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AIDS & CLASS.

How disease affects life, psychological health, relationships, intervention issues in families at lower socioeconomic levels.

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The purpose of this research is to examine how AIDS affects family life and experience in lower socioeconomic levels of society. The plan of the research will e to set forth the pattern of ideas articulated in two articles that give an account of a study of families in this group deal with this subject and then discuss the relevance of each study report to social work, as well compare and contrast the strengths and weaknesses of each.
The study by Lesar and Maldonado (1997) sought to identify which aspects of family life are affected and to measure statistically the experience of being psychologically, economically, and socially on adults and children in households where children are infected with AIDS. The focus of study by Rotheram-Borus and Others (1998) was on measuring statistically factors of conflict and stress between adolescents and parents in house

277) in thepart of California where he research was done. In their discussion of factors fostering parent-adolescentconflict and stress in households with PLAs, they conclude that parentallifestyle pathology, from unsafe or frequent sex to drug use, has far moreto do with stress levels than the fact of AIDS itself. The purpose of this research is to examine how AIDS affects familylife and experience in lower socioeconomic levels of society. 91),though they note that perceptions of stress by parents, not children, weremeasured in this study. 273). However, in the study by Rotheram-Borus, et al., therewas an attempt to replicate in the sample the demographic case profile ofthe group identified by the Centers for Disease Control as typical of casesof heterosexual AIDS, i.e., mainly Latino or African American mothers. The relevance of AIDS to family pathology and hence to social work inthese studies is the level at which intervention is optimally conceived.The study by Lesar and Maldonado points in the direction of support groupsfor affected populations and educational outreach to extended family andsignificant others on the part of social workers, who may be wellpositioned to help destigmatize pediatric AIDS. However, they also note thatin many pediatric-AIDS families contain parents who are also infected andwho often conceal the nature of their or their children's illness becauseof the social stigma of AIDS. The study by Rotheram-Borus, et al. A further aspect of stress in this regard is anexternality: the fact that 63% of the households under study "were onpublic assistance and unemployed currently" (1998, p. This would seem on its face to be ahighly practical bit of advice, although they do imply that the highlylimited public and private funding for facilities and staff might make suchresources difficult to create. Bothstudies appear to have been undertaken with a view toward forecastingpossible lines of development of clinical outreach protocols that couldrespond effectively to populations that comprised the subjects ofinvestigation. Pediatric AIDS arrests bothphysical and emotional development of children at the very time "whenchildren are expected to become more autonomous" (Lesar & Maldonado, 1997,p. AIDS aggravatesthe intensity of strains on family life and stability that are common tothe development of virtually any family. 87). 277). Thiswould be especially true in families of lower educational or socioeconomicstatus, which points to a persistent pattern of family stress and chaos. The child's helplessness in turn, Lesar and Maldonado hypothesize,may "have a far-reaching impact on the whole family" (p. Parent-adolescent conflict and stress when parents are living withAIDS. Impact of children with HIVinfection on the family system. Nevertheless, what makes AIDS households differentis the marked presence of specific manifestations of socially andphysically pathological behavior--which, to be sure, might have acted as anAIDS catalyst patterns of PLAs--consistent with life in substance-abusingor multiple-sex-partner families and consistent with failures of "medicaladherence," or commitment to treatment protocols. Both studies cited in this research made use of statistical models toanalyze the results of their data collection, and both establish thebackground for the scope of study by referencing existing literature onrelated topics. In otherwords, the experience of social isolation might overwhelm the a need andopportunity for social workers to shape a scenario and protocol ofintragroup support of families affected by pediatric AIDS. 85). (1997, June). . M., & Draimin, B. 85). Second, they say the following: PLAs probably do notchange these [lifestyle pathology] patterns immediately upon learning theyare seropositive for HIV" (Rotheram-Borus & Others, 1998, p. . Equally, they note, the limited size of thesample study, including the self-selected nature of the subjects of study,mean that the subjects "may in fact compose a somewhat different group thanthe total sample of pediatric HIV-exposed children" (1997, p. They refer to the "opportunity toimprove problem-solving skills, coping repertoire, and overallinterpersonal relationships" (1997, p. 273). In other words,social factors per se and not epidemiological factors or physical symptomsof AIDS, contributed to adolescent-PLA conflict. The focusof study by Rotheram-Borus and Others (1998) was on measuring statisticallyfactors of conflict and stress between adolescents and parents inhouseholds where one or more family members (not children especially) haveAIDS, and whether and to what extent the presence of AIDS in a given familyfunctioned as a key factor determining the nature of the relationship. 