Evidence-based gender findings for children affected by HIV and AIDS — a systematic overview
Identifieur interne : 002084 ( Pmc/Corpus ); précédent : 002083; suivant : 002085Evidence-based gender findings for children affected by HIV and AIDS — a systematic overview
Auteurs : Lorraine Sherr ; Joanne Mueller ; Rebecca VarrallSource :
- AIDS Care [ 0954-0121 ] ; 2009.
Abstract
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.
Url:
DOI: 10.1080/09540120902923105
PubMed: 22380982
PubMed Central: 2903774
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PMC:2903774Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Evidence-based gender findings for children affected by HIV and AIDS — a systematic overview</title><author><name sortKey="Sherr, Lorraine" sort="Sherr, Lorraine" uniqKey="Sherr L" first="Lorraine" last="Sherr">Lorraine Sherr</name><affiliation><nlm:aff id="A1">Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London NW3 2PF, UK</nlm:aff></affiliation></author><author><name sortKey="Mueller, Joanne" sort="Mueller, Joanne" uniqKey="Mueller J" first="Joanne" last="Mueller">Joanne Mueller</name><affiliation><nlm:aff id="A1">Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London NW3 2PF, UK</nlm:aff></affiliation></author><author><name sortKey="Varrall, Rebecca" sort="Varrall, Rebecca" uniqKey="Varrall R" first="Rebecca" last="Varrall">Rebecca Varrall</name><affiliation><nlm:aff id="A1">Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London NW3 2PF, UK</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22380982</idno><idno type="pmc">2903774</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903774</idno><idno type="RBID">PMC:2903774</idno><idno type="doi">10.1080/09540120902923105</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">002084</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002084</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Evidence-based gender findings for children affected by HIV and AIDS — a systematic overview</title><author><name sortKey="Sherr, Lorraine" sort="Sherr, Lorraine" uniqKey="Sherr L" first="Lorraine" last="Sherr">Lorraine Sherr</name><affiliation><nlm:aff id="A1">Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London NW3 2PF, UK</nlm:aff></affiliation></author><author><name sortKey="Mueller, Joanne" sort="Mueller, Joanne" uniqKey="Mueller J" first="Joanne" last="Mueller">Joanne Mueller</name><affiliation><nlm:aff id="A1">Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London NW3 2PF, UK</nlm:aff></affiliation></author><author><name sortKey="Varrall, Rebecca" sort="Varrall, Rebecca" uniqKey="Varrall R" first="Rebecca" last="Varrall">Rebecca Varrall</name><affiliation><nlm:aff id="A1">Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London NW3 2PF, UK</nlm:aff></affiliation></author></analytic><series><title level="j">AIDS Care</title><idno type="ISSN">0954-0121</idno><idno type="eISSN">1360-0451</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>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.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ainsworth, M" uniqKey="Ainsworth M">M. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">AIDS Care</journal-id><journal-id journal-id-type="publisher-id">caic</journal-id><journal-title-group><journal-title>AIDS Care</journal-title></journal-title-group><issn pub-type="ppub">0954-0121</issn><issn pub-type="epub">1360-0451</issn><publisher><publisher-name>Taylor & Francis</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22380982</article-id><article-id pub-id-type="pmc">2903774</article-id><article-id pub-id-type="doi">10.1080/09540120902923105</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Evidence-based gender findings for children affected by HIV and AIDS — a systematic overview</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Sherr</surname><given-names>Lorraine</given-names></name><xref ref-type="corresp" rid="COR1">∗</xref><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Mueller</surname><given-names>Joanne</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Varrall</surname><given-names>Rebecca</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><aff id="A1">Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London NW3 2PF, UK</aff></contrib-group><author-notes><corresp id="COR1"><sup>∗</sup>Corresponding author. Email: <email>l.sherr@pcps.ucl.ac.uk</email></corresp></author-notes><pub-date pub-type="epub"><day>30</day><month>9</month><year>2009</year></pub-date><pub-date pub-type="ppub"><month>8</month><year>2009</year></pub-date><volume>21</volume><issue>S1</issue><fpage>83</fpage><lpage>97</lpage><history><date date-type="received"><day>5</day><month>1</month><year>2009</year></date><date date-type="accepted"><day>25</day><month>3</month><year>2009</year></date></history><permissions><copyright-statement>© 2009 Taylor & Francis</copyright-statement><copyright-year>2009</copyright-year><license license-type="open-access" xlink:href="http://www.informaworld.com/mpp/uploads/iopenaccess_tcs.pdf"><license-p>This is an open access article distributed under the <ext-link ext-link-type="uri" xlink:href="http://www.informaworld.com/mpp/uploads/iopenaccess_tcs.pdf">Supplemental Terms and Conditions for iOpenAccess articles published in Taylor & Francis journals</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>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.</p></abstract><kwd-group><title>Keywords</title><kwd>gender</kwd><kwd>HIV/AIDS</kwd><kwd>children</kwd><kwd>policy</kwd></kwd-group></article-meta></front><body><sec><title>Background</title><p>Gender plays a well-established role in HIV prevention, transmission, vulnerability and response. Comprehensive studies have shown differential vulnerabilities and circumstances which affect males and females. This has covered epidemiology, access to treatment and research inclusion. Yet curiously, gender issues for children are neglected. In the non-HIV/AIDS literature gender is seen as an important factor in a number of developmental arenas, such as education, child development, cognition, socialising and parental interactions. Indeed, mental health, behavioural problems and access to education are all well-documented issues that are affected by gender.