Identifying the mental health needs of children living in families with AIDS or HIV infection

Fears of South African children affected by HIV/AIDS

Although fears are part of normal development, the living environment of HIV/AIDS affected children is conducive to the development of particular fears. This study examined the fears of 39 South African children (7-13 years) living in a low socioeconomic community with a high prevalence of HIV/AIDS. The aim was to consider if these children were a special population with regard to their fears. The Free Option Method was used to identify the children's fears. Data were analyzed by means of a priori thematic analysis, followed by a qualitative analysis. The expressed fears could be described with fear categories previously reported by normative samples. The wild animal category and specifically snake fears were reported most. The second analysis revealed a substantial minority of fears reflecting life in the South African HIV/AIDS affected context. It was concluded that the children represented a normative population who experienced particular fears due to their special circumstances. Further investigation of HIV/AIDS affected children's fears and related psychological issues is recommended.

Risk factors for distress in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers

In contrast to previous research on parental drug abuse, the present study examined comorbid drug addiction and HIV infection in the father as related to his adolescent child's psychological distress. Individual structured interviews were administered to 505 HIV-positive and HIV-negative drug-abusing fathers and one of their children, aged 12-20. Structural equation modelling tested an hypothesized model linking paternal latent variables, ecological factors and adolescent substance use to adolescent distress. Results demonstrated a direct pathway between paternal distress and adolescent distress, as well as an indirect pathway; namely, paternal distress was linked with impaired paternal teaching of coping skills to the child, which in turn was related to adolescent substance use and, ultimately, to the adolescent's distress. There was also an association between paternal drug addiction/HIV and adolescent distress, which was mediated by both ecological factors and adolescent substance use. Findings suggest an increased risk of distress in the adolescent children of fathers with comorbid drug addiction and HIV/AIDS, which may be further complicated by paternal distress. Results suggest several opportunities for prevention and treatment programmes for the children of drug-abusing fathers.

Adjustment of Adolescents of Parents Living with HIV

Family environment and rates of mental health and behavioral problems in HIV-negative adolescents and their parents living with HIV (PWH) were compared to adolescents and parents from non HIV-affected families living in similar inner-city neighborhoods. Adolescents and their parents were interviewed and a case-control sample was constructed. Data on sixty-two matched pairs of adolescents of PWH and those of neighborhood parents and forty-six matched pairs of PWH and HIV-negative parents were examined. Compared to neighborhood controls, adolescents of PWH experienced greater life stressors and family conflict and reported lower self-esteem. PWH reported greater emotional distress and substance use. However, there were no significant differences in emotional distress or externalized problem behaviors between the two adolescent groups. Clinical implications are discussed.

Aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers

This study examined aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers. Data were collected via individual structured interviews of low-income, predominantly African American and Hispanic, father-child dyads (N = 415). Structural Equation Modeling was used to assess the interrelationship of several latent constructs with respect to adolescent aggression. Results showed a mediational model linking paternal attributes (including HIV status) and ecological factors with the father-child relationship, which impacted peer influences and the adolescent's vulnerable personality, which was the most proximal construct to aggressive behaviors. Ecological factors were also mediated by peer influences and directly linked with adolescent aggression.

Hugging my uncle: the impact of a parent training on children's comfort interacting with persons living with HIV

OBJECTIVE

HIV-related stigma affects not only persons living with HIV (PLwHIV) but also their communities and families including children. This study aimed to determine whether an interactive training administered to community parents significantly increases their children's reported comfort interacting with PLwHIV.

METHODS

A randomized clinical trial with random-quota dwelling unit sampling and a random invitation to treatment had 238 parent and 238 child participants.

RESULTS

For children of trained parents, significant increases in comfort were obtained, baseline to 6-month follow-up, on 14 of 22 reported daily activities with PLwHIV. For children who recently interacted with a person living with HIV, this comfort predicted the number of recent activities, even after controlling for closeness to the person living with HIV and for the number of persons with HIV known, living or deceased.

CONCLUSIONS

Training parents to be HIV health educators of their children significantly impacts youth and shows promise for reducing HIV-related stigma and social isolation.

A qualitative investigation of adolescents' experiences with parental HIV/AIDS

The present qualitative study investigated the implications of parental HIV/AIDS for affected adolescents. The purpose of the study was (a) to understand adolescents' perceptions of and experiences with parental HIV/AIDS and (b) to explore how parental HIV/AIDS affects adolescents' psychosocial functioning, particularly in the home and school environments. Semistructured interviews were conducted with 9 adolescents between the ages of 11 and 17. Major themes included loss, transitions, disclosure, school implications, paradoxical situations, support networks, and coping. Findings validated and expanded on previous research and yielded hypotheses for future research.

Making the most of the moment: when a child's mother has breast cancer

The demands and uncertainties associated with adjustments to chronic illness present challenges to maintaining a stable family life. Little has been reported about mother-child relationships within the cancer experience and even less about interventions that may be useful to help these dyads maintain stability. The focus of this article is a pilot study of an intervention addressing the mother-child relationship of women with breast cancer and their school-aged children. A part of the data collection comprised interviews of mothers and fathers to assess their perceptions of the influence of the intervention on the quality of the mother-child relationships after the program. Using inductive content analysis, the fathers' and mothers' data were organized into categories, domains, and an explanatory construct, called making the most of the moment. The processes by which the intervention affected the mother-child relationships and implications for professionals who work with families are reported.

