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Background
Families (or family groups to give due acknowledgement to the wide variety of family groups that exist across the world) are the primary providers of protection, support and socialisation of children and youth. The influence of families accounts in a large measure for variations between outcomes among children and youth with respect to their coping capacity, adjustment, health, educational achievement, and work productivity. This general principle pertains also under conditions of severe stress. In fact, family influences are even more important when the external environment is either not supportive of children’s development or adverse. Families in the face of the epidemic
From the start of the epidemic, families have absorbed, in better or worse ways, children and other dependents left vulnerable by AIDS-induced deaths, illness, household and livelihood changes, and migration. Similarly, families have contributed more or less successfully to the protection of young people from HIV infection. Families, extended kin, clan and near community are the mainstay of children’s protection in the face of the AIDS epidemic - as they have been in poor countries under other severely debilitating social conditions, including slavery, war, famine and natural disaster. Only a very small proportion of AIDS-affected children and families, estimated to be about 5 percent, are currently reached by any efforts external to their communities in addition to the support received from kith and kin.  |
A major set of policy questions revolve around the optimum balance between expanding external programmes, including alternative care for children (which is increasing rapidly), increasing the financial and other resources of families, and expanding and ensuring their access to essential services, such as health care, education and social protection. Why preserve the family?
There are competing claims about how HIV and AIDS is affecting the structure and capacity of families, and thereby their ability to care for children, absorb dependents and protect young people from infection. Some argue that high levels of adult mortality have resulted in very large numbers of families being reduced to child-headed and skip-generation households. What families remain are neither willing nor able to care for neglected, abandoned or orphaned children of kin. It is contended that the situation is leading to widespread abuse, exploitation and neglect of already vulnerable children. Available data, however, does not confirm widespread distortion of family structure, and families continue to absorb the children of kin provided they have the means to do so. Families are, and have always been, the only safety net in many of the countries and communities worst-hit by the AIDS epidemic. Many of these communities have already endured centuries of disaster of various kinds. It is feared that too great a reliance on external programmes, which are generally transient, may undermine existing coping mechanisms and leave affected families and children worse off than before, a situation not uncommon in the aftermath of relief and development aid. There have, however, been few fine-grained analyses, statistical or anthropological, sensitive to history, culture and contextual variation, of the ways in which different kinds of families adjust, and have adapted their household economics, time use, social relationships, nutrition, health care, education and work priorities in the face of challenges and crises. Similarly, there is little understanding of variations in family responses to protect children and adolescents from HIV infection, the worst effects of poverty, as well as neglect and abuse what determines these variations in response, and how families should best be supported to maximise benefits for children. There are also few studies on how best to support families to care for vulnerable children as opposed to best practices for external programmes and services. In sum, families need to be strengthened, in ways not yet entirely clear, to provide care and protection for children and adolescents to promote the health and wellbeing of children and adolescents; mitigate the effects of poverty and HIV/AIDS on children and adolescents, and prevent the spread of HIV among children and adolescents. The work of Learning Group 1 will be done through commissions to lead authors for key papers.
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