</p><p>Our society is bisected by gender. Within families, as within societies, gender affects the biological susceptibility to HIV/AIDS as well as the social susceptibility as gender roles, gender differences and gender responses intertwine with daily life. Much has been written about gender discrimination (<xref ref-type="bibr" rid="R9">Bhana, 2007</xref>), and how, from an early age, roles and role differentiation may adversely affect children generally, and girls specifically. Clearly family plays a key role in the construction of gender, gender roles, gender expectations and gender differences (<xref ref-type="bibr" rid="R7">Belden & Squires, 2008</xref>). Within this construction, there are a number of aspects of gender-related issues that are highly relevant to the study of HIV/AIDS, programme provision and research questions. In addition to biological gender differences, issues relate to gender differences in provision (within families and within the social network), social and cultural constructs of gender which disadvantage or disempower sub-groups, violence, sexual attitudes, gender selection and preferential treatment in terms of schooling, <xref ref-type="bibr" rid="R3">Alderman, Hoddinott, and Kinsey (2006)</xref>, <xref ref-type="bibr" rid="R32">Liu, Raine, Venables, Dalais, and Mednick, (2003)</xref>nutrition, attention and provision, genital mutilation and marriage (<xref ref-type="bibr" rid="R4">Andersson, Cockcroft, & Shea, 2008</xref>). There are also gender issues associated with care, caring roles and the imbalance of impact on a young child with disruption of care according to the gender of the child and the caregiver.</p><p>Given these important aspects of gender, it is vital that research, policy and programme provision take gender into account from the earliest stages. This is done as a matter of course in the adult literature, yet is piecemeal within the children's literature. Ignoring gender may directly affect both boys and girls. Given that, traditionally, greater gender discrimination is reported against girls; their situation should not be overlooked or inaccurately described. However this does not imply that boys are invulnerable. The lack of focus on boys may conversely indicate a greater effort to bring the focus on boys into line with girls. Lack of attention to the situation of boys may have consequences for gender discrimination against girls and women. Not aggregating by gender does both males and females a disservice.</p><p>This review explores the issues of gender within key elements of HIV as it affects the lives of children. It provides detailed information in order to summarise gender-based knowledge and present guidance on gender sensitivity and provision in future policies for children.</p></sec><sec sec-type="methods"><title>Methods</title><p>As part of the Joint Learning Initiative on Children and AIDS, a series of systematic reviews were undertaken to study the evidence base. Six systematic reviews reported here provide the most up to date evidence base on research surrounding children and HIV on key topics. The six areas examined in relation to children are:
<list list-type="order"><list-item><p>HIV treatment resistance.</p></list-item><list-item><p>Adherence to treatment.</p></list-item><list-item><p>HIV and schooling.</p></list-item><list-item><p>HIV and nutrition.</p></list-item><list-item><p>HIV and cognitive development.</p></list-item><list-item><p>HIV and bereavement.</p></list-item></list>Two different methods of analysis were undertaken. For Topics 1 and 2 (HIV treatment resistance and adherence to treatment)clear and recent systematic reviews already existed. For the purpose of this study, all shortlisted papers from these reviews were gathered and recoded according to gender variables. In addition, if any more recently published studies meeting the same criteria were identified, they were added to the body and subjected to the secondary analysis by gender as described below.</p><p>For the remaining four topics (schooling, nutrition, cognitive development and bereavement), original systematic literature reviews were undertaken. Research evidence was gathered by detailed study of peer-reviewed published studies. We gathered articles using electronic database searches covering Embase, Medline and Psychinfo until 2006. For all searches the terms “HIV”, “AIDS” and “Children” were used and specialised searches then included terms such as “Orphan”, “School”, “Education”, “Bereavement”, “Nutrition” and “Development”. A search for allied studies was conducted by following up cross-referred articles. Identified articles were reviewed and hand sorted to include all reports that reached adequacy criteria. These criteria included sufficient sample size, presence of a control group and adequate outcome measures.</p><p>For each of the six topics, the finalised list of included studies was then subjected to a gender analysis. This second level review coded on the presence or absence of reported data on gender distribution (both for the child sample and the parent data where appropriate). Studies were then scrutinised to explore whether the results firstly reported on gender, secondly were analysed by gender and finally provide a review of gender-based findings.