92), or essentially engaging in interventions at theindividual-family and/or individual-patient level that would be meant totruncate the continuation of lifestyle pathologies of PLAs that exacerbatesocial pathology, including or especially the experience of stress in theparent-adolescent relationship. This is especially significant in light of a point that Lesar andMaldonado do make, that families containing pediatric AIDS "have lesscommunity support . In the interim, they suggest a rather wide rangeof possible intervention strategies of which social workers might be apart. Given the social stigma attached to AIDS,particularly among populations of lower socioeconomic status, it isdifficult to construct a scenario wherein a non-AIDS caregiver of apediatric-AIDS child would lend support to, or trust "experience-basedadvice" being lent by, an AIDS-infected caregiver of a pediatric-AIDSchild. In Lesarand Maldonado's study, a unique subject-recruitment criterion was thatfamilies had to have a child infected with AIDS; in the other study theunique recruitment criteria were that an adolescent had to be present inthe household and that one or more parents in the household had beendiagnosed with AIDS. Lesar and Maldonado describe the uniquelydestructive influence of pediatric AIDS on normal family routine, owing tothe chronic nature of the disease and the fact that in many households withpediatric AIDS, at least one adult is likely to have AIDS, which can betransmitted perinatally from mother to child. It is with these behaviorpatterns, which may be found among non-AIDS families and AIDS familiesalike, and which are statistically concentrated at the lower end of thesocioeconomic scale, that evidence of adolescent-parent conflict can bemost credibly associated. J., Robin, L., Reid, H. This does not men that social workers should somehow be barred fromattempting to facilitate support-group intervention or educational outreachto social networks of families affected by AIDS; it does mean that there islikely to be a gap between the conception and the execution of such worthygoals. Rotheram-Borus, M. Thus the AIDS per se, i.e., AIDS as a chronic or terminal illness, isnot necessarily the problem as far as psychoemotional and psychosocialfamily stressors in AIDS-infected households are concerned. However, the study by Rotheram-Borus, et al, (1998) appearsto have accomplished data analysis more effectively and meaningfully thanthe one by Lesar and Maldonado (1997). The study by Lesar and Maldonado (1997) sought to identify whichaspects of family life are affected and to measure statistically theexperience of being psychologically, economically, and socially on adultsand children in households where children are infected with AIDS. A. [and] less peer-group identity than do homosexualmen," who comprise a significant percentage of the HIV population. . Now they suggest educational outreach toaffected families and to the extended social networks of such families, aswell as the establishment of support groups in clinical settings that wouldfunction as a caregivers' resource. Citing the difficulties of delivering physical and psychologicalhealth care to AIDS-infected families and the social stigma associated withAIDS in general, as well as the concentration of new AIDS cases insocioeconomically disadvantaged neighborhoods and populations inparticular, the study of parent-adolescent conflicts hypothesized that"sociodemographic factors [e.g., household income, gender, ethnicity],physical health [e.g., overall well-being of parents], and the parents'lifestyle" [e.g., use of controlled substances, safe-sex practices] couldaffect the stressful and chaotic character and level of conflict and stressin households where there are parents living with AIDS, or PLAs (Rotheram-Borus & Others, 1998, p. But this is somewhat problematic. References Lesar, S., & Maldonado, Y. (1998,Spring). 274; Rotheram-Borus & Others, 1998, p. 84). Family Process, 37, 83-94. suggests "the importance of preventive interventions forPLAS" (1998, p. The scope of each study was limited by the demographics ofsubjects, inasmuch as subjects were recruited from the ranks of social-service case populations served by health-related agencies (Lesar &Maldonado, 1997, p. 277)point out, studies of HIV impact on the family "is a relatively recenttopic of investigation." Accordingly, Lesar and Maldonado explain that morestudy needs to be done on the caregiving parents' perceptions of how AIDSimpacts family experience. Families in Society, 78, 272-79. The plan ofthe research will e to set forth the pattern of ideas articulated in twoarticles that give an account of a study of families in this group dealwith this subject and then discuss the relevance of each study report tosocial work, as well compare and contrast the strengths and weaknesses ofeach. First they refer to studies showing that families withchronic or terminal illness nevertheless may successfully maintainhousehold routines. In addition, one importantfactor that Lesar and Maldonado do not seem to fully appreciate with regardto the shape that social worker intervention might take is that in manypediatric-AIDS households, where caregiving parents, like children, may beinfected with the disease, parental-lifestyle behavior vis-à-vis AIDS maynot necessarily foster positive response to such support resources as mightbe made available to caregivers. An important reason for this can be found in the study by Rotheram-Borus, et al. This, asRotheram-Borus, et al, point out, is inconsistent with "earlier studies ofchildren living with parents with other chronic illnesses" (1998, p. That is not because the latter studywas in itself flawed but rather because, as Lesar and Maldonado (p. They make two pointsin this regard. The impactmay be financial or emotional and may extend beyond the nuclear unit towardfamily members/caregivers who do not live in the household.

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