Sherr Lorraine, Mueller Joanne, Varrall Rebecca
Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.
AIDS Care. 2009;21 Suppl 1(S1):83-97. doi: 10.1080/09540120902923105.
This review (under the International Joint Learning Initiative on Children and AIDS) provides a detailed evidence analysis of gender, children and AIDS. Six systematic reviews provide the most up to date evidence base on research surrounding children and HIV on key topics of treatment resistance and adherence, schooling, nutrition, cognitive development and orphaning and bereavement. Traditional systematic review techniques were used to identify all published studies on four key topics, then studies were selected according to adequacy criteria (sufficient size, control group and adequate measures). A gender analysis was performed on included studies, detailing whether gender was measured, results were analysed by gender or any gender-based findings. For family studies, both the gender of the parents and gender of the child are needed. Secondary analysis by gender was performed on existing systematic reviews for treatment resistance and adherence. Of the 12 studies on treatment resistance, 11 did not look at gender. One found boys at a seven-fold risk compared to girls. For medication adherence, gender was not significant. Of the 15 studies on schooling, 12 analysed findings by gender with an overall female disadvantage. Of the 14 studies on nutrition, nine analysed by gender with mixed findings. Of the 54 studies on cognitive development, 17 provided gender data, but only four analysed by gender with few differences established. Of the 15 studies on bereavement, seven analysed data by gender again with mixed findings. Major policies fail to provide gender data for young children. WHO, UNAIDS and the international data sets are not gathered or coded by gender for young children (generally under 15 years of age) despite well-established gender challenges in later life. This review shows that the current evidence base is inadequate. Data on gender variation and outcome are urgently needed to inform policy and research on children and HIV.
本综述（在儿童与艾滋病国际联合学习倡议下）对性别、儿童与艾滋病进行了详细的证据分析。六项系统综述提供了关于儿童与艾滋病毒研究的最新证据基础，涉及治疗耐药性与依从性、学校教育、营养、认知发展以及孤儿与丧亲等关键主题。采用传统的系统综述技术来识别所有已发表的关于四个关键主题的研究，然后根据充分性标准（足够的样本量、对照组和适当的测量方法）选择研究。对纳入研究进行了性别分析，详细说明是否对性别进行了测量、结果是否按性别进行分析或有任何基于性别的发现。对于家庭研究，需要父母的性别和孩子的性别。对现有的关于治疗耐药性与依从性的系统综述进行了按性别分类的二次分析。在12项关于治疗耐药性的研究中，11项未考虑性别因素。一项研究发现男孩的风险是女孩的七倍。对于药物依从性，性别因素不显著。在15项关于学校教育的研究中，12项按性别分析了结果，总体上女性处于劣势。在14项关于营养的研究中，9项按性别进行了分析，结果不一。在54项关于认知发展的研究中，17项提供了性别数据，但只有4项按性别进行了分析，确定的差异很少。在15项关于丧亲的研究中，7项再次按性别分析了数据，结果也不一致。主要政策未能提供幼儿的性别数据。尽管在后期生活中存在公认的性别挑战，但世界卫生组织、联合国艾滋病规划署和国际数据集并未按性别收集或编码幼儿（一般指15岁以下）的数据。本综述表明，目前的证据基础并不充分。迫切需要关于性别差异和结果的数据，以为儿童与艾滋病毒相关的政策和研究提供信息。