</p></sec><sec><title>Results</title><sec><title>HIV treatment resistance</title><p>A systematic review (<xref ref-type="bibr" rid="R5">Arrivé et al., 2007</xref>)looked at all studies that examined Neviripine (NVP)resistance in mothers and children. They identified 33 reports where “offspring” received NVP, of which 24 were excluded on methodological grounds. The 11 that were entered into a meta-analysis (covering 339 children)revealed that half the children who became infected despite NVP treatment developed resistance. No data on gender of the child were given. A relevant study on treatment resistance was subsequently identified in the literature. Only this study provided gender related data, and revealed that boys were at a seven-fold risk of developing resistance to treatment. In this research, resistance was defined as triple resistance (resistance to three classes of drugs) (<xref ref-type="bibr" rid="R19">Delaugerre et al., 2007</xref>)</p></sec><sec><title>Adherence to treatment</title><p>The most comprehensive review — carried out by <xref ref-type="bibr" rid="R51">Simoni et al. (2007)</xref> — reported that gender was not a significant factor in treatment adherence. Few studies appeared to analyse gender.</p></sec><sec><title>HIV and schooling</title><p>Fifteen studies meeting inclusion criteria were identified comparing the impact of HIV infection on schooling (<xref ref-type="bibr" rid="R1">Ainsworth, Beegle, & Koda, 2005</xref>; <xref ref-type="bibr" rid="R2">Akresh, 2004</xref>; <xref ref-type="bibr" rid="R8">Bennell, 2005</xref>; <xref ref-type="bibr" rid="R10">Bhargava, 2005</xref>; <xref ref-type="bibr" rid="R11">Bicego, Rutstein, & Johnson, 2003</xref>; <xref ref-type="bibr" rid="R13">Case & Ardington, 2005</xref>; <xref ref-type="bibr" rid="R14">Case, Paxson, & Ableidinger, 2004</xref>; <xref ref-type="bibr" rid="R15">Chatterji et al., 2005</xref>; <xref ref-type="bibr" rid="R23">Evans & Miguel, 2007</xref>; <xref ref-type="bibr" rid="R28">Kamali et al., 1996</xref>; <xref ref-type="bibr" rid="R36">Mishra et al., 2005</xref>; <xref ref-type="bibr" rid="R37">Monasch & Boerma, 2004</xref>; <xref ref-type="bibr" rid="R38">Nyamukapa & Gregson, 2005</xref>; <xref ref-type="bibr" rid="R48">Sharma, 2006</xref>; <xref ref-type="bibr" rid="R58">Yamano & Jayne, 2005</xref>).</p><p>Of these, 12 analysed findings by gender (see <xref ref-type="table" rid="T1">Table 1</xref>), with an overall female disadvantage.</p></sec><sec><title>HIV and nutrition</title><p>Fourteen studies were identified comparing the effect of HIV infection on nutrition between HIV affected and control children (<xref ref-type="bibr" rid="R10">Bhargava, 2005</xref>; <xref ref-type="bibr" rid="R12">Bridge, Kipp, Jhangri, Laing, & Konde-Lule, 2006</xref>; <xref ref-type="bibr" rid="R15">Chatterji et al., 2005</xref>; <xref ref-type="bibr" rid="R18">Crampin et al., 2003</xref>; <xref ref-type="bibr" rid="R28">Kamali et al., 1996</xref>; <xref ref-type="bibr" rid="R31">Lindblade, Odhiambo, Rosen, & DeCock, 2003</xref>; <xref ref-type="bibr" rid="R34">Masmas et al., 2004a</xref>, <xref ref-type="bibr" rid="R35">b</xref>; <xref ref-type="bibr" rid="R36">Mishra et al., 2005</xref>; <xref ref-type="bibr" rid="R40">Panpanich, Brabin, Gonani, & Graham 1999</xref>; <xref ref-type="bibr" rid="R42">Rivers, Silvestre, & Mason, 2004</xref>; <xref ref-type="bibr" rid="R45">Ryder, Kamenga, Nkusu, Batter, & Heyward, 1994</xref>; <xref ref-type="bibr" rid="R46">Sarker, Neckermann, & Muller 2005</xref>; <xref ref-type="bibr" rid="R55">Watts et al., 2007</xref>).</p><p>Of these, nine reported and analysed the findings by gender (see <xref ref-type="table" rid="T2">Table 2</xref>). The findings were mixed with some identifying a gender disadvantage, while others failed to establish a gender difference.</p></sec><sec><title>HIV and cognitive development</title><p>In total, 54 studies on the effect of HIV on cognitive development were identified (Sherr, Mueller, Varrall, & JLICA Working Group 1, 2008, in press). Of these 17 provided data on gender of participants, only four proceeded to analyse their findings according to gender: few differences were identified.</p></sec><sec><title>HIV and bereavement</title><p>Despite the fact that many millions of children have lost parents to HIV, we could only identify 15 controlled studies on the issue of HIV and bereavement (<xref ref-type="bibr" rid="R6">Atwine, Cantor-Graae, & Bajunirwe, 2005</xref>; <xref ref-type="bibr" rid="R10">Bhargava, 2005</xref>; <xref ref-type="bibr" rid="R16">Cluver & Gardner, 2006</xref>; <xref ref-type="bibr" rid="R20">Dowdney et al., 1999</xref>; <xref ref-type="bibr" rid="R24">Forehand et al., 1999</xref>; <xref ref-type="bibr" rid="R26">Grantham-McGregor, Walker, & Chang, 2000</xref>; <xref ref-type="bibr" rid="R27">Gregson et al., 2005</xref>; <xref ref-type="bibr" rid="R29">Lee, Detels, Rotherham-Borus, & Duan, 2007</xref>; <xref ref-type="bibr" rid="R30">Lester et al., 2006</xref>; <xref ref-type="bibr" rid="R33">Makame, Ani, & Grantham-McGregor, 2002</xref>; <xref ref-type="bibr" rid="R39">Operario, Pettifor, Cluver, MacPhail, & Rees, 2007</xref>; <xref ref-type="bibr" rid="R43">Rotherham-Borus, Stein, & Lester, 2006</xref>; <xref ref-type="bibr" rid="R44">Rotherham-Borus, Weiss, Alber, & Lester, 2005</xref>; <xref ref-type="bibr" rid="R47">Sengendo & Nambi, 1997</xref>; <xref ref-type="bibr" rid="R54">Tremblay & Israel, 1998</xref>; <xref ref-type="bibr" rid="R56">Wolchik, Tein, Sandler, & Ayers, 2006</xref>; <xref ref-type="bibr" rid="R57">Wood, Chase, & Aggleton, 2006</xref>).</p><p>It is important to note both the gender of the children as well as the gender of the deceased parent to understand the complexities of gender effects. Of these studies, four reported on the gender of parent and child, one provided no gender data and 12 described gender of the child. Seven of the studies proceeded to analyse the data by gender. Mixed gender differences were noted with patterns and clusters of response (see <xref ref-type="table" rid="T3">Table 3</xref>). There was no systematic difference pointing to overall gender differences.</p></sec></sec><sec><title>Discussion</title><p>Few studies report specifically on gender within the literature on HIV and child outcomes. Despite the wealth of literature on HIV treatment and children, and existence of clear systematic reviews of this evidence, gender is rarely even mentioned. When gender is recorded, a distinction between biological gender issues and pre-existing social factors is not explicit. Furthermore, if gender is recorded, it does not necessarily follow that results are analysed according to gender.