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Book and Media Reviews
August 16, 2006

Children and HIV

Author Affiliations

Book and Media Reviews Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA.

JAMA. 2006;296(7):869-873. doi:10.1001/jama.296.7.870-a

A Generation at Risk makes a huge contribution to our understanding of the impact of the HIV epidemic upon children. The book examines clearly and concisely the effect on children's lives in developed and developing countries. The authors rightly point out that children were neglected in early discussions on the epidemic.

The book provides invaluable insight into children's lives and what it means to watch a parent become sick and die. There is a cascade of events in children's lives during the illness and death of a parent. Children are often the chief caregivers for a sick parent and suffer great anxiety before the death; they worry about the parent and then about their future after the parent dies. After the death, the grieving child may be removed from the familiar community and from the school, which often provides the only remaining structure in the child's life. Grief may be suppressed or simply not given an opportunity for expression, because practical issues predominate. The psychological impact on children is often overlooked, and they are then more likely to be depressed and anxious, with subsequent behavioral problems that further reduce their chances of being cared for properly.