Heymann Jody, Kidman Rachel
Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, H3A 1A3, Canada.
AIDS Care. 2009;21 Suppl 1:34-42. doi: 10.1080/09540120902927593.
Families play central roles in the HIV/AIDS pandemic, caring for both orphaned children and the ill. This extra caregiving depletes two family resources essential for supporting children: time and money. We use recent data from published studies in sub-Saharan Africa to illustrate deficits and document community responses. In Botswana, parents caring for the chronically ill had less time for their preschool children (74 versus 96 hours per month) and were almost twice as likely to leave children home alone (53% versus 27%); these children experienced greater health and academic problems. Caregiving often prevented adults from working full time or earning their previous level of income; 47% of orphan caregivers and 64% of HIV/AIDS caregivers reported financial difficulties due to caregiving. Communities can play an important role in helping families provide adequate childcare and financial support. Unfortunately, while communities commonly offer informal assistance, the value of such support is not adequate to match the magnitude of need: 75% of children's families in Malawi received assistance from their social network, but averaging only US$81 annually. We suggest communities can strengthen the capacity of families by implementing affordable quality childcare for 0-6 year olds, after-school programming for older children and youth, supportive care for ill children and parents, microlending to enhance earnings, training to increase access to quality jobs, decent working conditions, social insurance for the informal sector, and income and food transfers when families are unable to make ends meet.
家庭在艾滋病毒/艾滋病大流行中发挥着核心作用，既要照顾孤儿，又要照顾患病者。这种额外的照料消耗了抚养孩子所需的两项重要家庭资源：时间和金钱。我们利用撒哈拉以南非洲已发表研究的最新数据来说明资源短缺情况，并记录社区的应对措施。在博茨瓦纳，照顾慢性病患者的父母陪伴学龄前儿童的时间较少（每月74小时对96小时），让孩子独自在家的可能性几乎是原来的两倍（53%对27%）；这些孩子面临更多的健康和学业问题。照料工作常常使成年人无法全职工作或赚取以前的收入水平；47%的孤儿照料者和64%的艾滋病毒/艾滋病照料者报告称，照料导致了经济困难。社区可以在帮助家庭提供充足的儿童照料和经济支持方面发挥重要作用。不幸的是，虽然社区通常会提供非正式援助，但这种支持的价值不足以满足需求的规模：马拉维75%的儿童家庭从其社交网络获得了援助，但平均每年只有81美元。我们建议，社区可以通过为0至6岁儿童提供负担得起的优质儿童照料服务、为大龄儿童和青少年提供课后活动项目、为患病儿童和父母提供支持性照料、小额贷款以增加收入、培训以增加获得优质工作的机会、体面的工作条件、为非正规部门提供社会保险，以及在家庭无法维持生计时分发收入和食品等方式，来增强家庭的能力。
