Previous studies have indicated that children were vulnerable for development disruptions when a parent became chronically ill and was under emotional distress (Bauman et al., 2002
; Keypour, Arman, & Maracy, 2011
). In this study, we found that children’s self-esteem, everyday stress, and delinquent behaviors were related to families with both HIV-infected parents. In the families with both HIV-infected parents, children face more challenges in dealing with insecurity, financial difficulties, and discrimination associated with HIV, which could lead to worries and pressure for family responsibilities. Children living in such families may also lack family affection and care necessary for their well-being, which increased the risk to develop psychological and behavioral problems (Fang et al., 2009
; Wild, 2002
). These challenges became serious for children in the families with both HIV-infected parents, as they are often deprived of capable adult caregivers. The finding has suggested that special attention is needed for children living with both HIV-infected parents.
Parental care is important to children’s behavioral adjustment and mental health. As anticipated, there are significant correlations between parental care and children’s self-esteem and delinquent behaviors. A recent study indicated that HIV-infected mothers were often more stressed in their parental roles and exhibited poorer parental skills (Murphy et al., 2010
). The poorer parental skills led to poor quality of parental care, and this was the underlying mechanism for children’ problematic behaviors in association with parental HIV infection (Murphy et al., 2010
). Poor parental care also weakened parent–child bonding, which played an important role in children’s psychological development. Children often imitate and model their parents’ behaviors (Jones, 2007
; Ohene, Ireland, McNeely, & Borowsky, 2006
). The HIV-affected parents’ self-esteem (Murphy, Marelich, & Amaro, 2009
; Usmiani & Daniluk, 1997
) and psychological adjustment (Lee et al., 2002
), in particular, affected their children’s self-esteem and psychological adjustment. All factors mentioned above significantly attributed to children’s behavioral problems such as low self-esteem and delinquency. A family is the primary origin of the behavior patterns and the basic unit of care for children. Thus, family-centered intervention programs have the potential to help families and children to fight against the negative impact of global HIV epidemics.
We found that some PLHs’ indicators such as gender and education were associated with children’s everyday stress. In contrast to the previous studies (Cederfjäll, Langius-Eklo, Lidman, & Wredling, 2001
), we found that male PLHs had significant influence on their children’s everyday stress compared with female PLHs. This might indicate the crucial role of fathers in family lives and family structures. In poor rural areas, males are usually the breadwinners and bear the primary responsibilities of the whole family. A family will experience serious economic distress with male HIV-affected parents and a family’s ability to maintain normal family functions will diminish, suggesting the important role of fathers in children’s well-being (Sherr, 2010
). PLHs with higher education might have more resources to better deal with the challenges and give their children a better family environment. The study indicated that children’s everyday stress was increased in families with both HIV-affected parents and in families with two or more children.
Several potential limitations should be noted. First, the sample sizes were not large enough to solidly identify some relationships. Second, the dependence on self-reported measures may cause possible information bias. Third, the cross-sectional design of the study prevents the establishment of causality; for example, we cannot determine the causal direction between parental care and delinquent behaviors. Fourth, there could be some other unmeasured potential factors correlated with children’s stress and delinquency. Fifth, since the Everyday Stressors Index used in this study had not been previously validated with young children, conclusions based on the instrument should be made with caution. In addition, the study was conducted in a rural area where a large proportion of HIV infections were caused by former plasma donations and most PLH participants were farmers, with low levels of education and family income (Ding, Li, & Ji, 2011
). The challenges faced by children living in these families may differ from those living in urban areas of China.
The findings of this study support the importance of improving parental care to enhance children’s psychosocial health and children’s behavior adjustment impacted by parental HIV infection. The findings suggest that the severity of psychological and behavioral problems of children living in different HIV-affected families may be dependent not only on children’s own factors but also on their parental and family level factors. Therefore, parental and family level factors should be considered when providing care and support to children living in HIV-affected families.