, 2004.

Boost the link between research and action

At present it is urgent to link research to action and allow concrete and operational implementation of findings and scientific recommendations for children affected by HIV/AIDS.

As mentioned by Appaix and Dekens, studies relative to aid and support strategies and programmes are currently requested. This is the case in Mali with a network of people working with orphans and vulnerable children called Network of Stakeholders for Orphans and other Vulnerable Children (Réseau des intervenants auprès des orphelins et d’autres enfants vulnérables; RIOEV) Appaix and Dekens, 2005.

One the one hand, these studies are essential to better plan action and on the other hand to identify needy children, the different types of support, and the number of children receiving each type of support.

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