</p><p>Gender of the child was not reported as a significant factor in outcome for medication adherence in a systematic review of adherence in children. Adherence is vital for efficacy in children (<xref ref-type="bibr" rid="R51">Simoni et al., 2007</xref>), yet the majority of studies are not conducted in resource-poor settings where the majority of HIV infected children reside. Studies are confounded by their coverage of a wide age range of children. These issues may have skewed the current picture. In terms of resistance to treatment, our analysis find that the only study to report on gender shows that males are reported at seven times greater risk than females. This dramatic finding was identified in the <italic>only</italic> study that carried out gender-based analysis (<xref ref-type="bibr" rid="R19">Delaugerre et al., 2007</xref>). In addition to this outcome of male vulnerability being particularly important given the traditional focus on female disadvantage, the finding vividly highlights the gender gap in the evidence base and would suggest an urgent need to examine resistance data by gender.</p><p>Similarly, gender disparities are noted in other areas of the child HIV treatment literature. Sex differences have been noted in disease progression in children (<xref ref-type="bibr" rid="R21">ECS, 2002</xref>, <xref ref-type="bibr" rid="R22">2003</xref>). Two studies have demonstrated that girls were at elevated risk of infection in mother to child transmission (<xref ref-type="bibr" rid="R25">Gabiano et al., 1992</xref>; <xref ref-type="bibr" rid="R52">Temmerman et al., 1995</xref>). <xref ref-type="bibr" rid="R53">Thorne and Newell (2004)</xref>studied 3231 mother child pairs (1684 boys (52%)and 1547 girls (47.9%)). Of these, 10.6% (350 children — 48.6% boys and 51.4% girls)were infected. Associations between gender and mother to child transmission in multivariable regression (allowing for antiretroviral treatment, cesarean section and maternal CD4 cell count)girls were 1.5 times at greater risk of HIV infection relative to boys. When the data were examined according to mode of delivery (Caesarian section or vaginal delivery), for C Section girls were twice as likely to be infected compared to boys. Read et al. (2003, cited in <xref ref-type="bibr" rid="R53">Thorne et al., 2004</xref>)noted in a meta-analysis of HIV postnatal transmission via breastfeeding that boys were at a significantly greater risk of HIV infection than girls. <xref ref-type="bibr" rid="R17">Coovadia et al. (2007)</xref>monitored 1372 infants and found that of those who were HIV negative at six weeks, mixed breast and formula feeding was associated with increased HIV infection to the infant. In this study they reported on gender (49% males, 49% females)and showed that gender played no part in transmission. These data lend further support to the need for systematic investigation of gender within child HIV research.</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Gender findings on systematic review of impact of HIV on schooling.</p></caption><table frame="hsides" rules="groups" width="100%"><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><thead><tr><td rowspan="1" colspan="1">Study</td><td rowspan="1" colspan="1">Country</td><td rowspan="1" colspan="1">Sample</td><td rowspan="1" colspan="1">Control group</td><td rowspan="1" colspan="1">Gender description Yes/No Child/Parent</td><td rowspan="1" colspan="1">Analysed by gender effects Yes/No Child/Parent</td><td rowspan="1" colspan="1">Child gender findings</td><td rowspan="1" colspan="1">Death of parent gender findings</td><td rowspan="1" colspan="1">Child and parent gender interaction</td></tr></thead><tbody><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R1">Ainsworth, Beegle, and Koda (2005)</xref></td><td rowspan="1" colspan="1">Tanzania</td><td rowspan="1" colspan="1">Kagera health and development survey - longitudinal survey from 1991 to 1994. About 757 households completed all rounds. Sixty-two primary schools</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Female negative effect on hours of attendance</td><td rowspan="1" colspan="1">Maternal death Negative effect on enrolment and attendance</td><td rowspan="1" colspan="1">Female maternal, female double orphans Negative effect on hours of attendance</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R2">Akresh (2004)</xref></td><td rowspan="1" colspan="1">Burkina Faso</td><td rowspan="1" colspan="1">Survey of 606 household heads and their 812 wives. About 300 paired households that had exchanged a foster child between 1998 and 2000</td><td rowspan="1" colspan="1">Siblings</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">-</td><td rowspan="1" colspan="1">-</td><td rowspan="1" colspan="1">-</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R8">Bennell (2005)</xref></td><td rowspan="1" colspan="1">Uganda, Malawi, Botswana</td><td rowspan="1" colspan="1">Review and analysis of empirical studies, DHS surveys</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">See below</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Botswana</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Maternal death Negative effect on repeating grade and dropping out Double parental death Negative effect on dropping out, positive effect on attendance</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Uganda</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Maternal death Negative effect on dropping out Paternal death Negative effect on repeating grade. Double death negative effect on dropping out positive effect on attendance</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Malawi</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">None independent of parental gender</td><td rowspan="1" colspan="1">Maternal death Negative effect on repeating grade</td><td rowspan="1" colspan="1"><italic>Female paternal orphans,</italic> male double orphans<break></break>Negative effect on dropping out Female paternal/ double negative effect on attendance</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R10">Bhargava (2005)</xref></td><td rowspan="1" colspan="1">Ethiopia</td><td rowspan="1" colspan="1">The National Survey of Prevalence and Characteristics of Orphans in Ethiopia (2001– 2002). (MMPI), ∼ 1000 orphans completed inventory</td><td rowspan="1" colspan="1">Non-AIDS orphans</td><td rowspan="1" colspan="1">Y Child<break></break>Maternal death</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>Female</italic><break></break>Negative effect on participation</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R11">Bicego, Rutstein, and Johnson (2003)</xref></td><td rowspan="1" colspan="1">Zimbabwe Kenya, Tanzania, Ghana, Niger</td><td rowspan="1" colspan="1">DHS surveys 1995–2000</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Maternal and double parent death Negative effect on correct grade level</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R13">Case and Ardington (2005)</xref></td><td rowspan="1" colspan="1">South Africa</td><td rowspan="1" colspan="1">Longitudinal data from a demographic surveillance area office. HSE surveys. ∼ 20,000 children</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">No gender difference on any measure of schooling</td><td rowspan="1" colspan="1">Maternal and double parent death Negative effect on enrolment, years completed money spent on education</td><td rowspan="1" colspan="1">No interaction</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R14">Case, Paxson, and Ableidinger (2004)</xref></td><td rowspan="1" colspan="1">Ten subsanaran Africa</td><td rowspan="1" colspan="1">Nineteen DHS studies (Ghana, Kenya, Malawi, Mozambique, Namibia, Niger, Tanzania, Uganda, Zambia, Zimbabwe)</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">No gender difference on any measure of schooling</td><td rowspan="1" colspan="1">No gender difference Negative effect on enrolment for all orphans</td><td rowspan="1" colspan="1">No interaction</td></tr><tr><td rowspan="1" colspan="1">Chatterji, et al. (2005)</td><td rowspan="1" colspan="1">Rwanda Zambia</td><td rowspan="1" colspan="1">Zambia: 496 primary caregivers, 504 children, 563 adolescents Rwanda: 570 primary caregivers 656 children, 402 adolescents</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">?</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R23">Evans and Miguel (2007)</xref></td><td rowspan="1" colspan="1">Kenya</td><td rowspan="1" colspan="1">About 7815 children with completed questionnaire data and parental mortality data</td><td rowspan="1" colspan="1">Y Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">No gender difference</td><td rowspan="1" colspan="1">Maternal death Negative effect on participation</td><td rowspan="1" colspan="1">No interaction</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R28">Kamali et al. (1996)</xref></td><td rowspan="1" colspan="1">Uganda</td><td rowspan="1" colspan="1">Rural population cohort 10,000 people 52% under 15 yrs. Demographic, socio-economic, serological surveys</td><td rowspan="1" colspan="1">Y Non-orphans</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1">?</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R36">Mishra et al. (2005)</xref></td><td rowspan="1" colspan="1">Kenya</td><td rowspan="1" colspan="1">The 2003 KDHS. About 9865 households. Population-based nationally–representative surveys link individual HIV test results</td><td rowspan="1" colspan="1">Y HIV + parents HIV- parents</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Female<break></break>Negative effect on attendance</td><td rowspan="1" colspan="1">Maternal death, paternal death Negative effect attendance<break></break>Double positive effect on attendance vs. single orphans</td><td rowspan="1" colspan="1">Not detailed</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R37">Monasch and Boerma (2004)</xref></td><td rowspan="1" colspan="1">Forty sun-Saharan Africa</td><td rowspan="1" colspan="1">Twenty-three MICS surveys Fourteen DHS surveys</td><td rowspan="1" colspan="1">Y Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">No gender difference On attendance</td><td rowspan="1" colspan="1">Double parental death<break></break>Negative effect on attendance</td><td rowspan="1" colspan="1">No interaction No difference maternal or paternal orphans, boys or girls</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R38">Nyamukapa and Gregson (2005)</xref></td><td rowspan="1" colspan="1">Zimbabwe</td><td rowspan="1" colspan="1">First round data from Manicaland study. About 8399 households About 2402 children of primary school completion age.</td><td rowspan="1" colspan="1">Y Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Male negative effect on completion rate</td><td rowspan="1" colspan="1">Maternal death Negative effect on completion rate Paternal death Positive effect on completion rate</td><td rowspan="1" colspan="1">Female paternal orphans<break></break>Positive effect on completion compared with non-orphans</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R48">Sharma (2006)</xref></td><td rowspan="1" colspan="1">Malawi</td><td rowspan="1" colspan="1">Longitudinal. Five rounds between 2000 and 2004.<break></break>Five hundred and thirty-four rural households</td><td rowspan="1" colspan="1">Y Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Female<break></break>Negative effect on dropping out</td><td rowspan="1" colspan="1">No gender difference Negative effect on dropping out for all orphans</td><td rowspan="1" colspan="1">No interaction</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R58">Yamano and Jayne (2005)</xref></td><td rowspan="1" colspan="1">Kenya</td><td rowspan="1" colspan="1">Three-year panel of rural household surveys. About 1266 households included in all three surveys.</td><td rowspan="1" colspan="1">Y Children No adult mortality</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Female<break></break>Negative before death<break></break>Male Negative after death</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr></tbody></table><table-wrap-foot><fn><p>Notes: DHS = Demographic & Health Surveys; HSE = Household Socio-Economic; KDHS = Kenya Demographic & Health Survey; MICS = Multiple Indicator Cluster Survey; C-SAFE = Consortium for Southern Africa Food Emergency; WFP = World Food Program; OVC = orphans and vulnerable children; PWH = parents with HIV/AIDS; STI = sexually transmitted infection.