Hiv In Children In The Uk: Effects On The Child And Family

Introduction

The overarching theme of this essay is the effect of child health on the child and family. Concepts of health and illness are explored in pursuit of ways in which children’s health can be protected and maintained on different levels.

The Human Immunodeficiency Virus (HIV) and its consequent disease state (AIDS) have in recent decades become a notable pandemic affecting the lives and livelihoods of ever increasing numbers of patients and the affected (UNICEF, 2011). HIV is a terminal (lifelong) illness. However, advances in modern medicine, the improved availability and effectiveness of drug regimens means that the disease can now be managed better, enabling enhanced and prolonged lives for the infected (UNAIDS, 2008). It is therefore imperative that knowledge of HIV is improved, as this will help develop effective strategies for the promotion of affected children’s health, particularly in their formative years.

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In this regard, the understanding of factors influencing the health of children enables the raising awareness of the opportunities for effective health promotion. It aslo encourages focus on the effects of illness and poor health on the children and their families (Judd, et al., 2007). The effect of HIV in children in the UK and the overall health and well-being of children living with HIV including those exposed through maternal infection; children vulnerable to the impacts of HIV and AIDS such as those who have been orphaned, those living outside parental care, or in poor families; and children who are especially vulnerable to exposure to HIV because of their circumstances, such as those injecting drugs and those who are abused or sexually exploited, is the focus of this essay.

This exploration of child health is conducted with particular focus on HIV in children in the UK. The incidence, prevalence, and changing patterns of disease are discussed backed by statistical evidence which enables the contextualization of the child health issue. The impacts of child health policies and provisions on the well-being of the child and family are also explored.

Trends in child health issues

Often, and to most people, health is considered to be the absence of disease or ill-health. However, advances in research into health have led to the identification of several influences making it essential to enhance this limited definition to encompass these. Health derives from the interaction of complex aspects and factors in a child’s environment such as genetic endowment and behavioural responses, each constantly affecting and influencing the other (Glanz, et al., 2008). In consideration of this, WHO defines health as, “… a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity” (WHO, 2005).

Health can therefore be identified as a resource for daily life, a positive concept that emphasizes physical capabilities, as well as personal and social resources which infer the maintenance and optimization of function through time (Hall and Elliman, 2006). Child health, in this regard, is defined as the extent to which an individual child or groups of children are able or enabled to: develop and realize their full potential; satisfy their needs; and, develop capacity allowing their successful interaction with their physical, biological and social environment (Silberfeld, 2007; UNICEF, 2009).

Comprehensive health promotion is based on the recognition that health and well-being are a result of the interaction of various multiple factors such as biological, psychological, social, cultural, and physical (Albon and Mukherji, 2008). In this regard, child health has to be looked at holistically to encompass not only the absence of illness but also other essential development aspects such as a healthy environment in which to grow and develop, play and learn.

Based on this view and crucial to the assessment of child health, three domains are defined: health condition (the illnesses and disorders of body systems such as disease, injury, impairment, or signs and symptoms); functioning (the manifestations of health in daily life reflecting the direct and indirect effects of health); and, health potential (the development of health assets (capacities or reserves) that provide the capacity for response to physical, psychological, and social challenges as well as risk states which lead to vulnerability to poor health) (Green and Tones, 2010). Child health has at its core the growth and development of healthy children with capacity to reach their full potential as citizens of the world.

Effects of poverty and inequality, for instance, may result in other compound factors such as poor nutrition, opportunity for educational development, and violence in the neighbourhood (physical safety), all of which lead to poor child health and/or health potential (Jones, et al., 2007; Wall, 2010). Poverty is often linked to poor health outcomes and significantly impacts children who suffer disproportionately, childhood being the most vulnerable periods in the life course (Wall, 2010). This is especially significant since a child’s quality of life is interwoven with the life and experience of the family in which they live or their carers. Without addressing problems affecting the child at home such as poverty, nutrition, housing, safety, as well as socio-cultural factors, the best quality of life for the child may not be attained (Department of Health, 2009; Shaw, et al., 2005). Such problems have been shown to have effects on health and well-being of individuals, and especially children in their critical and sensitive phases of development.

