HIV-infected children in Ukraine worse off in orphanages

Children infected with HIV are better off in a disadvantaged family than in a materially well-provided orphanage. This is the outcome from research carried out by Leiden child education specialists among HIV-infected children in the Ukraine. Their findings will be published this month in Child Development.

Natasha Dobrova-Krol: ‘HIV-infected children in orphanages would benefit from greater stability and personal care.'

Delayed development

Natasha Dobrova-Krol and her colleagues from the department of Education and Child Studies studied 64 Ukrainian children with an average age of 4 years; some of these were infected with HIV, others were not. Of the two groups, half lived with their parents, and the other half had been living for the past six months in an orphanage. The material and medical conditions in the orphanages that formed part of the study were good. Nonetheless, growing up in an orphanage seems to be linked to arrears in physical growth and in cognitive development. HIV-infection was also a factor in delayed development, but the negative effects of institutional care were much greater.

Lack of stability

The research findings confirm Dobrova-Krol's suspicions based on previous studies: institutional care has a negative effect on the child's optimal development. In terms of their development, HIV-infected children in a family were better off than children brought up in an institution, whether they were infected or not. And this applied even though the families concerned were struggling with major problems: poverty, drug addiction and inadequate housing. In the orphanages, thre is better medical care and supervision of medication. But Dubrovna-Krol says: 'It seems to be primarily the stability and quality of the relationship with the carer that matters. This is precisely what is missing in orphanages. Children grow up in large groups, with a group of carers twho are constantly changing. By the age of three, a Ukranian orphan will have had at least 30 different carers.'

Standing on their own two feet

Dobrova-Krol herself grew up in the Ukraine before moving to the Netherlands in 2001. The situation in Ukrainian orphanages has affected her deeply since she worked as a volunteer in such an orphanage during her student time. 'What I immediately became aware of was the need of the older children to share their problems with me,' she explains. 'It is very difficult for them to learn to stand on their own two feet. Other studies have shown that the delay in development of institutionalised children only increases as they grow older. Many children end up living in poverty or turning to crime.'

Ukraine is among the top three European countries for the most rapid spread of AIDS. Twenty per-cent of children of mothers with HIV end up in orphanages.'

Epidemic

Population statistics from UNICEF paint a sombre picture of the future in the Ukraine. The country is suffering from poverty, unemployment and a high rate of drug addiction, and is currently one of the top three countries where the AIDS epidemic is spreading most rapidly. Twenty per-cent of children whose mothers are infected with HIV are rejected and end up in an orphanage. Dobrova-Krol: ‘These children are avoided by adoption agencies and foster parents. As a result they often have no other option than institutional care.'

Adoption

In the opinion of Dobrova-Krol, this situation has to change. 'Every effort should be focused on preventing such children being rejected. Families where there is HIV should be given social and financial support in fulfilling their tasks in bringing up their children. 'If a child is abandoned by its family, then the Ukrainian government should do everything possible to stimulate foster care and adoption. 'Care within an adoptive family is not only better for the child, it is also less than half the cost of care within an orphanage.'

Stable and sensitive care

And what about if, in spite of all the efforts, a child is still placed in the care of an orphanage? 'In that case, stable and sensitive care is the prime consideration.' says Dobrova-Krol. ‘This means that the way orphanages are organised has to change: fewer children in a group, more carers, and more consistent work rosters. Children need stability and personal care.'

By the age of three, a Ukrainian orphan will have had at least 30 carers.

Practical follow-up

Dobrova-Krol, who obtained her doctorate in December based on broader research among HIV-infected children in the Ukraine, is aware that the orphanages themselves feel the need for practical follow-up on the Leiden study. 'The orphanages are particularly keen to know what they can do to improve their care. We are now planning follow-up studies to see how we can help the people running the orphanages to respond better to the development needs of the children, including the one-to-one contact.'

Training programme

Dobrova-Krol has high expectations of such interventions. Professor Rien van IJzendoorn's research group, of which Dobrova-Krol is a member, has previously developed a training programme that uses video feedback to provide parents and carers with advice on child-rearing. The programme encourages a sensitive approach to upbringing and so could be of help to the carers in the Ukrainian orphanages. Dobrova-Krol's doctoral research has shown that sensitive care promotes better physical growth and improved cognitive development of orphanage children infected with HIV. Sensitive care is also linked to a safe bond between child and parents.

ISED prize

The publication by Dobrova-Krol and her colleagues was last year crowned with the ISED prize for an article in an international publication. The jury's comment was that it was an excellent, relevant study, with an innovative aim and significant results. The prize, consisting of a certificate and a financial award, was presented to Dobrova-Krol at the national ISED Day on 12 November 2009.

Dobrova-Krol, N.A., Van IJzendoorn, M.H., Bakermans-Kranenburg, M.J., & Juffer, F (2010). Effects of Perinatal HIV Infection and Early Institutional Rearing on Physical and Cognitive Development of Children in Ukraine. Child Development, 81(1), 237-251.

(23 February 2010/Tristan Lavender)