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Gender findings on systematic review of the effects of HIV on nutrition.</p></caption><table frame="hsides" rules="groups" width="100%"><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><thead><tr><td rowspan="1" colspan="1">Study</td><td rowspan="1" colspan="1">Country</td><td rowspan="1" colspan="1">Sample</td><td rowspan="1" colspan="1">Control group</td><td rowspan="1" colspan="1">Gender Yes/No Child/Parent</td><td rowspan="1" colspan="1">Analysed by gender Yes/No Child/Parent</td><td rowspan="1" colspan="1">Child gender findings</td><td rowspan="1" colspan="1">Death of parent gender findings</td><td rowspan="1" colspan="1">Child and parent gender interaction</td></tr></thead><tbody><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R10">Bhargava (2005)</xref></td><td rowspan="1" colspan="1">Ethiopia</td><td rowspan="1" colspan="1">National orphans in Ethiopia (2001–2002), ∼1000</td><td rowspan="1" colspan="1">Non-orphans and non-AIDS orphans</td><td rowspan="1" colspan="1">Y Child Parent (Maternal death only)</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Bridge, Kipp, Jhangri, Laing, and Konde-Lule (2006)</td><td rowspan="1" colspan="1">Uganda</td><td rowspan="1" colspan="1">Cross-sectional, questionnaire and anthropometric measures About 205 homes sampled</td><td rowspan="1" colspan="1">Children from non-AIDS affected households</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1"><italic>No gender difference</italic></td><td rowspan="1" colspan="1"><italic>No gender difference</italic> No negative effect for orphans on nutritional status</td><td rowspan="1" colspan="1"><italic>No interaction</italic></td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R15">Chatterji et al. (2005)</xref></td><td rowspan="1" colspan="1">Rwanda and Zambia</td><td rowspan="1" colspan="1">Zambia: 496 primary caregivers 504 children, 563 adolescents Rwanda: 570 primary caregivers, 656 children, 402 adolescents</td><td rowspan="1" colspan="1">Orphans compared with vulnerable children Other children</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R18">Crampin et al. (2003)</xref></td><td rowspan="1" colspan="1">Malawi</td><td rowspan="1" colspan="1">Population survey About 1106 children included</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R28">Kamali et al. (1996)</xref></td><td rowspan="1" colspan="1">Uganda</td><td rowspan="1" colspan="1">Rural population cohort 10,000, 52% < 15yrs</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Lindblade, Odhiambo, Rosen, and DeCock (2003)</td><td rowspan="1" colspan="1">Kenya</td><td rowspan="1" colspan="1">1999 with follow up in 2000, 1347 children at baseline,</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1"><italic>No gender difference</italic> On health and</td><td rowspan="1" colspan="1"><italic>Paternal death</italic> Negative effect on malnourishment</td><td rowspan="1" colspan="1"><italic>No interaction</italic></td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R34">Masmas et al. (2004a)</xref></td><td rowspan="1" colspan="1">Guinea-Bissau</td><td rowspan="1" colspan="1">78.3% follow-up Approximately 1100 interviews (300 case children, 800 non-orphan controls)</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent (Maternal)</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">nutritional status <italic>No gender difference</italic> On nutritional status</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1"><italic>-</italic></td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R35">Masmas et al. (2004b)</xref></td><td rowspan="1" colspan="1">Guinea-Bissau</td><td rowspan="1" colspan="1">Approximately 1100 interviews (300 case children, 800 non-orphan controls)</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent (Maternal death only)</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>No gender difference</italic> On mortality</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R36">Mishra et al. (2005)</xref></td><td rowspan="1" colspan="1">Kenya</td><td rowspan="1" colspan="1">The 2003 KDHS About 9865 households</td><td rowspan="1" colspan="1">Positive and negative parents</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child (Sample size too small)</td><td rowspan="1" colspan="1"><italic>Male</italic><break></break>Negative effect on stunting, being underweight and wasting</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Panpanich, Brabin, Gonani, and Graham (1999)</td><td rowspan="1" colspan="1">Malawi</td><td rowspan="1" colspan="1">Cross-sectional study (76 orphanage children, 137 village orphans, 80 village non-orphans)</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>Female — in orphanages</italic> Negative effect on malnourishment <italic>No gender effect — village orphans</italic></td><td rowspan="1" colspan="1">Maternal deathNegative effect on malnourishment</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R42">Rivers, Silvestre, and Mason (2004)</xref></td><td rowspan="1" colspan="1">Botswana Uganda Malawi</td><td rowspan="1" colspan="1">Analysis of: 30 DHS and MICS II surveys, two sub-national UNICEF surveys, six C-SAFE/WFP</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child<break></break>(Sample sizes small)</td><td rowspan="1" colspan="1"><italic>No gender difference</italic> On health and nutritional status</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Ryder, Kamenga, Nkusu, Batter, and Hey ward (1994)</td><td rowspan="1" colspan="1">Zaire</td><td rowspan="1" colspan="1">About 466 HIV + women, their children and fathers About 606 HIV-women, their children and the fathers</td><td rowspan="1" colspan="1">HIV- women and families</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R46">Sarker, Neckermann, and