Child health has gained significance from the realization of critical differences from adult health with consideration of broader aspects of health specific to children being elucidated (National Research Council (US)/ Institute of Medicine (US), 2004; British Medical Association, 1999). Differences with adult health include: dependence on adult carers or family for their raising, determination of diets, and access to services; different manifestations of poor health; developmental differences with more focus on children’s cognitive, emotional, social and physical growth critical in their growth and development; and their demography, with a large proportion of children in the UK living in poverty (Albon and Mukherji, 2008; UNICEF, 2009). Due to these critical issues, children’s health should be given due regard and attention to safeguard their future potential and the sustenance of society. Appropriate approaches should encompass comprehensive and coordinated care to address the needs of both adults and children in a family setting meeting overall health and social care needs (Adams, et al., 2002).

Studies on child health in the UK conducted by the Department of Helath and private agencies have shown that practically all aspects of health fare worse among children from less affluent families and communities creating a link between poverty and poor child health (UNICEF, 2009; Hall and Elliman, 2006). Others studies conducted globally have aslo obtained similar findings, a direct relationship between illness and mortality (morbidity) with manifestations of deprivation whether social or economic such as poverty and unemployment. This shows that health differences are largely the product of the inequality in the distribution of wealth and income ().

Currently, 3.5 million children live in poverty in the UK, almost a third of all the children. Close to half of this population live in conditions of severe poverty with families having as little as ?12 per day per person to cater for every need (food, toys, clothing, electricity and heating, and transport). Additionally, 18% dependent children in the UK live in households where no adults are in employment (UNICEF, 2009). This paints a grim picture for their overall health and well-being. This situation is made dire with regard to chronic illnesses such as HIV and AIDS affecting children directly or indirectly, often altering the capacity and ability of adult caregivers in their role, catering for the affected children. Often the condition also results in loss of parents or caregivers infected with the disease (Judd, et al., 2007).

With poverty, the provision of good nutrition essential particularly for disease management in condition of HIV, quality housing in safe neighbourhoods and overall health promoting lifestyles is challenged. The HIV and AIDS condition is also prone to stigma and social segregation, which significantly enhances inequality over and above that due to poverty (Shaw, et al., 2005). These combined, and in addition to other environmental and social factors such as the relationships in the family and community, may profoundly impact the health of affected children. The nature and strength of such interactions may differ across an individual’s lifep, and early influences may set in place a series of vulnerabilities and strengths that could significantly affect the fullness of life (Silberfeld, 2007).

The HIV infection and its health consequences are discussed below exploring statistical evidence on incidence, prevalence and changing patterns of disease.

Human Immunodeficiency Virus (HIV)

Like all viruses, HIV cannot grow or reproduce independently and needs to infect cells of living organisms in order to replicate (to make new copies of themselves). However, unlike other viruses which are killed and cleared by the human immune system, HIV attacks essential components of the immune system itself, the T-helper cells of the immune system. The destruction of the cells of the immune system weakens the immune system until the body is no longer able to fight off other infections that it would usually be able to prevent, a condition referred to as AIDS (Acquired Immunodeficiency Syndrome). These subsequent infections are what lead to the death of the affected individual. They include conditions such as Tuberculosis, Kaposi’s sarcoma, among many others, often referred to as opportunistic infections (UNAIDS, 2008).

HIV infection in children is often a result of mother-to-child transmission (MTCT) with a vast majority occurring due to maternofetal transmission of blood during birth or during postnatal breast-feeding. Other transmission routes such as through the sharing of needles in intravenous drug use or sexual activity/abuse are rare and only rise as children approach puberty (WHO, 2005). Overall, in the UK, over 2000 children aged 14 and under diagnosed with HIV as at end of June 2012 have been infected through MTCT. The population of children infected accounts for approximately 2% of overall HIV infections (Judd, et al., 2007).

