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Learning Group 1 explores variations in family response on the frontlines of the pandemic, and assembles evidence on models of family support for children as well as the role of systems and services strengthening in protecting children and adolescents from HIV infection and the worst effects of poverty and social disruption. Regional and time variations, in terms of epidemic stage, are important considerations, as are child age and gender, and urban and rural location. The following papers have been commissioned and completed. They investigate, and make recommendations for actions, on key issues. Comments on the proposals and correspondence for the authors should be sent to JLICAFamilies@hsrc.ac.za.  The JLICA final report (10 February 2009) 
JLICA final report: executive summary
The Integrated Reports are also available for download, at the bottom of this page. 1. Families and crisis in the developing world: Implications for responding to children affected by HIV/AIDS | This paper reviews literature on the way in which families in the developing world have been affected by and coped with crises in the past. It is anticipated that the insights gained from the review will enable us to discern optimal strategies for assisting families affected by HIV and AIDS. Apart from historical data, some of the more recent crises that are analysed include the Ethiopian and Angolan wars and fertility change, the Rwandan genocide, and mortality and the Khmer Rouge Killing Fields. The paper also offers perspectives on important constructs - family, family change, crisis and coping mechanisms. Dr Sangeetha Madhavan and Dr Laurie DeRose - University of Maryland, USA
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Download the paper brief and key findings | | | 2. Demographic evidence of family and household changes in response to the effects of HIV/AIDS in Southern Africa: Implications for efforts to strengthen families | 
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This paper builds on existing reviews of HIV/AIDS and children, and focuses on ‘changing families' as a consequence of the epidemic, and ‘strengthening families' as a response. The literature and data review covers trends in population structure, family and household trends and life-cycles, changing families and households in the era of HIV and AIDS, the meaning and measurement of family strength, and how this knowledge can be used to direct activities at strengthening families. The paper describes the impact of timing of the epidemic (with special reference to the maturity of the epidemic in southern Africa, expanded access to ART, and the emerging epidemics in India and Eastern Europe), as well as current blind spots - particularly, the role played by young adults in families, and non-resident members. Dr Victoria Hosegood - London School of Hygiene and Tropical Medicine, UK & Human Sciences Research Council, South Africa
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Download the paper brief and key findings | | | 3. Dreams and disappointments: Migration and families in the context of HIV and AIDS | The purpose of this paper is to explore the short- and long-term implications of migration for families, and to extrapolate what might be applied to the context of HIV and AIDS. This paper a) reviews some of the data concerning world migration and population mobility, including numbers, major reasons for migration, and key definitions and b) discusses the links between population mobility and HIV, briefly from the point of view of population mobility as a potential factor behind the spread of HIV, and from the less studied point of view of migration as an effect of AIDS, in particular as the latter might pertain to families. Dr Mary Haour-Knipe – Independent consultant, Geneva
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| 4. Qualitative accounts of family and household changes in response to the effects of HIV and AIDS: A review with pointers to action | This review of qualitative, anthropological and cultural literature examines how, in the context of HIV and AIDS, families and households are structured, how they function, how they respond to shocks, and how they develop and/or change over time. It documents how families and households are conceived and the contextual factors that inform these conceptions; the roles that kinship, culture, economics, politics and geography play in the organisation of families and households; and the value placed on children and other members of the family. The goal of the paper is to describe practical strategies for strengthening families and households to better respond to the impact of HIV and AIDS on children, in particular. Ms Vuyiswa Mathambo – Human Sciences Research Council, South Africa and Mr Andy Gibbs - Independent consultant, South Africa
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Download the paper brief and key findings | | | 5. The family as the locus of action to protect and support children affected by or vulnerable to the effects of HIV/AIDS | This paper reviews literature and re-analyses existing databases (DHS, MICS) etc to revise some sections of the monograph AIDS and the Family, with a view to: examine how HIV/AIDS has affected the capacity of families to meet the needs of their members, especially orphans and vulnerable children; identify the needs for family strengthening and potential resources that would enable families to maintain and expand their capacity to provide for vulnerable children; and describe possible linkages with community service programmes and policy options that could protect and support those aspects of family capital relevant to the needs of children affected by HIV and AIDS. Dr Mark Belsey – Consultant, USA | | * Paper currently being edited, will be posted shortly. | | | 6. What is the potential of cash transfers to strengthen families affected by HIV and AIDS? A review of the evidence on impacts and key policy debates |  |
