This report examines the impacts of HIV on the care choices of children, exploring how HIV affects whether or not children can remain within parental care, and on the alternative care options open to them. It is based on qualitative research in Malawi, India and Ukraine, and on a global literature review. It is in response to alarming global evidence on the rising numbers of children outside of parental care, and growing global recognition that responses to HIV should centre on increased support to families as the best means of providing care and protection for children
The research findings point towards four key conclusions:
The care choices of children affected by HIV are constrained
Children affected by HIV do not currently have the same care choices as other children. They are more vulnerable to losing their parents at an early age, often due to inadequate access to Anti-Retroviral Therapy (ART). HIV-related ill health, discrimination, poverty and stress can also have indirect impacts on the numbers of children outside of parental care, contributing to the complex range of risk factors which push children away from families. Children affected by HIV may be denied extended family care, access to some residential care facilities, foster care and adoption because of discrimination, or misguided worries about HIV-positive children infecting other children or requiring specialist medical care.
Children affected by HIV should have the same care choices open to them as other children
Children affected by HIV, like all children, should be able to stay with parents unless it is in their best interest to be separated. Where this is not possible, it should be recognised that extended families currently care for the vast majority of children outside of parental care in many settings, and offer a positive choice for many children. HIV-affected children outside of family care should be offered the same range of care options as other children. Residential care, particularly large-scale, dormitory-style care,
Families affected by HIV need more support to care for children
Families affected by HIV need to be offered more support to care for children, and whilst many of these support needs are similar to the support needs for other vulnerable families, HIV-affected families do face some particular challenges. For example, bouts of ill-health combined with poor access to health care make it particularly hard for HIV-positive carers to earn a regular income. Discrimination against HIV-positive adults prevents access to work or basic services.
In providing support to families, it is essential to recognise differences between family types
In supporting HIV-affected, and indeed any vulnerable family, it is essential to recognize differences between family types. For example, grandparent carers often offer enormous love and emotional support to children, but may struggle with poverty. Children in aunt or uncle care or living with older married siblings may be more likely to suffer from abuse and discrimination than those in grandparent care. Children in step-families are particularly vulnerable to family separation. Women in all kinds of families take on the bulk of responsibility for children’s care, and in many instances bring up their own children, and their grandchildren, nieces, nephews or siblings with minimal male support. Some men do struggle against social norms and bring up children alone. In all cases, single-parent/ single-carer households have particular support needs.
