Commentary: Pediatric Psychology Research Informing Policy for AIDS-Affected Youth in Africa

Two articles in this issue of the Journal of Pediatric Psychology (JPP) address the impact of HIV/AIDS on children and adolescents in Africa (Cluver et al, in press; Puffer et al., in press), where the AIDS epidemic continues to take a costly toll on families. In Kenya 6.3% of the population has HIV (1.5 million individuals) and these numbers climb in South Africa, where 17.8% of people live with HIV (5.6 million people) (Joint United Nations Programme on HIV/AIDS, 2010). These papers represent important work in the area of pediatric psychology and warrant attention both from researchers in the area of HIV/AIDS and from the field as a whole. As such, we would like to praise some of the unique strengths that these articles contribute to this area of inquiry as well as highlight the importance of these efforts to the field and pediatric psychology in general. Specifically, these works are excellent examples of the importance of working with populations that can be difficult to access, the necessity of considering the cultural framework of research populations, and the potential for connecting research to policy in meaningful ways. The authors of both studies should be commended for the work presented here. There are relatively few published studies related to families affected by HIV/AIDS in Africa because of the numerous challenges inherent in executing such work. Both studies presented in this issue used methods designed to obtain a representative sample, no easy task in research with vulnerable populations. Obtaining approvals to work with vulnerable youth can be challenging, and designing studies such that communities will be interested and willing to participate is critical to success. Furthermore, Cluver and colleagues conducted longitudinal tracking of orphans, noting challenges due to settlements being destroyed and children living in transient housing and other dangerous living situations. To retain 71% of this highly unsettled sample after 4 years is a testament to organization, perseverance, and belief in the value of the work being done. Furthermore, this high retention rate speaks to the valuable relationships formed between researchers and families living with this devastating illness. Description of the strategies used to build community connections in future publications will be helpful to advancing these kinds of endeavors in other countries. Without such efforts and long-term bonds, information affecting the welfare of these children would be lacking. Next, both manuscripts provide excellent descriptions of the cultural contexts in which the studies were conducted, aiding the reader’s understanding of the relevance of the work and providing a framework for considering the findings. Understanding cultural norms is critical to HIV/ AIDS research. For example, Puffer and colleagues note specific factors of orphans’ lives in Muhuru Bay, Nyanza Province that may predispose youth to risk, including economic disadvantages and cultural norms that increase the likelihood of engaging in higher risk sex. These rich descriptions enhance the reader’s ability to draw conclusions from the data. A description of cultural norms is also essential for communicating with both international and national audiences where context plays a central role in shaping behavior and may be different from broader societal norms.