Muller (2005)</xref></td><td rowspan="1" colspan="1">Uganda</td><td rowspan="1" colspan="1">Cross-sectional survey (241 orphans, 278 non-orphan controls)</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>No gender difference</italic> On health status</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R55">Watts et al. (2007)</xref></td><td rowspan="1" colspan="1">Zimbabwe</td><td rowspan="1" colspan="1">Analysis of data from ∼30,000 children</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1"><italic>No gender difference</italic> On heath and nutritional status</td><td rowspan="1" colspan="1"><italic>Maternal death</italic> Heightened risk of stunting and being underweight<break></break><italic>Paternal death</italic> Heightened risk of stunting Double parental death heightened risk of being underweight</td><td rowspan="1" colspan="1"><italic>No interaction</italic></td></tr></tbody></table><table-wrap-foot><fn><p>Notes: DHS = Demographic & Health Surveys; HSE = Household Socio-Economic; KDHS = Kenya Demographic & Health Survey; MICS = Multiple Indicator Cluster Survey; C-SAFE = Consortium for Southern Africa Food Emergency; WFP = World Food Program; OVC = orphans and vulnerable children; PWH = parents with HIV/AIDS; STI = sexually transmitted infection.</p></fn></table-wrap-foot></table-wrap><p>Our original systematic reviews demonstrate the lack of attention given to gender considerations in key areas of the children and HIV literature. Of those that do analyse data with gender as a variable, findings are equivocal. Our review identifies females at a disadvantage for school attendance and achievement, with more mixed findings for nutritional status and bereavement outcomes. Male children may be at a disadvantage with respect to treatment resistance. Parental gender is much less well explored, with only four of 15 papers on bereavement reporting the gender of the deceased parent. We know that reporting orphan type in terms of parent gender is vital (Sherr, Varrall, Mueller, & JLICA Working Group 1, 2008). Individual settings and circumstances need to be taken into account given the lack of comprehensive data. No clear difference by gender was found within the cognitive development and HIV literature (<xref ref-type="bibr" rid="R50">Sherr et al., 2008</xref>, in press), however, as only four of 54 studies analysed by gender, conclusions are tentative. These findings need to be treated with caution given that the overall literature is inadequate, with gender often under reported and analysed.</p><p>Overall, the child literature is difficult to navigate. The neglect of gender information in parenting, a constant oversight of fathers and the focus on mothers may skew understanding. In studies of early childhood there is often incomplete gender data. This is most notable for babies, where the term “infant” supplants male and female infants, and the literature is invariably not disaggregated by gender. Even when gender is recorded, the data is often not analysed according to gender and thus data for evidence-based understanding (such as in transmission, infection, outcome, schooling, nutrition, bereavement and cognitive development)is not clarified by gender. Many major policies fail to provide gender data for young children. Global statistics are collected by gender only for those over 15 years of age. This was true for many reports such as World health Organisation, UNAIDS and international country data sets. Treatment need, uptake, rollout, cotrimoxicol availability were all not recorded according to gender in global statistics. It is crucial to know of any gender considerations in terms of treatment access and availability. Not surprisingly there appears to be a lack of gender focus in programmatic provision for young children; girl children run a risk of discrimination whilst boy children may be overlooked.</p><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Gender findings for systematic review of studies on the effect of HIV and bereavement.</p></caption><table frame="hsides" rules="groups" width="100%"><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><thead><tr><td rowspan="1" colspan="1">Study</td><td rowspan="1" colspan="1">Country</td><td rowspan="1" colspan="1">Sample</td><td rowspan="1" colspan="1">Control Group Yes/No</td><td rowspan="1" colspan="1">Gender Yes/No Child/Parent</td><td rowspan="1" colspan="1">Analysed by gender Yes/No Child/Parent</td><td rowspan="1" colspan="1">Child Gender findings</td><td rowspan="1" colspan="1">Death of Parent Gender findings</td><td rowspan="1" colspan="1">Child and Parent gender interaction</td></tr></thead><tbody><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R6">Atwine, Cantor-Graae, and Bajunirwe (2005)</xref></td><td rowspan="1" colspan="1">Uganda</td><td rowspan="1" colspan="1">11–15 yrs 123 case children (parent(s) died of AIDS), 110 controls</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">No gender difference on psychological distress measures</td><td rowspan="1" colspan="1"><italic>No gender difference</italic> On psychological distress (orphans higher distress)</td><td rowspan="1" colspan="1"><italic>No interaction</italic></td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R10">Bhargava (2005)</xref></td><td rowspan="1" colspan="1">Ethiopia</td><td rowspan="1" colspan="1">The National Survey Orphans in Ethiopia (2001–2002) Approximately 1000</td><td rowspan="1" colspan="1">Non-orphans and non-AIDS</td><td rowspan="1" colspan="1">Y Child Parent (Maternal death)</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>Female</italic><break></break>Negative effect on emotional adjustment and social adjustment</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R16">Cluver and Gardner (2006)</xref></td><td rowspan="1" colspan="1">South Africa</td><td rowspan="1" colspan="1">6–19 yrs Thirty case/30 matched controls</td><td rowspan="1" colspan="1">Non-orphans</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">No gender differences<break></break>On psychological well-being</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R20">Dowdney et al. (1999)</xref></td><td rowspan="1" colspan="1">UK</td><td rowspan="1" colspan="1">2–16 yrs<break></break>Sixteen boys, 29 girls matched controls</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1"><italic>Male</italic><break></break>Negative effect on externalising scores, and total problem scores</td><td rowspan="1" colspan="1"><italic>No gender difference</italic> Psychological disturbance scores</td><td rowspan="1" colspan="1"><italic>No interaction</italic></td></tr><tr><td rowspan="1" colspan="1">Forehand et al (1999).