The effects of caregiver and household HIV on child development: a community-based longitudinal study of young children

Child Care Health Dev. 2016 Nov;42(6):890-899. doi: 10.1111/cch.12387. Epub 2016 Aug 11.

Abstract

Objective: Many studies that document child outcomes in the context of parental HIV - which has been established as a risk factor for child development - focus on older children/adolescents. Studies also concentrate on the status of the primary caregiver, not other household members who might be infected.

Design: This study examined the effects of caregiver and household HIV on child development (4-13 years) in South Africa and Malawi (2011-2014).

Methods: Data were gathered from 989 children and their primary caregivers at baseline and repeated at 12-15 months follow-up (86.5% follow-up rate). Only caregivers of a single child and caregiver/child dyads without missing data were included, providing a sample of 808 dyads for analysis. Children were divided into three groups according to caregiver-reported HIV burden: having an HIV-positive primary caregiver (19.8%), having HIV in the household (14.2%) or no HIV (66%).

Results: The HIV burden was positively associated with an array of negative child outcomes, often mediated by caregiver depression levels. Family HIV burden at baseline affected child behavioural problems at follow-up indirectly through carer depression (B = 0.02; CI = 0.003, 0.06). Internalizing (B = 0.02; CI = 0.002, 0.05) and externalizing problems at follow-up (B = 0.01; CI = 0.0002, 0.03) were also indirectly affected by family HIV burden through caregiver depression.

Conclusions: The data suggest that family HIV can affect child development, emphasizing the important role of depression in the pathway to such an effect. Community-based interventions directed at alleviating parental depression in the presence of HIV may help to interrupt the cycle of family HIV and adverse child outcomes.

Keywords: HIV; caregivers; child development; depression; violence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Caregivers / psychology
  • Caregivers / statistics & numerical data*
  • Child
  • Child Behavior Disorders / epidemiology
  • Child Behavior Disorders / etiology*
  • Child Development
  • Child of Impaired Parents / psychology*
  • Child, Preschool
  • Depression / epidemiology
  • Depression / etiology
  • Family Health / statistics & numerical data*
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / psychology*
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Malawi / epidemiology
  • Male
  • Middle Aged
  • Quality of Life
  • Socioeconomic Factors
  • South Africa / epidemiology
  • Young Adult