The overarching goal of this application is to advance a programmatic line of research investigating behavioral interventions for vulnerable youth populations, specifically those at-risk for HIV, to serve as the foundation for a career in academia as an independent research scientist. The proposed project specifically addresses two areas of high priority put forth by NIMH's Division of AIDS Research (DAR): (1) innovative research designed to better understand unique multilevel factors related to HIV-risk reduction, and (2) prevention science aimed at understanding the psychosocial needs of children affected by HIV. In addressing these objectives the proposed study examines a specific population of youth vulnerable to HIV infection, preadolescent (and adolescent) children of mothers living with HIV (MLH). These children are at risk for behaviorally-acquired HIV infection through genetic and environmental transmission of HIV-related risk behaviors. Because MLH are living longer than they were in previous decades, more children are living with MLH than ever before. Research that examines this growing population of youth under a lens of HIV prevention is scarce. To address NIMH's objectives, the project proposes adapting an existing evidence-based intervention to children of MLH. In doing so it examines specific HIV-related family-level factors associated with the sexual risk of youth affected by HIV. It proposes that MLH are in a unique position to reduce their children's HIV risk through protective parenting practices-including, facilitating discussions about HIV, HIV disclosure, and sexuality, providing structure i the form of monitoring and supervision, and building a healthy parent-child relationship. It is hypothesized that through strengthening protective parenting practices, children of MLH will have shifts in sexual attitudes, knowledge, intentions, and behavior, which will reduce their risk for HIV infection. To test this hypothesis, three Specific Aims are proposed: (1) adapt a family-based intervention for youth of MLH through a structured process of adaptation, (2) implement the intervention with a cohort of youth (ages 10 to 15 years-old) and their MLH, and (3) evaluate the effects of the intervention. The project focuses on MLH-child dyads, primarily African-American, living in and around Atlanta, GA, and through collaboration with local non-governmental organizations (NGOs), recruits these dyads for two phases of the study. Phase I uses qualitative methodology in the form of focus groups and individual interviews with MLH and their children to inform the development of the intervention. Phase II samples 60 MLH dyads, half will receive the intervention and half will serve as controls. All Phase II participants are assessed pre- and post-intervention and parenting and youth sexual risk outcomes are explored. Results will inform (1) the expansion of this intervention to a larger-scale, (2) the process of adapting EBI's to specific, vulnerable populations, and (3) our understanding of youth HIV risk in children affected by HIV, including family factors.
The public health burden of HIV is enormous, as each year approximately 50,000 Americans become infected with the virus, a quarter of whom are women (Prejean et al., 2009). Uninfected children of mothers living with HIV (MLH) represent a growing population of vulnerable youth at-risk for behavioral infection due to intergenerational transmission of genetic and environmental risks. To decrease youth HIV risk via facilitation of protective parenting, the proposed investigation adapts, implements, and evaluates an existing evidence-based family intervention for MLH and their preadolescent children, the results of which will serve as basis for future large-scale interventions with similar aims.
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