Household impacts of AIDS: using a life course approach to identify effective, poverty-reducing interventions for prevention, treatment and care

Abstract

A life course approach was used to assess household level impacts and inform interventions around HIV risk and AIDS vulnerability across seven major age-related stages of life. Our focus was sub-Saharan Africa. We provided a qualitative review of evidence from published literature, particularly multicountry reviews on impacts of AIDS, on determinants of risk and vulnerability, and reports of large surveys. Areas of potential stress from birth to old age in households affected by AIDS, and interventions for dealing with these specific stresses were identified. While specific interventions for HIV are important at different stages, achieving survival and development outcomes demands a wider set of health, social security and development interventions. One way to determine the priorities amongst these actions is to give weighting to interventions that address factors that have latent impacts later in life, which interrupt accumulating risk, or that change pathways to reduce the risk of both immediate and later stress. This qualitative review suggested that interventions, important for life cycle transitions in generalised epidemics where HIV risk and AIDS vulnerability is high, lie within and outside the health sector, and suggested examples of such interventions.

A Network-Individual-Resource Model for HIV Prevention

“…Indeed, acquiring HIV itself is a significant mental and physical stressor that may also dramatically impact the economic welfare of the individual and his or her important networks. 17 Thus, the NIR model recognizes that altering behavior is more difficult to the extent that individuals and their networks face chronic and severe stressors and easier to the extent that they have environments and networks with resources that help them meet such challenges.…”

From trauma to transmission: exploring the intersection of adversity, substance use, and HIV risk in women’s life histories

“…Though high quality evidence is limited, interventions that take a life course approach have been shown to positively impact long-term outcomes including physical and mental health, and substance use [ 32 – 34 ]. Relevant to our findings where most women described orphanhood and discontinued school engagement, there is evidence that maintaining consistent school enrollment among children and orphaned adolescents, including the delivery of grants and the use of incentives for extended family who become caretakers, can be an effective approach to help them thrive in the life course [ 35 ]. Additionally, provision of reproductive and sexual health education and services to at-risk adolescents and young women, including contraception, health education, services for partner and sexual violence has been shown as an effective approach at preventing early pregnancy and intimate partner violence, which were common among participants in our study [ 35 ].…”

The relevance of timing of illness and death events in the household life cycle for coping outcomes in rural Uganda in the era of HIV

“…Isolating the effects of a single source of stressors, such as the effect of the HIV/AIDS epidemic, can be challenging for policy-makers [ 4 – 6 ]. Studies that have conducted long-term monitoring still find it difficult to demonstrate the impact of HIV/AIDS and household ability to cope [ 4 , 5 , 7 – 10 ].…”

“…Studies show that when environmental, economic, political and health-related events occur, the response strategies vary depending on the household characteristics and level of asset ownership [ 8 , 10 ], factors which may also be associated with the household’s life cycle stage. There are few studies in Uganda analysing how the ‘age’ of the household influences the ability to cope and those studies that have been performed use national-level data and focus on a single age group, such as the elderly [ 14 ].…”