Recognizing the potentially serious effects on children of losing their parents to AIDS, efforts are now being made worldwide to address the needs of these children. Such efforts need to be comprehensive and include involvement of communities. In addition, there is often mention of the need to """"""""build resilience"""""""" in the children, but few intervention efforts have this focus, and it is unknown whether such a goal is really achievable. The goal of the proposed project, therefore, is to test the effectiveness of an intervention in South Africa that is specifically designed to promote resilience in young children of HIV-infected mothers. A second goal is to examine the effects on children of their parents being able to access antiretroviral (ARV) treatment, something that has become a reality in some resource-poor countries, but remains a global economic issue.
The specific aims of the project are to: (1) Describe the psychosocial effects of parental HIV disease on young children in South Africa by comparing them to children whose parents are not HIV-infected; (2) Assess the effectiveness of an intervention for HIV-infected mothers and their children to improve maternal functioning and help mothers promote resilience in their children at two different ages and stages of development- 3 yrs, and 6-10 yrs; and (3) Identify psychological and medical factors (including initiation of ARVs) affecting HIV-infected mothers that contribute to changes in the adaptive functioning of their children. The study design will be a randomized controlled trial in which 440 HIV-infected mothers and their children (stratified by age group) will receive either standard community-based services, or, in addition to standard services, enrollment in a 9-month, manual-guided, intervention that includes support groups for those who can attend and home-visiting for those who are ill. Evaluations will be conducted at baseline, 9 and 24 months to test sustainability of effect. Comparison with 110 non-HIV-affected children will identify the effects of parental HIV disease on children and establish normal values for the instruments in this context. Millions of children will lose their parents to AIDS in the coming years, but presently there is no evidence that efforts aimed at """"""""building resilience"""""""" can benefit these children. The proposed intervention is designed to be provided largely by community volunteers, and therefore, if proven effective, could be replicated in other resource-poor countries and potentially benefit large numbers of children.
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