Families living with HIV M. J. ROTHERAM-BORUS, D. FLANNERY, E. RICE, & P. LESTER University of California, Los Angeles Abstract Given the historical emergence of the AIDS epidemic first among gay men in the developed world, HIV interventions have primarily focused on individuals rather than families. Typically not part of traditional family structures, HIV-positive gay men in Europe and the US lived primarily in societies providing essential infrastructure for survival needs that highly value individual justice and freedom. Interventions were thus designed to focus on at-risk individuals with programmes that were age and gender segregated. As the epidemic has unfolded, the early focus on individuals has become inadequate: families live with HIV, not just individuals. Families’ structure, economy, migration patterns, and developmental life cycles are affected by HIV, and these changes radiate throughout the community creating parallel stresses. Family-based, intergenerational models of detection, prevention and treatment services offer enhanced opportunities for effective interventions and suggest very different intervention settings and strategies. However, these models also require addressing the family’s basic needs for survival and security in order to be successfully implemented and sustained over time. As HIV was an opportunity for marginalized persons in the developed world to ‘turn their life around’, the strengths of families in the developing world may be mobilized to contribute to the community’s long-term health, survival and security needs. Introduction When documenting the scope of the HIV pandemic, the number of HIV-infected persons is the typical yardstick: there are 38 to 42 million persons living with HIV and nearly 13 million AIDS orphans (WHO, 2003). However, these individuals are linked and nested within their families, society’s basic social unit (Repetti et al., 2002). Families are affected by HIV, not individuals (Boyd-Franklin et al., 2000; Pequegnat et al., 2001; Pequegnat & Szaponick, 2000; Schuster et al., 2000). The impact of HIV radiates intergenerationally, from grandparents who must assume responsibility for their children, to AIDS orphans who become young parents, having had no role models during their own childhood (Rotheram-Borus et al., 1997). Yet, intervention models consistently focus on medical and psychosocial interventions for individuals. When a family model is adopted, the framework for existing interventions shifts. Simultaneously, the economic safety nets serving as a backdrop to evidence-based interventions in the developed world (e.g. health insurance, disability payments, child welfare, subsidized housing) are not typically available to the areas most impacted by HIV (e.g. Africa and Asia). Without consideration of the family’s economic context, combating HIV will not be a high priority activity. Correspondence: Mary Jane Rotheram-Borus, Center for Community Health, 10920 Wilshire Blvd., Suite #350, Los Angeles, CA 90024-6521. Tel: 310-823-8541. Fax: 310-794-8297. E-mail: Rotheram@ucla.edu ISSN 0954-0121 print/ISSN 1360-0451 online # 2005 Taylor & Francis DOI: 10.1080/09540120500101690 AIDS Care, November 2005; 17(8): 978  /987