Worldwide an estimated 15 million children have lost one or both parents to HIV. The stress on children, however, occurs far before the child is orphaned. It has been documented that children whose parents are living with HIV suffer significant psychological distress. Adverse effects of the AIDS pandemic on children affected by HIV are related to both the emotional distress and the worsening economic privation that they experience as parental health deteriorates. Stigma, school difficulties and dropout, diminished nutritional status, lack of shelter, and inadequate access to health care have all been documented among children affected by HIV. Additionally, minors whose parents have died or can no longer provide for them, live with increased vulnerability to exploitation and violence. While the HIV pandemic has put many children in crisis, interventions to mitigate the psychosocial effects on children are lacking in resource-poor settings. Programs to address the effects of the AIDS pandemic on children must be designed, piloted and evaluated in areas of the world with the highest HIV burden. This application is submitted through the R21 mechanism to assess the mental health status of children affected by HIV and to pilot an intervention to support these children and prevent negative psychosocial outcomes. The proposed research will be performed in 6 health facilities in the Harvard Medical School affiliated Partners In Health (PIH) project in rural Haiti. The clinical work of PIH has served as a model for HIV treatment worldwide since it was one of the first sites to provide ART in a resource-poor country. Medications and services are provided to community members free of charge through funds from PEPFAR and the Global Fund to Fight AIDS, TB and Malaria. In this context of comprehensive primary health care and HIV care and treatment, children affected by HIV will be selected for a feasibility study to examine: 1) the prevalence of psychiatric symptoms, level of psychosocial functioning and HIV-risk behaviors among children affected by HIV; 2) the coping skills, social support and psychiatric symptoms of the HIV positive parents and/or caregivers of the children; 3) the association of psychosocial functioning of the child with variables collected for both children and adults. Lastly, a group intervention for HIV affected children will be piloted to generate preliminary data for a larger, R01 study designed to prevent poor outcomes in HlV-affected children.
