The overarching goal of this application is to advance a programmatic line of research investigating youth psychosocial adjustment in the context of the family, particularly among families facing unique stressors such as maternal HIV. The objective of this study is to examine the longitudinal relations among various family stressors and processes with child outcomes and to explore the role of family support as a buffer against these stressors. The proposed project addresses the NIMH's Division of Aids Research (DAR) objective of conducting social and behavioral research on the impact of HIV, including an examination of the consequences of maternal HIV for children's psychosocial adjustment, family processes (e.g., parenting) among families affected by HIV, and the social support networks of mothers living with HIV (MLH) and their children. An estimated 1.2 million adults in the U.S. are living with HIV, and as the life expectancy for individuals who are HIV+ has begun to approach that of the general population, MLH are increasingly able to raise their children. MLH face the unique challenge of managing the physical and psychological effects of their illness while balancing childrearing responsibilities and mitigating the negative impact of their illness on thei families. As a result, MLH tend to experience elevated parenting stress, compromised parenting quality, and stress related to the decision of whether to disclose their HIV serostatus to their children. Also, children of MLH are at greater risk for experiencing psychosocial adjustment difficulties compared to children of non-infected parents. Faced with these challenges, families affected by maternal HIV may turn to their social networks for support. However, despite preliminary evidence that family social support may protect MLH and their children against family stress, families affected by HIV report lower levels of social support than non-affected families. Despite the many stressors and relatively low social support experienced by MLH and their children, little is known about how these various family processes are related to one another over time. Thus, applying cutting-edge statistical techniques as well as qualitative methods, the current study aims to (1) examine transactional longitudinal relations among parenting practices, parenting stress, maternal HIV disclosure, and child psychosocial adjustment; (2) examine the buffering role of mothers' and children's social support in these family processes; and (3) qualitatively explore these family and community processes as they relate to HIV disclosure and youth adjustment. This project will draw quantitative data from an NIMH-funded parent study testing an HIV disclosure intervention, TRACK-II. Phase I will involve quantitative data collection and analysis with a sample of 110 MLH-child dyads in Atlanta, GA, and Los Angeles, CA. Phase II will involve qualitative data collection and analysis with a subsample of 16 dyads. Phase III will involve integration of quantitative and qualitative findings, data closeout, and dissemination. Results will inform clinical interventions among families affected by maternal HIV by highlighting relevant targets for treatment and determinants of change.
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). Children of mothers living with HIV are at greater risk of experiencing psychosocial adjustment difficulties, including internalizing and externalizing problems (Tomkins & Wyatt, 2008). To promote youth adjustment and reduce the public health burden of mental health difficulties among children of MLH, the proposed investigation longitudinally examines predictors, moderators, and determinants of change of child adjustment.
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