Coping in adolescent children of HIV-positive and HIV-negative substance-abusing fathers

The authors examined coping in the adolescent children of drug-abusing fathers who have, or are at risk for contracting, human immunodeficiency virus (HIV). The ability to cope is an important factor in the adolescent's own risk behaviors, including drug use and associated problems. Each father and his adolescent child were separately administered a structured interview regarding personality, drug use, relationships, coping, and other behaviors. Adolescent adaptive coping was found to be related to greater conventionality, less marijuana use, fewer intra- and interpersonal problems, paternal adaptive coping, and a close father-child bond. Moreover, analysis using a risk factor index indicated an exponential increase in adolescent maladaptive coping with each additional psychosocial risk. Implications for policy and intervention are also discussed.

Telephone support group intervention for persons with hemophilia and HIV/AIDS and family caregivers

The purpose of this pilot project was to test the feasibility of a telephone support group intervention for persons with hemophilia and HIV/AIDS and for their family caregivers. Their support needs were unique because they did not identify with predominant groups of persons with AIDS and were geographically dispersed from peers. The 12 week intervention involved separate telephone support groups for hemophiliacs and for family caregivers. The two groups, comprised of a predetermined maximum of six people, were co-led by a professional and a peer. The support group for family caregivers involved six people and the group for men with hemophilia included five people, including one peer facilitator and one professional facilitator in each group. The telephone support group discussions were taped, transcribed, and analyzed for prevalent themes. The peer and professional facilitators maintained weekly field notes. All participants reported that the telephone groups had a positive impact on meeting their support needs. They believed that they had benefitted from sharing information and that the support groups had decreased their feelings of isolation and loneliness. Participants, however, contended that the intervention should be longer than 12 weeks.

Clinical care issues for women living with HIV and AIDS in the United States

As the number of women infected with HIV in the United States continues to increase, the medical community is faced with the challenge of providing adequate and appropriate care to them. This paper reviews key questions concerning the state of knowledge on the epidemiology, biology, and clinical care of women living with HIV and AIDS in the United States. Because heterosexual transmission accounts for a growing number of cases among women, biological factors and cofactors that may enhance women's susceptibility to HIV infection are also reviewed. HIV-related gynecological issues are presented separately to evaluate whether gynecological complications are distinct in HIV-uninfected and HIV-infected women. Questions of whether there are sex-specific differences in the efficacy and adverse effects of new antiviral agents are discussed. In addition, significant gaps are highlighted that still exist in our understanding of both the effects of HIV and HIV-related drugs upon pregnancy. Finally, the psychiatric stresses and complications that affect women living with HIV and AIDS are also discussed. In each section of this review, gaps in our knowledge of these issues are identified. To properly address these disparities in knowledge, not only do efforts to gather sex-specific biomedical data need to be more exacting, but there is a distinct need to conduct more sex-specific research concerning HIV.

Resilience and risk: childhood and uncertainty in the AIDS epidemic

In a study of depression and risk among HIV-affected young people (children whose parents are infected with or have died from HIV/AIDS), subjects did not report high risk sexual or substance use behavior. Findings are attributed to parental participation in a community-based HIV service program that provides parents with HIV prevention education and long term social and emotional support. Multi-generational community based models of prevention that include parents as critical elements of instruction may also be effective in substance abuse treatment programs and in programs for children who experience difficulty in school.

[Secrecy in children with HIV infection]

The secrecy surrounding the disease of parents and children infected with HIV leads to psychic and affective isolation and difficulties of communication within the family. Psychological management may possibly help to resolve the problem of secrecy between parents and children. We analyzed the organization and dynamics of the secret surrounding children contaminated by their mothers. The analysis was prospective and was based on semi-directive interviews and drawings. We followed up, over a period of two years, ten children (mean age: 4 years, range: 4 months to 12 years) with different ethnic and socio economic backgrounds. In each family, the child was the target of the secret, the pediatrician the guardian, and the mother (or her substitute) the keeper. The organization of the secret around the other potential guardians varied from one family to another. Two modes of intra-family communication were observed: the secret (reserved for the youngest children) and the tacit. One child suffered from a disorder related to the secret, the others had depressive and reactional symptoms. At the end of the study, the manner of approaching, and especially dealing with, the question of the secret had changed appreciably in each family: disclosure to the family circle (three cases), passage of the child from the secret to the tacit (two cases), and easier questioning of the pediatrician in all of the cases. Nonetheless, in no case had the secret been completely lifted for the child. Four children asked to continue psychological management. The changes in the dynamics of the secret and the appeasement observed in the families suggest that psychotherapeutic aid should be offered to families where a child has been contaminated with HIV by the mother.

The family with AIDS: multiple challenges for caregivers

Acquired Immune Deficiency Syndrome (AIDS) continues to increase in the United States, especially among minority groups. The disease is impacting not only individuals, but entire families through multiple infections of family members. This results in simultaneous illness and multiple loss within the family system. Delivery and management of quality care for the family is often made difficult by the lack of resources experienced by families with limited income and the multiplicity of problems associated with poverty in the US. This presents numerous challenges to health care providers. Utilizing a case study, this article presents a model demonstrating the coordination of services among several providers as a means of meeting a variety of family needs and providing quality, cost-effective care.