Strengthening families through early intervention in high HIV prevalence countries

Abstract

Families have been at the forefront of the response to the HIV/AIDS epidemic in high-prevalence countries. They have also borne the greatest costs associated with the epidemic, including impoverishment, which has strained their capacity to care for vulnerable members. Within this context, there is consensus that strengthening the capacity of families to care for children is one of the most important strategies for mitigating the impacts of the HIV/AIDS epidemic on children's lives in high-prevalence countries. It is argued that evidence-based early intervention programmes that enhance caregiving and link caregivers with supports and services can play a pivotal role in strengthening families. Based on a systematic review, we recommend that two intervention strategies that should be given consideration within the context of high-prevalence countries, because of their demonstrated benefits in other settings, are nurse home visiting for first time, low-income pregnant mothers and their young children as well as early childhood development programmes for low-income children and families.

Keywords:

• strengthening families
• high prevalence
• early intervention
• poverty

Notes

1. Given that there is considerable variation in family formations in terms of structure, residency and function, “family” is defined flexibly and understood in its broadest sense, as a social grouping and a social institution. It is understood that family members can be related through kinship (biological and social) and/or marriage, union, or other partnership arrangements.

2. Because few programmes specifically define themselves as “family strengthening”, the defining criteria for inclusion were programmes that seek to enhance family functioning and/or outcomes for children through family-level interventions.

3. The present emphasis on early childhood in this article is not intended to discount the urgent need for large-scale evidence-based interventions with older children and their families in high-prevalence contexts. Unfortunately, the evidence on programmes to strengthen families directed towards older children and youth in high income countries is less established and also does not lend itself to application in high-prevalence countries (for further elaboration, see Chandan & Richter, 2008).

4. The term “children affected by AIDS” is an umbrella phrase which captures the diverse, often overlapping ways, children's lives have been and are being altered by the epidemic. These include being HIV-positive themselves, having mothers, fathers, or other caregivers who are HIV-positive, losing a parent(s) to AIDS, living in families that foster children affected by HIV/AIDS and/or living in communities where large numbers of people are affected by HIV/AIDS (Sherr, 2005).

5. Expanded within the context of the HIV epidemic, the reliance on home-based care is a response to the inability of public health services, particularly hospitals, to meet the care needs of increasing numbers of patients with AIDS-related illnesses (Campbell, 2004).