100 Grief and Loss Across the Lifespan
children is one more experience of being controlled. Sympathy for mothers who
have substance use problems or other behaviors that put children at risk is often
lacking, yet these ambiguous losses are then disenfranchised and more painful as
women lack support. The painful loss women experience is clear, as is their need
for support and validation to process their grief.
Whether due to death or removal by CPS, the loss of a child of elementary
school age violates parental notions that they should have care and responsibil-
ity for the child. Grieving these losses requires ability to revise the assumptive
world wherein the child outlives the parent and/or will always be with the
parent. Further, a parent’s responsibility to provide care for bereaved siblings
adds additional challenge to her or his own coping. Finding ways of continu-
ing the (revised) bond with the child is critical to moving through such loss.Readings
A Small Miracle: Perinatal HIV Transmission
Deborah Calvert
Deborah Calvert is a social worker at Children’s Hospital of Philadelphia with decades
of experience working with children and their families. After years in the NICU, she
moved to the Special Immunology Family Care Center. The Center is dedicated to
providing comprehensive medical, psychosocial, and developmental services that are
family-centered and responsive to the needs of HIV infected and affected children and
their families. To this end, the program provides psychosocially supported medical
care for (a) HIV exposed infants, (b) perinatally—infected children, teens, and young
adults, and (c) infected caregivers.I saw the young mother and her 4-month-old walking down the hall and she
seemed to have a sense of relief on her face. I knew she had just been told that
her son had his third negative test for HIV and was considered HIV negative,
just like the majority of our families. Meanwhile, I had just been working with
Ashley (not her real name) who at age 10 was processing something even
adults have trouble understanding.
Ashley was born with HIV. She has been coming to our clinic to receive
her antiviral medications since she was an infant. A bright, bubbly little girl,
she has been living with her aunt ever since her mother died when she was 3.
I will talk more about the work with Ashley and other children like her after
providing some context for work with families dealing with HIV.
Since the mid-1990s, advances in prenatal HIV treatment have signifi-
cantly reduced mother to child transmission. Early in the HIV/AIDS epi-
demic, transmission rates from mothers with HIV to their newborn children
tended to be about 20% to 30%, but since the development of highly active
antiretroviral treatment (HAART), the transmission rate in the United States
has dropped below 1% (Peters et al., 2003). Extensive outreach by pediatric,
obstetrical, and public health providers, HIV community agencies, and others
helped pregnant women get tested for HIV and then start on HAART if they
had HIV infection. It is important for women to know their own health status