Approximately 100,000 of the over one million people in the United States infected with HIV are women, 80% of whom are in their childbearing years. Consequently, AIDS has already become one of the leading causes of death in children between the ages of 1 and 4 in the United States. Maternal and infant HIV infection is occurring disproportionately among lower socioeconomic populations and minority women. Poverty, drug use, severe stress, and family disorganization characterize the ecological environment of these infants. As a result, these infants, already at risk for developmental delays because of the impact of the HIV infection, are at even greater risk for delays in their developmental trajectory. The quality of parental caregiving has been found to be a major environmental determinate of a normal child's social, physical, and mental development. Within the context of HIV-infected families, the quality of caregiving is critical. Yet, providing care to a seropositive child creates further strains on the family, which is already compromised by the burden of illness in the biological mother. Inadequate caregiving may also be caused by other lifestyle characteristics of the mother and family. The quality of parenting in these at-risk infants may influence the progress of the child's illness. The field of psychoneurology has demonstrated that stressful caregiving environments may create physiological responses in the child, specifically the immune system, at a time when the child is highly vulnerable to such changes. The overall goal of this longitudinal study of HIV seropositive infants born to HIV-infected women is to identify child, parent, family and community factors that influence the developmental trajectory of these children. Special emphasis will be placed on whether quality of parental caregiving plays a mediating role in developmental outcomes and, with HIV-infected infants, in the progression of the disease. This prospective longitudinal study will be done at the Duke Infectious Diseases Clinic where medical services and supportive care are currently provided in a comprehensive team approach. Infants sero-positive for HIV will be enrolled in the study when the infant first enters the Pediatric Infectious Disease program, generally about 24 months of age, and followed until the child is at least 12 months old, with a subsample followed to 18 and 24 months as feasible within the 3 year time frame. Date will be collected using multiple methods (interview, questionnaires, observation, and assessment) with multiple informants (parents, health care staff, research team) over time. Data collection methods assess selected infant, caregiver, family, and community characteristics, the quality of parental caregiving, and disease progression and developmental outcomes in the child. The ultimate goal is to identify factors which place infants born to HIV seropositive women at developmental or health risk so as to identify appropriate interventions to help parents or other primary parental caregivers cope with HIV and more adequately meet the child's developmental needs.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (SRCM)
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University of North Carolina Chapel Hill
Schools of Nursing
Chapel Hill
United States
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Cho, June; Holditch-Davis, Diane; Miles, Margaret S (2010) Effects of gender on the health and development of medically at-risk infants. J Obstet Gynecol Neonatal Nurs 39:536-49
Polzer Casarez, Rebecca L; Miles, Margaret Shandor (2008) Spirituality: a cultural strength for African American mothers with HIV. Clin Nurs Res 17:118-32
D'Auria, Jennifer P; Christian, Becky J; Miles, Margaret Shandor (2006) Being there for my baby: early responses of HIV-infected mothers with an HIV-exposed infant. J Pediatr Health Care 20:11-8
Miles, Margaret Shandor; Holditch-Davis, Diane; Eron, Joseph et al. (2003) An HIV self-care symptom management intervention for African American mothers. Nurs Res 52:350-60
Black, Beth Perry; Miles, Margaret Shandor (2002) Calculating the risks and benefits of disclosure in African American women who have HIV. J Obstet Gynecol Neonatal Nurs 31:688-97
Mallory, Caroline; Miles, Margaret Shandor; Holditch-Davis, Diane (2002) Reciprocity and retaining African-American women with HIV in research. Appl Nurs Res 15:35-41
Holditch-Davis, D; Miles, M S; Burchinal, M et al. (2001) Parental caregiving and developmental outcomes of infants of mothers with HIV. Nurs Res 50:5-14
Miles, M S; Gillespie, J V; Holditch-Davis, D (2001) Physical and mental health in African American mothers with HIV. J Assoc Nurses AIDS Care 12:42-50