This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of the GAMMA study 015 is to evaluate the impact of a structured model of disclosure of HIV diagnosis to children and adolescents infected with HIV status. However, limited information exists on when and how to disclose, as well as the full impact of disclosure. Disclosure may entail revelation of family secrets, ramifications of which differ among culture. This prospective study tested the following hypotheses: 1. The standardized clinicals model for pediatric disclosure described herein will favilitate disclosure 2. Most Puerto Rican families will prefer support of an interdisciplinary health care team to reveal the HIV diagnosis to their children/adolescent. 3. This model will foster good psychosocial adjustment post-disclosure. In order to test this hypotheses, we investigated the real-time consequences of disclosure of an HIV/AIDS diagnosis to children and adolescents who have been primarly infected via perinatal transmission. Utilizing the Tasker conceptual model of four phases of disclosure we developed a standardized clinical model for pediatric disclosure of the HIV diagnosis. Our model utilized the following strategies to prepare staff and families for the final disclosure phase: 1. In trainning seminars and practice sessions for health professionals with strategies for developmentally appropiated pediatric disclosure. 2.Longitudinal parent educational / intervention sessions with the staff and parent peer support group sessions along the four phases of disclosure. 3. Longitudinal individual assessment / intervention sessions pre- and post disclosure for the children. 4. Teaching-support groups for HIV infected youngsters post-disclosure in order to optimize the effect of disclosure. We are in the final phase of data entry and analysis with the statistical support from RCMI-Clninical Research Center to complete GAMMA 015 goal and publish a second manuscri
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