Current global estimates are that approximately 35 million adults (15-49 yrs) are infected with HIV, and sub Saharan Africa, with over 12.3 million children orphaned by AIDS, is one of the worst hit regions in the world. In Zimbabwe, the number of orphans could reportedly rise to 1.4 million in the next 5 years. Statistics on orphans, however, reflect only a small fraction of the total number of children affected by HIV/AIDS, and according to UNICEF (2001), it is the population of children living with HlV-affected parents which needs to be the focus of attention. Mounting evidence indicates that the emotional impact on such adolescent children is especially pronounced, in large part because these children are forced to confront the ever-changing demands of chronic parental illness with little access to psychosocial support. The proposed research, to be conducted in Zimbabwe, has 6 specific aims: 1) to conduct formative research and use the data, in conjunction with ethnographic data from current research, to adapt and implement a psychosocial support and coping skills intervention (Project TALC/TLC/CLEAR) with adolescent children (12-18) living with an HIV-positive parent; 2) to pilot test the intervention in 1 village and refine the intervention protocol based on these findings; 3) to conduct a full implementation of the modified intervention in 2 urban and 2 rural settings with families where at least 1 parent is HIV positive; 4) to assess the effectiveness of the intervention on psychosocial, behavioral, health, and clinical outcomes obtained at baseline, 6, 12, 24, and 36 months from randomly selected intervention and control families; 5) to ascertain psychosocial changes through longitudinal analysis; and 6) to modify the intervention protocol based on the findings, and make the intervention available for wider dissemination. Project TALC/TLC/CLEAR, which is based on social cognitive theory, has been implemented and evaluated with HlV-affected families in the U.S., and proven effective in reducing problem behaviors and emotional distress in both intervention children and parents. The intervention consists of 5 modules (i.e. staying healthy, family relationships, setting goals and reducing risk, mental health, and bereavement) designed to build coping skills and adolescent self-awareness of the link between negative emotions and dysfunctional behaviors. A team of trained nurses and social workers will deliver the intervention sessions for each module to small groups of parents and children, either alone or together, depending on the topic. The results from the proposed study will determine the extent to which the translation, implementation and evaluation of this intervention is effective in meeting the psychosocial needs of adolescent children in Zimbabwe whose parents are infected with HIV.
