(UNICEF, 2012). By affecting parents and other caregivers who are HIV-positive, the HIV pandemic also adversely affects infants, children, and adolescents who are not HIV-positive themselves by affecting their families and depriving them of parental care and protection. As of 2011 an estimated 17.3 million children and adolescents up to 17 years old had lost at least one parent to the HIV pandemic4 (Luo, 2012). HIV can also indirectly harm children and adolescents by weakening communities and social support networks, welfare systems, and economies.
The health and psychosocial well-being of children and adolescents affected by HIV are influenced by a range of critical factors. Mediators of adverse effects include trauma, relocation, residence in poorer households, and residence with more distantly related caregivers, which can lead to inadequate access to nutrition, shelter, and health care, lack of educational support, lack of legal and other forms of protection, and other effects (UNICEF, 2007). When a parent dies, the grieving process, the deprivation of emotional and material support, and other life changes that occur because of this loss can affect a child’s health and well-being (Cluver and Orkin, 2009; Nyamukapa et al., 2008; Whetten et al., 2011a). Depending on the economic status of their available caregiver, children often enter into excessive labor and stop attending school (Whetten et al., 2011b). In some cases, children and adolescents with sick and dying parents end up becoming the primary caregivers and financial and emotional supporters of their households, essentially losing the opportunity of being children (UNICEF, 2007). In settings where stigmatization is high, children and adolescents who lose parents because of HIV/AIDS are faced with more psychosocial stressors than do non-orphans and children orphaned by other causes (Cluver and Gardner, 2007; Cluver and Orkin, 2009; Cluver et al., 2007). Children and adolescents living within communities that experience a high HIV burden are also at a greater risk of homelessness, of exposure to HIV, and of physical and sexual abuse and exploitation (UNAIDS et al., 2002, 2004). Orphans and abandoned children in these communities, both boys and girls, are at high risk of experiencing additional traumatic events of this kind (Whetten et al., 2011a).
In addition to the vulnerabilities of younger children, the international community has also recognized the vulnerabilities of adolescents between the ages of 15 and 24 years along with the opportunities for interventions during this important developmental transition period (UN, 2001; World
4 In 2001, a consensus was reached among members of the Joint United Nations Programme on HIV/AIDS (UNAIDS) Reference Group on Estimates Modelling and Projection and international researchers on the definition of HIV/AIDS orphans. An AIDS orphan was defined as “a child who has at least one parent who has died due to AIDS” and a double (or dual) AIDS orphan as “a child whose mother and father have both died, at least one due to AIDS” (UNAIDS Reference Group on Estimates Modelling and Projections, 2002, p. W9).