Stigma as experienced by children of HIV-positive parents: a narrative review

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 not 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.