</td><td rowspan="1" colspan="1">USA</td><td rowspan="1" colspan="1">6–11 yrs 20 case children 40 controls</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y maternal death</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1"><sup>–</sup></td><td rowspan="1" colspan="1"><sup>–</sup></td><td rowspan="1" colspan="1"><bold>–</bold></td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R27">Gregson et al. (2005)</xref></td><td rowspan="1" colspan="1">Zimbabwe</td><td rowspan="1" colspan="1">15–18 yrs About 1523 teenagers population survey</td><td rowspan="1" colspan="1">Non-OVC</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1"><italic>Female</italic><break></break>Increased risk of HIV infection, STI symptoms and teenage pregnancy</td><td rowspan="1" colspan="1"><italic>Maternal death</italic> Increased sex and marriage, no secondary school education, poor reproductive health.</td><td rowspan="1" colspan="1"><italic>Female maternal orphans</italic><break></break>Increased risk HIV poor reproductive health, commencement of sex and marriage, no secondary school</td></tr><tr><td rowspan="1" colspan="1">Lee, Detels, Rotherham-Borus, and Duan (2007).</td><td rowspan="1" colspan="1">USA</td><td rowspan="1" colspan="1">11–18 yrs About 206 adolescents with PWH intervention, 207 control group</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Male<break></break>Increased risk of depression</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R30">Lester et al. (2006)</xref></td><td rowspan="1" colspan="1">USA</td><td rowspan="1" colspan="1">12–18 yrs About 423 adolescents intervention vs. no intervention</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Female<break></break>increased risk of depression</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R33">Makame, Ani, and Grantham-McGregor (2002)</xref></td><td rowspan="1" colspan="1">Tanzania</td><td rowspan="1" colspan="1">10–14 yrs Forty-one AIDS orphans, 41 controls</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Female negative effect on internalising problems</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Operario, Pettifor, Cluver, MacPhail, and Rees (2007)</td><td rowspan="1" colspan="1">South Africa</td><td rowspan="1" colspan="1">15–24 yrs<break></break>About 11,904 cases national survey</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>Female</italic><break></break>Increased risk of HIV infection, commencement of sex and multiple partners Male Increased risk of unprotected sex</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R43">Rotherham-Borus, Stein, and Lester (2006)</xref>.</td><td rowspan="1" colspan="1">USA</td><td rowspan="1" colspan="1">11–18 yrs<break></break>Longitudinal 6 year study, 288 (intervention vs. no intervention)</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>Female</italic><break></break>Increased risk of emotional distress <italic>Male</italic><break></break>Increased substance</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Rotherham-Borus, Weiss, Alber, and Lester (2005)</td><td rowspan="1" colspan="1">USA</td><td rowspan="1" colspan="1">11–18 yrs<break></break>Six year study About 414 adolescents</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child Parent</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>No gender difference</italic> On psychosocial adjustment</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Sengendo, and Nambi (1997)</td><td rowspan="1" colspan="1">Uganda</td><td rowspan="1" colspan="1">About 172 orphans (6–20 yrs), 24 controls</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1">Y Parent</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1"><italic>Maternal death</italic> Increased risk of depression</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Wolchik, Tein, Sandler, and Ayers (2006)</td><td rowspan="1" colspan="1">USA</td><td rowspan="1" colspan="1">Mean age 11.46, 339 cases longitudinal</td><td rowspan="1" colspan="1">Y</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1">Y Child</td><td rowspan="1" colspan="1"><italic>Female</italic><break></break>Negative effect on fear of abandonment, internalising problems and self-esteem</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr><tr><td rowspan="1" colspan="1"><xref ref-type="bibr" rid="R57">Wood, Chase, and Aggleton (2006)</xref></td><td rowspan="1" colspan="1">Zimbabwe</td><td rowspan="1" colspan="1">7–22 yrs<break></break>Fifty-six O VC, 41 adults</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">N</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td></tr></tbody></table></table-wrap><p>Despite well-established gender challenges in later life, the omission of gender data from current policy and research leads to ignorance by neglect. Gender needs to be routinely monitored and analysed in research with young children. Clear gender differences in early adulthood, such as distribution of HIV infection by age, treatment access and adherence cannot be traced to childhood if no data are available. Data on gender variation and outcome are urgently needed to inform policy and research. 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|clé= PMC:2903774
|texte= Evidence-based gender findings for children affected by HIV and AIDS — a systematic overview
}}
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| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a SidaSubSaharaV1
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