Franco Lynne Miller, Burkhalter Bart, de Wagt Arjan, Jennings Larissa, Kelley Allison Gamble, Hammink Marie-Eve
University Research Company, LLC, 7200 Wisconsin Ave., Suite 600, Bethesda, MD 20814, USA.
AIDS Care. 2009;21 Suppl 1(S1):49-59. doi: 10.1080/09540120902923089.
As global commitment grows to protect and support children affected by HIV and AIDS, questions remain about how best to meet the needs of these children in low prevalence settings and whether information from high prevalence countries can appropriately guide programming in these settings. A 2007 search for the evidence in low prevalence settings on situational challenges of HIV and AIDS-affected children and interventions to address these challenges identified 413 documents. They were reviewed and judged for quality of documentation and scientific rigor. Information was compiled across eight types of challenges (health and health care, nutrition and food security, education, protection, placement, psychosocial development, socioeconomic status, and stigma/discrimination); and also assessed was strength of evidence for situational and intervention findings. Results were compared to three programming principles drawn from research in high prevalence countries: family-centered preventive efforts, treatment, and care; family-focused support to ensure capacity to care for and protect these children; and sustaining economic livelihood of HIV and AIDS-affected households. Findings show that children affected by HIV and AIDS in low prevalence settings face increased vulnerabilities similar to those in high prevalence settings. These findings support seeking and testing programmatic directions for interventions identified in high prevalence settings. However, low prevalence settings/countries are extremely diverse, and the strength of the evidence base among them was mixed (strong, moderate, and weak in study design and documentation), geographically limited, and had insufficient evidence on interventions to draw conclusions about how best to reduce additional vulnerabilities of affected children. Information on family, economic, sociocultural, and political factors within local contexts will be vital in the development of appropriate strategies to mitigate vulnerabilities.
随着全球在保护和支持受艾滋病毒和艾滋病影响儿童方面的承诺不断增加，对于如何在低流行率环境中最好地满足这些儿童的需求，以及高流行率国家的信息能否适当地指导这些环境中的项目规划，仍然存在疑问。2007年，一项针对低流行率环境中受艾滋病毒和艾滋病影响儿童的情况挑战及应对这些挑战的干预措施的证据搜索，共识别出413份文件。对这些文件进行了审查，并根据文件质量和科学严谨性进行了评判。信息是按照八类挑战（健康与医疗保健、营养与粮食安全、教育、保护、安置、心理社会发展、社会经济地位以及耻辱感/歧视）进行整理的；同时还评估了情况和干预措施研究结果的证据力度。研究结果与从高流行率国家的研究中得出的三项项目规划原则进行了比较：以家庭为中心的预防努力、治疗和护理；以家庭为重点的支持，以确保有能力照顾和保护这些儿童；以及维持受艾滋病毒和艾滋病影响家庭的经济生计。研究结果表明，在低流行率环境中，受艾滋病毒和艾滋病影响的儿童面临着与高流行率环境中类似的、不断增加的脆弱性。这些研究结果支持为在高流行率环境中确定的干预措施寻找并测试项目规划方向。然而，低流行率环境/国家极其多样化，而且其中证据基础的力度参差不齐（在研究设计和文件记录方面有强、中、弱之分），地域有限，并且关于干预措施的证据不足，无法就如何最好地减少受影响儿童的额外脆弱性得出结论。当地背景下有关家庭、经济、社会文化和政治因素的信息，对于制定减轻脆弱性的适当战略至关重要。