While local groups, NGOs and FBOs have provided assistance to families in the forms of cash, food, clothing, livelihoods projects, and labour-sharing, credit, and a range of health and education support initiatives, these don't constitute a response at scale or a coherent social policy. This paper reviews three main categories of interventions aimed at the economic strengthening of families affected by HIV and AIDS: 1) cash transfers; 2) employment programs; and 3) credit and livelihoods interventions. In practice there are many conceptual overlaps between these approaches, and they are often implemented in combination. HIV and AIDS pose enormous challenges to an already difficult set of problems faced in attempting to finance, design and implement social protection policies and programmes. This review takes into account what is underway in sub-Saharan Africa, as well as international programmes to explore a wider set of options and broaden the lessons learned. Dr Michele Adato and Ms Lucy Bassett – International Food Policy Research Institute, USA
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Download the paper brief and key findings | | | 7. A review of the socioeconomic impact of antiretroviral therapy on family wellbeing | This review evaluates the benefits of, and barriers to, ART at a microeconomic level, especially for families. In order to facilitate appropriate action, the paper focuses on three issues: making an assessment of the quality of existing research on the micro-economic impact of ART and identify gaps; determining the ways and the extent to which paediatric ART programmes impact, not only on the wellbeing of children, but also the welfare of their family members and caregivers; evaluating the economic impact of adult ART on their family's income, stigma within and beyond the family, and its effects on children's wellbeing. Dr Jose Kimou and Dr Clément Kouakou – Université de Cocody, Cote d’Ivoire and Paul Auguste Assi – Family Health International, Cote d’Ivoire
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Download the paper brief and key findings | | | 8. Strengthening families through HIV/AIDS prevention, treatment, care and support - A review of the literature |  |
This paper aims to provide recommendations on how HIV/AIDS prevention, treatment, care and support programmes can be implemented in ways that strengthen families. It does this through, initially, an analysis of current programmatic efforts that may handicap appropriate responses to strengthening the capacity of families to care for vulnerable children. It then attempts to utilize a family focus and explore how the needs of a family approach are reflected or neglected in current policies around prevention, treatment, care and support (this paper links to Paper 7 by Jose Kimou - A review of the socioeconomic impact of antiretroviral therapy on family wellbeing). The analysis selects a number of core programmatic efforts and conducts an overview, in a systematic way, to provide a critical and evidence-based analysis on the impact on children generally and vulnerable children specifically. Prof. Lorraine Sherr – University College London, UK
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Download the paper brief and key findings | | | 9. Families' efforts to secure the future of their children in the context of multiple stresses, including HIV and AIDS | The goal of this paper is to provide an in depth review of how parents plan and act to secure the future of their children in a context of multiple stresses. The review paper draws on a) a broader critical review of literature and b) a recently completed qualitative research in Malawi and South Africa to examine how parents plan and act to secure the future of their children in the context of their knowledge of existing threats to children's welfare including chronic illness in light of the AIDS epidemic, and perceptions of what threat their children will face in the future. Dr Scott Drimie – RENEWAL, International Food Policy Research Institute, USA and Dr Marisa Casale - HEARD, South Africa
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Download the paper brief and key findings | | | 10. Programmes to strengthen families: Reviewing the evidence from high-income countries | This paper analyses programmatic responses to strengthening families both in the North and South with the goal of identifying common components of successful interventions and programs that can be meaningfully applied to children affected or infected by HIV/AIDS. It primarily includes programmatic responses with a strong evidence base that have demonstrated through evaluation and impact studies to be successful in improving outcomes for children and youth, in particular, and families more generally. The review concludes with how the best evidence on strengthening families can inform family HIV/AIDS programming and strengthen the ability of families infected and affected by HIV/AIDS to respond with resilience to the HIV/AIDS pandemic. Dr Upjeet Chandan and Prof Linda Richter – Human Sciences Research Council, South Africa
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| | | | 12. Children thrive in families: Family-centred models of care and support for orphans and other vulnerable children affected by HIV and AIDS | This paper summarises the global evidence that we were able to access from the formal and informal literature related to family-centered models of support to children affected by HIV/AIDS, within the time and budgetary limitations of this study. It also collates the views and perspectives of respondents from selected implementing agencies about family-centered approaches to care for vulnerable children, and how they integrate such an approach into the design of their programs that focus on orphans and other vulnerable children. The evidence presented in this paper aims to provide guidance to national level policy makers and program planners within implementing agencies on the opportunities and challenges of family-centered approaches to supporting children affected by HIV/AIDS. Dr Angela Wakhweya, Ms Rebecca Dirks and Dr Kwaku Yeboah - Family Health international, Prevention and Mitigation Division, USA
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