In 2011, there were 73,659 people in the UK diagnosed with HIV and receiving care. This number has increased every year in the previous decade, a 58% increase from 2002. 1 in every 500 men and 1 in 1000 women live with HIV and 1% of the total number of people receiving care are children under 15. Unfortunately, more people continue to be infected compounding the health problem (UNICEF, 2011). It is noteworthy that a study conducted between 2003 and 2006 did show that 64% of HIV-positive children resident in the UK had been born abroad with the unlinked anonymous surveillance program of 2006 that 1 in every 440 women giving birth in England and Scotland were HIV-positive with a 0.09% prevalence of previously undiagnosed infection. In the decade to 2006, the prevalence of HIV in women born in the UK increased by 66% (Judd et al., 2007).

Children affected by HIV not only suffer from the direct effects of the disease state but also from the fact that their primary caregivers are often also affected, struggling with the effects of the disease, or have died from the disease (UNICEF, 2011). The management of the disease condition also entails long-term complex medication regimes which require readiness and motivation of affected individuals to pursue antiretroviral therapy to slow down its effects. Compliance with treatment regimens and good nutrition enables infected individuals to live long healthy lives enabling the recovery of their immune systems to robust state (Judd et al., 2007).

A significant challenge to HIV’s life-long treatment regime is the problem of compliance, and with regard to children who often are difficult to administer medications to, the unavailability of paediatric formulations due to their relatively low prevalence, as well as the adverse side effects of medication present notable problems with the management of the condition (Judd et al., 2007). Children are also usually dependent on adult caregivers and with them probably also dealing with their own challenges, compliance and proper management of disease may not be achieved (Wall, 2010). It is therefore important to consider supporting the entire family rather than the individual child to achieve their overall well-being and health. This can best be achieved through effective health promotion strategies.

Health promotion strategies associated with HIV in the UK

Health promotion refers to the process in which people are enabled to increase control over their own health and its influences thereby achieving improvement in their health. This occurs primarily through the development of public policies of health addressing the prerequisites such as income, food security, housing, employment, and quality working conditions; as well as preventive and protective mechanisms (Department of Health, 2013).

The UK’s government targets and objectives for the improvement of children’s and young people’s health nationally and locally is outlined in its overarching three year Public Service Agreements (PSA). They include the following: reduction in child poverty; improvement of the health and well-being of children and young people; improvement of child safety; enhancement of numbers of children and young people on the path to success; providing health and better care for all, including the tackling of health inequalities, as well as; enhancing participation in education and sport (Department of Health, 2009).

These targets and objectives govern the development of laws, rules, and regulations developed at various levels of government (national, state or local). They determine the availability of public support services, as well as the regulation of the provision of services administered by private entities. These are integral to how communities in the entire region operate (Green and Tones, 2010). However, despite these endeavours and the Government’s statutory requirement to end child poverty by 2020 (as enshrined in the Child Poverty Act, 2010), it is predicated that by then, unfavourable policies and economic situation/constraints will push another 1 million children into poverty (Shaw, et al., 2005).

Particular focus in HIV in children is the prevention especially of Mother-to-Child Transmission (MTCT) which is the main cause of their HIV infection. Several initiatives are undertaken, in this regard, such as the Unlinked Anonymous Surveillance program and the Voluntary confidential reporting mechanisms enhancing surveillance of this transmission route. These initiatives rely on voluntary confidential reports from paediatricians and obstetricians, as well as the use of prophylaxis (anti-retroviral therapy) to prevent transmission. These surveillance initiatives have had huge success leading to a sharp decrease of infections, with continued application of appropriate interventions having the promise of reduction of transmission rates to less than 1% (Judd et al., 2007).

