Mason Sally, Sultzman Vickey Olds
a Institute for Juvenile Research, University of Illinois at Chicago , Chicago , IL , USA.
b School of Social Work , Indiana University Northwest , Gary , IN , USA.
AIDS Care. 2019 Sep;31(9):1049-1060. doi: 10.1080/09540121.2019.1573968. Epub 2019 Jan 31.
This narrative review examines the effects on children of stigma by association with an HIV-positive parent. It expands on previous reviews by including all HIV-affected children, whether orphaned or living with a parent with HIV, and considers the broad effects of stigma-by-association (SBA), including but not limited to the psychological impact. Studies met the following criteria - sample included children, ages 6-19 years old, who were HIV-positive but were currently living with or had lived with a parent who was HIV-positive (i.e., AIDS orphans). Study findings included children's perspectives on stigma and were available in English. Studies for inclusion were identified by searches in Psychinfo, Proquest, and PubMed from 1996 through 2016. This review substantiates that children across countries and cultures experience HIV SBA. SBA is associated with psychological or emotional problems, disrupted peer and adult relationships, and poor school outcomes for children. Orphans were more likely than children living with positive parents to experience negative outcomes, which can have a long-term impact. Felt stigma was as prevalent as enacted stigma and may become the focus of intervention as HIV disease increasingly becomes a concealable disease. The review findings also point to the complexity of relationships between SBA and variables such as poverty and mental health and the bi-directional relationship between SBA and depression. We adapt a stigma framework developed for people living with HIV (PLWHIV) to structure the results of this review. With these findings, we can develop interventions that support stigma reduction with children and their parents, responding to the wide range of stigma consequences and customized to the children's family and cultural context.
本叙述性综述探讨了与感染艾滋病毒的父母相关联而产生的污名化对儿童的影响。它在前述综述的基础上进行了扩展，纳入了所有受艾滋病毒影响的儿童，无论其是否成为孤儿或与感染艾滋病毒的父母共同生活，并考虑了关联污名化（SBA）的广泛影响，包括但不限于心理影响。纳入的研究符合以下标准：样本包括6至19岁的儿童，他们自身艾滋病毒呈阳性，但目前与艾滋病毒呈阳性的父母共同生活或曾经与这样的父母生活在一起（即艾滋病孤儿）。研究结果包括儿童对污名化的看法，且研究报告为英文。通过检索1996年至2016年期间的Psychinfo、Proquest和PubMed数据库来确定纳入的研究。本综述证实，不同国家和文化背景的儿童都经历过艾滋病毒关联污名化。关联污名化与心理或情感问题、同伴及成人关系的破裂以及儿童学业成绩不佳有关。与父母呈阳性的儿童相比，孤儿更有可能经历负面结果，而这些结果可能会产生长期影响。感知到的污名与实际遭受的污名一样普遍，随着艾滋病毒疾病越来越成为一种可隐瞒的疾病，感知到的污名可能会成为干预的重点。综述结果还指出了关联污名化与贫困和心理健康等变量之间关系的复杂性，以及关联污名化与抑郁之间的双向关系。我们采用了为艾滋病毒感染者（PLWHIV）制定的污名框架来构建本综述的结果。基于这些研究结果，我们可以制定相应的干预措施，以帮助减少儿童及其父母所遭受的污名，应对广泛的污名化后果，并根据儿童的家庭和文化背景进行定制。
