Fathers and HIV/AIDS: A Missing Factor in Developing Interventions But Not in the Lives
6.3 Special Populations and Issues
(Danziger 1995 ; Inazu and Fox 1980 ). Children reporting initiation of sexual intercourse during teen years often report high levels of confl ict and/or strained relationships with their parents (Longmore et al. 2009 ; Price and Hyde 2009 ) . Conversely, adolescents reporting warm and supportive relationships with parents and lower levels of family confl ict tended to delay initiation of intercourse (Lenciauskiene and Zaborskis 2008 ; Price and Hyde 2009 ) .
Other studies that focused on father–child communication revealed interesting fi ndings. Lehr and colleagues ( 2005 ) examined predictors of father–child commu-nication about sexuality among a sample of 155 fathers of adolescent sons. Fathers were more likely to talk with sons who were further along in pubertal development.
Fathers who had more permissive sexual values were more likely to share sexuality information with their sons. The study fi ndings also revealed that fathers with lower education levels reported more sexuality communication with their sons.
Additionally, fathers who had more communication with their own fathers about sexuality reported more sexuality communications with their sons. Likewise, fathers who had more positive outcome expectations (e.g., talking to their sons about sex would strengthen their relationship with their sons, prevent their sons from engaging in negative health behaviors) were more likely to engage in sexual-ity communication with their sons. Similar to other studies examining self-effi cacy as a determinant of the sexuality communication between parents and children, fathers who reported greater self-effi cacy for sexuality communication reported more sexuality communications with their sons (Lehr et al. 2005 ) . Kirkman and colleagues ( 2002 ) interviewed 32 parents (including mothers and fathers) and 19 adolescents ages 12–14 with the intention of learning the diffi culties fathers have in communicating about sexuality with children. Results revealed that fathers experienced diffi culties in sexual communication because they felt that it was the mother’s role to talk with children about sex.
A more popular term for serodiscordant couples is magnet couples (i.e., one positive, one negative viewed synonymously as the polarities of magnets). This raises questions regarding the needs of fathers in their roles as providers and caregivers to children and adolescents with HIV/AIDS. Additional issues emerge with regard to fathers with signifi cant others and mothers who are HIV-positive and how this impacts their roles and responsibilities as caregivers and providers as well as how their partner’s status affect their own health and mental health needs.
6.3.2 Gay Fathers
The number of gay fathers is on the rise and some of these men are seropositive themselves and may be adopting seropositive children. The attention to this issue is extremely sparse. Only one report to date was located that focused on being a gay father living with HIV. In a discussion on his decision to father a child after being diagnosed with HIV, Blum ( 2008 ) wrote:
I became a father at the age of 40, after having been HIV-positive for more than 10 years. My family includes my son, his bisexual mother, and my male partner of 7 years, as well as our families and friends. Our son just celebrated his second birthday – full of laughter and in love with trucks, balls, and animals. (p. 5) Blum ( 2008 ) further discusses his father identity in relation to his gay identity.
He added:
Parenthood is one of the greatest achievements of my life. There is always something new, profound, common, thrilling, and, at times, overwhelming. Although I am a gay dad, very little of my life is “gay” as I once defi ned it. To me, being “gay”
meant pursuing cultural and political activities, engaging in an active social life with other gay people, and taking adventure-fi lled vacations. Now, the free time neces-sary to engage in these activities is a thing of the past. When I am not working, I am taking care of our son. (p. 7).
Because of the gay rights movement fatherhood is now a viable option for gay men. The role of gay fathers in the context of HIV treatment, prevention, and care is an area greatly in need of attention. As members of family systems, the potential for gay fathers to play an important role in reducing the spread of HIV among children and youth are endless. Understanding is needed regarding the role of gay fathers as caregivers for children and mothers with HIV/AIDS. Questions arise regarding the role that gay fathers play in adopting children. Focusing on the role that single and same gender coupled men can play in responding to the need for adoptive parents for children orphaned by HIV/AIDS is worthy of attention.
6.3.3 Incarcerated Fathers
Fathers who are incarcerated are vulnerable both with regard to their children’s, their family members’, and their own health (Robertson et al. 2004 ; Royal et al. 2009 ) .
Among both state and federal prisoners who are parents with minor children, Blacks comprised the largest racial/ethnic group. In state prisons, 49% of parents were Black compared to 29% of Whites, and 19% of Hispanics (Mumola 2000 ). Similarly, in federal prison, Blacks (44%) are the largest racial/ethnic group among parents, followed by Hispanics (30%) and Whites (22%) (Glaze and Maruschak 2008 ) . From 1991 to 2007, the number of parents incarcerated in state or federal correctional facilities increased by 79% while the number of children with an incarcerated parent increased by 80% (Glaze and Maruschak 2008 ) . Black children with a parent incarcerated in a state or federal correctional facility comprise 6.7% of all minor children in the United States compared to 0.9% for White and 2.4% for Hispanics.
Black children are seven times more likely to have a parent in a state or federal prison compared to Whites. Hispanic children are twice as likely to have a parent in a state or federal prison compared to Whites. Sixty-three percent of the incarcerated fathers are aged 24–34 with 58% of the incarcerated fathers in the age range of 35–44 (Glaze and Maruschak 2008 ) . As of 2007, 1.6% of state prison inmates and 0.8% of federal inmates were known to be infected with HIV ( Maruschak and Beavers 2009 ) .
The prevalence of HIV among inmates is three times that for the general public.
The effect of prisoner re-entry on Black families and communities is increasingly receiving attention among practitioners, policy makers, and researchers (Gadsen and Rethemeyer November 2001). Ex-offender fathers can infl uence their children’s behavior, including their risk behavior (particularly their son’s) (Icard et al. 2008 ) . Specifi cally of concern is the role that former incarcerated fathers might play in the intergenerational transmission of attitudes and norms that may place their children at risk of exposure to HIV.
6.3.4 Homeless Fathers
The limited attention to homeless parents has focused on mothers. The marginality of homeless fathers introduces a number of issues that may have a signifi cant effect on developing HIV treatment and prevention interventions. This includes such issues as HIV-positive fathers’ relationship with their children and the implications of these relationships for the health outcomes of fathers and their children.
Understanding the health consequences for foster children resulting from a deceased mother and homeless fathers is also of concern. Little is known about the mental and physical health status of HIV/AIDS homeless fathers affected by the relation-ship between adult children and their homeless fathers. Fathers who are homeless or experiencing unstable housing are at high risk of being exposed to HIV. Extreme poverty, the pressures of daily survival needs, substance use, and mental illness result in homeless men being highly vulnerable to HIV infection (Culhane et al.
2001 ) . People who are homeless or experiencing unstable housing are 3–16 times more likely to be infected with HIV compared to people with similar sociodemo-graphic characteristics (Wolitski et al. 2009 ) . Approximately 3.5 million people
may experience homelessness in a given year (National Law Center on Homelessness and Poverty 2007 ). Approximately 3–10% of all homeless persons are HIV-positive – 10 times the rate of infection in the general population (Culhane et al. 2004 ).
Homeless men who are HIV-positive are more likely to receive inadequate care and early death. Representative studies of HIV among homeless and marginally housed adults are rare. In addition, estimates of HIV infection and other health problems vary dramatically as a function of sampling strategy (Moss et al. 2004 ; North and Smith 1993 ) . The limited attention to homeless parents has focused largely on mothers. Understanding is needed on homeless father–child relationships and the HIV/AIDS health status for both homeless fathers and their children.