Social ecological factors associated with future orientation of children affected by parental HIV infection and AIDS

Exploring the Longitudinal Influence of Perceived Social Support, HIV Stigma, and Future Orientation on Depressive Symptoms Among People Living with HIV in China

Prior studies demonstrated that perceived social support is negatively associated with behavioral and mental health problems among people living with HIV (PLWH). However, longitudinal data regarding the associations between perceived social support, internalized HIV stigma, future orientation, and depressive symptoms are limited. The current study aimed to investigate the possible indirect relationship between these variables using four-wave follow-up data (6-month intervals) from a sample of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20, age range: 18-60 years; 63.9% men). All participants were asked to complete an adapted version of Perceived Social Support Scale, Internalized HIV Stigma Scale, Optimism About the Future Scale, and Center of Epidemiological Studies Depression Scale. Results indicated that perceived social support at baseline was negatively related to depressive symptoms at wave 4. Internalized HIV stigma at wave 2 and future orientation at wave 3 indirectly affected the linkage between perceived social support at baseline and depressive symptoms serially over time. This study highlights the essential role of perceived social support in alleviating depressive symptoms among PLWH, and underscores the complex interplay in which internalized HIV stigma and future orientation serially mediated the relationship between perceived social support and depressive symptoms. These findings suggest the need for integrated interventions to enhance social support, address HIV-related stigma, and promote positive future orientation, which could potentially alleviate depressive symptoms and promote mental well-being among PLWH.

Psychological Mechanisms of Internalized HIV Stigma Affect Sleep Impairment among People Living with HIV in China: A follow-up Study

Prior studies have demonstrated that HIV-related stigma (e.g., internalized HIV stigma) is detrimental to the physical and mental health (e.g., sleep impairment and depressive symptoms) of people living with HIV (PLWH). However, follow-up data are limited regarding the longitudinal relationships between internalized HIV stigma, future orientation, self-esteem, depressive symptoms, and sleep impairment. The present study attempted to examine a mediation model involving these variables among Chinese PLWH. A two-wave follow-up design (6 months intervals) was employed in a final sample of 1,140 Chinese PLWH (Mage = 41.63, SD = 9.29, age range: 21-67 years; 64.6% men). Participants completed Internalized HIV Stigma Scale, Optimism About the Future Scale, Rosenberg Self-Esteem Scale, Center of Epidemiological Studies Depression Scale, and an adapted version of Pittsburgh Sleep Quality Index. Results revealed that internalized HIV stigma at baseline had a significant direct relationship with sleep impairment over time, and a significant indirect relationship with increased sleep impairment over time via future orientation and depressive symptoms. Furthermore, the linkage between internalized HIV stigma and sleep impairment was serially mediated via self-esteem and depressive symptoms. This study highlights the deleterious effects of internalized HIV stigma on the physical and psychological health of PLWH. The findings suggest that interventions targeting internalized HIV stigma and related factors such as future orientation, self-esteem, and depressive symptoms may facilitate improvements in sleep quality and overall well-being among PLWH.

Social Stigma during COVID-19 and its Impact on HCWs Outcomes

The COVID-19 emergency has significantly transformed the working environment and job demands. Providing care was emotionally difficult for healthcare workers. Uncertainty, stigmatisation, and potentially exposing their families to infection were prominent themes for healthcare workers (HCWs) during the crisis, which first broke out in China at the end of 2019, and then in Italy in early 2020. This study examined the effects of stigma, job demands, and self-esteem, and the consequences of working as a “frontline care provider” with patients infected with the coronavirus (COVID-19). A correlational design study involved 260 healthcare workers (HCWs) working in a large hospital in southern Italy. The following questionnaires were administered: (1) the Job Content Questionnaire (JCQ), for assessing psychological and physical demands; (2) the Professional Quality of Life Scale (ProQOL) to measure the quality individuals feel in relation to their work as “frontline care providers”, through three dimensions: compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS); (3) the Rosenberg Self-Esteem Scale, for evaluating individual self-esteem; (4) a self-administered multiple-choice questionnaire developed by See et al. about attitudes of discrimination, acceptance, and fear towards HCWs exposed to COVID-19. The findings suggest that stigma has a high impact on workers’ outcomes. Stigma may influence worker compliance and can guide management communication strategies relating to pandemic risk for HCWs.

Associations Between Internalized HIV Stigma and Tobacco Smoking Among Adolescents and Young Adults Living with HIV: The Moderating Role of Future Orientations

HIV stigma and future orientations impact the health of adolescents and young adults living with HIV (AYALWH); however, little is known about how these factors may impact tobacco use, and thereby long-term health status. This study examined associations between internalized HIV stigma, future orientations, and smoking behavior using a cross sectional survey of AYALWH ages 18 to 29 (N = 109). Greater levels of stigma were associated with increased odds of smoking, and greater future orientations were associated with a reduced odds of smoking. The interaction was significant, illustrating that stigma was significantly associated with an increased odds of smoking among AYALWH who reported low levels of future orientations, but not for those with high levels of future orientations. Findings underscore the importance of understanding how HIV stigma may undermine future aspirations of AYALWH. Interventions that target HIV stigma and future orientations may be critical for tobacco prevention and cessation.

