HIV This Week

Floyd S, Crampin AC, Glynn JR, Madise N, Mwenebabu M, Mnkhondia S, Ngwira B, Zaba B, Fine PE. The social and economic impact of parental HIV on children in northern Malawi: Retrospective population-based cohort study. AIDS Care 2007;19:781-90.

From population-based surveys in the 1980s in Karonga district, northern Malawi, 197 'index individuals' were identified as HIV-positive. 396 HIV-negative 'index individuals' were selected as a comparison group. These individuals, and their spouses and children, were followed up in 1998-2000. 582 of 593 index individuals were traced. 487 children of HIV-positive, and 1493 children of HIV-negative, parents were included in analyses. Rates of paternal, maternal, and double orphanhood among children with one or both parents HIV-positive were respectively 6, 8, and 17 times higher than for children with HIV-negative parents. Around 50% of children living apart from both parents had a grandparent as their guardian; for most of the rest the guardian was an aunt, uncle, or sibling. There were no child-headed households. Almost all children aged 6-14 were attending primary school. There was no evidence that parental HIV affected primary school attainment among children <15 years old. Children of HIV-positive parents were less likely to have attended secondary school than those of HIV-negative parents. The extended family has mitigated the impact of orphanhood on children, but interventions to reduce the incidence of orphanhood, and/or which strengthen society's ability to support orphans, are essential, especially as the HIV epidemic matures and its full impact is felt.

Editors’ note: Although it is encouraging that primary school enrolment in Malawi is not measurably affected by parental HIV infection, effects are being seen on secondary school attendance. The diminishing horizon of education and employment prospects for many orphans then limits the opportunities for their own children – the next generation. Counteracting these intergenerational effects can preserve social capital and social cohesion and build resilience to HIV.

Dasinger LK, Speiglman R. Homelessness prevention: the effect of a shallow rent subsidy program on housing outcomes among people with HIV or AIDS. AIDS Behav 2007;26(2):128-139.

This paper presents results of an evaluation of Project Independence (PI), a shallow rent subsidy program with services coordination support for very low income people with HIV or AIDS who live in Alameda County in the San Francisco Bay Area. By providing a small rental subsidy to eligible individuals and their families who are already stably housed, the philosophy of the program is to prevent homelessness before it starts. The housing outcomes of 185 PI clients were compared to those of 218 people who were not enrolled in the program but were presumed eligible for it, controlling for sociodemographic, HIV disease, and behavioural health characteristics. Using survival analysis techniques, non-program participants were found to be more likely to leave their rental housing at any given point in time compared to PI program participants. After one year of follow-up, while 99% of PI clients remained stably housed in their program-subsidized rental unit, only 32% of comparison group clients were still in rental housing. At two years, 96% of PI participants remained independently housed, compared to only 10% of non-participants. The success of the program suggests that Project Independence should be replicated and evaluated in other jurisdictions where a relatively high incidence and prevalence of HIV is combined with a lack of affordable housing for low income households.

Editors’ note: HIV infection can become impoverishing as it progresses. Those who are on very low incomes are particularly vulnerable to losing their housing. This intervention of a small rental subsidy was an investment which reaped large dividends for fully 96% of the 185 participants who received it. Two years later they were still stably housed - an effective mitigation tool addressing a social consequence of being poor and having HIV infection.