Children who have a confirmed HIV seroconversion should receive infectious disease management from specialist paediatricians. They should be involved in decisions about their care as much as possible, even when their capacity for independent decision is low (Judd et al., 2007). This is catered for in the long term plans of the Department of Health and the Department for Children, Schools and Families set out in the NHS Next Stage Review, The Children’s Plan and Healthy Lives, and Brighter Futures: The Strategy for Children and Young People’s Health. These reflect the Government’s ambition of enhancing child health with one of the main running themes being to refocus children’s health services as closer home as possible (Department of Health, 2009). This is achieved through managing children through ambulatory care and community based teams at home, school, and voluntary activity settings as, regarding HIV, longer term care provision continues intermittently throughout the lives of affected children.

Health providers, agencies and voluntary teams have, as a result of changes in approach towards family and community-based care, developed working partnerships to work closely with families and children in treatment-oriented services, health promotion, and community-based care, contributing to better management, knowledge of condition and requirements, as well as strict adherence to regimen and overall well-being (Green and Tones, 2010; Adams, et al., 2002). Tactful communication of information on health to children is required as they try to find logic about illness and its causes developing from incomprehension to concrete and formal logical explanations as they mature(Wall, 2010).

Health beliefs and behaviour

The beliefs that people have about health problems, perception of potential benefits accrued from action, barriers to action, and individual ability and capacity can serve to explain engagement or lack in behaviour that promotes health (Glanz et al., 2008). Several perceptions, individual characteristics, and condition can serve to influence such behaviour and to drive or impede action. These include:

Perceived seriousness or severity of health problem and its potential consequences (beliefs about the disease itself);
Perceived susceptibility or assessment of potential risks of developing health problem (Judd et al., 2007);
Perceived benefits of action or initiative;
Perceived barriers such as inconvenience, expense, adverse effects of treatment, and discomfort preventing engagement;
Individual characteristics including demographic (age, sex, race, ethnicity, education, etc.), psychosocial (personality, social class, and pressure from reference or peer groups, etc.), structural (previous contact with disease or knowledge about it)
Triggers or cues to action which prompt engagement in health-promoting behaviour such as pain and symptoms (internal), and events or information from media, other people, health provides, or the illness of other individuals (external) – the intensity is attached to the perceived threat (Glanz et al., 2008)
Self-efficacy/ability which refers to the confidence in one’s ability to alter outcomes which is often a key component in health behaviour change (Judd et al., 2007; Glanz et al., 2008).

It is noteworthy that the behaviour of children with regard to health influences and is influenced by parents, peers and others (members of the community, health service providers, among others) (Glanz et al., 2008). However, the behaviour of children, just as parenting response and style may directly affect the ability to adhere to treatment regimen affecting compliance and thereby outcome of treatment.

With a lack of understanding and underestimation of the threat of health problem leading to a lack of appreciation of its seriousness, their susceptibility, and the general causes and progress of disease, children affected by HIV may not be keen to adhere to their treatment regimen. This is especially so in HIV infection since, with proper management and care, symptoms exhibit intermittently. Adverse effects of medication which are common, the inconvenience of daily medication, and social issues such as segregation, therefore, act as barriers to their promotion of health-promoting behaviour (Judd et al., 2007).

Family demography is also a significant influence on health behaviour with regard to its composition, financial status and parental education (British Medical Association, 1999). Low-income parents and especially those impacted by chronic illness are often considered to be at greater risk for depression and psychological distress, and consequently low self-worth and control impacting their ability to cope with adverse life experiences. They are therefore often engaged in compensatory poor health habits and detrimental behaviour such as smoking, substance abuse and violence negatively impacting health promotion for them and their dependents and worsening outcomes of illness (UNICEF, 2011).

Poverty and its associated limiting factors also impacts compliance making factors such as costs of medication to be perceived as barriers with the little available resources used up on other essentials such as food and housing ignoring potential adverse consequences to health (Glanz et al., 2008).

Conclusion

As childhood disease burden shifts from acute infectious illnesses to chronic, long-term disease, the care of affected children becomes increasingly important. Early health particularly with regard to child health significantly influences future health and potential of not only the individual but the entire society. Greater focus need be trained on overall health and well-being of children, and particularly those infected and affected with HIV as it is often the case that their families are also adversely affected and likely unable, due to numerous challenges, to guarantee quality and comprehensive care.

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