Caregiver socioemotional health as a determinant of child well-being in school-aged and adolescent Ugandan children with and without perinatal HIV exposure

OBJECTIVE

Caregiver socio-emotional attributes are major determinants of child well-being. This investigation in vulnerable school-aged Ugandan children estimates relationships between children's well-being and their caregiver's anxiety, depression and social support.

METHODS

Perinatally HIV-infected, HIV-exposed uninfected and HIV-unexposed Ugandan children and their caregivers were enrolled. Perinatal HIV status was determined by 18 months of age using DNA-polymerase chain-reaction test; status was confirmed via HIV rapid diagnostic test when children were 6-18 years old. Five indicators of child well-being (distress, hopelessness, positive future orientation, esteem and quality of life (QOL)) and caregivers' socioemotional status (depressive symptoms, anxiety and social support) were measured using validated, culturally adapted and translated instruments. Categories based on tertiles of each caregiver psychosocial indicator were defined. Linear regression analyses estimated percent differences (β) and corresponding 95% confidence intervals (CI) for child well-being in relation to caregiver's psychosocial status.

RESULTS

As per tertile increment, caregiver anxiety was associated with 2.7% higher distress (95%CI:0.2%, 5.3%) and lower self-esteem/QOL (β = -1.3%/-2.6%; 95%CI: -5.0%,-0.2%) in their children. Child distress/hopelessness increased (β = 3.3%/7.6%; 95%CI:0.4%, 14.7%) and self-esteem/QOL decreased 2.3% (β = -2.3%/-4.4%; 95%CI: -7.2%, -1.3%) as per tertile increment in caregiver depression. Higher caregiver social support was associated with lower distress and higher positive outlook (β = 3%; 95%CI:1.4%, 4.5%) in their children. HIV-infected/exposed children had most caregiver depression-related QOL deficit (β = -5.2%/-6.8%; 95%CI: -12.4%, -0.2%) and HIV-unexposed children had most caregiver social support-related enhancements in positive outlook (β=4.5%; 95%CI:1.9%, 7.1%).

CONCLUSIONS

Caregiver anxiety, depressive symptoms and low social support were associated with worse well-being in school-aged and adolescent children. Improvement of caregiver mental health and strengthening caregiver social support systems may be a viable strategy for improving well-being of vulnerable children and adolescents in this setting.

Stigma as experienced by children of HIV-positive parents: a narrative review

This narrative review examines the effects on children of stigma by association with an HIV-positive parent. It expands on previous reviews by including all HIV-affected children, whether orphaned or living with a parent with HIV, and considers the broad effects of stigma-by-association (SBA), including but not limited to the psychological impact. Studies met the following criteria - sample included children, ages 6-19 years old, who were not HIV-positive but were currently living with or had lived with a parent who was HIV-positive (i.e., AIDS orphans). Study findings included children's perspectives on stigma and were available in English. Studies for inclusion were identified by searches in Psychinfo, Proquest, and PubMed from 1996 through 2016. This review substantiates that children across countries and cultures experience HIV SBA. SBA is associated with psychological or emotional problems, disrupted peer and adult relationships, and poor school outcomes for children. Orphans were more likely than children living with positive parents to experience negative outcomes, which can have a long-term impact. Felt stigma was as prevalent as enacted stigma and may become the focus of intervention as HIV disease increasingly becomes a concealable disease. The review findings also point to the complexity of relationships between SBA and variables such as poverty and mental health and the bi-directional relationship between SBA and depression. We adapt a stigma framework developed for people living with HIV (PLWHIV) to structure the results of this review. With these findings, we can develop interventions that support stigma reduction with children and their parents, responding to the wide range of stigma consequences and customized to the children's family and cultural context.

A randomized controlled trial of a resilience-based intervention on psychosocial well-being of children affected by HIV/AIDS: Effects at 6- and 12-month follow-up

BACKGROUND

Global literature suggests that resilience-based interventions may yield improvements in psychosocial well-being for vulnerable children, but limited data are available regarding the efficacy of such interventions among children affected by parental HIV/AIDS.

OBJECTIVE

To evaluate initial efficacy of a multi-level resilience-based intervention among children affected by parental HIV/AIDS in China in improving children's psychosocial well-being and resilience-related outcomes.

METHOD

Seven hundred-ninety children, 6-17 years of age, were recruited from rural China. Children were either AIDS orphans or were living with one or two parents infected with HIV/AIDS. Children and primary caregivers were randomly assigned to participate in a 4-arm trial to evaluate the Child-Caregiver-Advocacy Resilience (ChildCARE) intervention. This resilience-based psychosocial intervention provides programming at three levels (child, caregiver, community). Survey data were collected at baseline, 6-months, and 12-months in order to examine efficacy of the child-only and child + caregiver arms in improving children's psychological resilience.

RESULTS

Intervention groups displayed improvements in several resilience-related outcomes at 6- and 12-month follow-ups, including self-reported coping, hopefulness, emotional regulation, and self-control. The child-only intervention arm showed some fading of intervention effects by 12-months.

CONCLUSION

Preliminary findings suggest that the ChildCARE intervention is efficacious in promoting psychosocial well-being of children affected by parental HIV/AIDS in rural China. Targeting both children and caregivers for psychosocial intervention may be effective in improving children's resilience. Additional evaluation and modifications, including the inclusion of booster sessions, should be considered to further strengthen the program.