AIDS orphans in Kinshasa, Zaïre : incidence and socioeconomic consequences

A longitudinal case-control study was conducted over the period 1986-90 to assess the incidence morbidity mortality and socioeconomic consequences of becoming an AIDS orphan in Kinshasa Zaire. One group of control children was comprised of age-matched children with HIV-1-seropositive mothers who were alive at the time of death of the AIDS orphan case mother. The second group was comprised of children with HIV-1-seronegative mothers who were also alive at the time of death of the AIDS orphan case mother. Participants were recruit from the obstetric ward and follow-up clinic at two large municipal hospitals in Kinshasa Zaire and included 466 HIV-1 seropositive women their children and their fathers and 606 HIV-1-seronegative women and their children and fathers. The AIDS orphan incidence rate was 8.2 per 100 HIV-1 seropositive women-years of follow-up. Vertical rates of HIV-1 transmission were 41% and 26% respectively in AIDS orphan cases and in control children with HIV-1-seropositive mothers. Among children without vertically acquired HIV-1 infection morbidity rates and indices of social and economic well-being were similar for both AIDS orphans and control children. Five of 26 AIDS orphan cases and three of 52 control children died during follow-up. The authors conclude that children with HIV-1 seropositive mothers had a considerable risk of becoming AIDS orphans but the presence of a concerned extended family appeared to minimize any adverse health and socioeconomic effects experienced by orphan children.