Psychosocial Intervention in HIV-Affected Children in Haiti

描述(申请人提供)：据估计，全世界有1500万儿童因感染艾滋病毒而失去了父母中的一方或双方。然而，孩子的压力在孩子成为孤儿之前就已经发生了。有记录表明，父母感染艾滋病毒的儿童遭受严重的心理痛苦。艾滋病大流行对受艾滋病毒影响的儿童的不利影响既与他们的精神痛苦有关，也与他们因父母健康恶化而经历的日益严重的经济贫困有关。在感染艾滋病毒的儿童中，耻辱、学习困难和辍学、营养状况下降、缺乏住所以及获得医疗保健的机会不足都是有据可查的。此外，父母已经去世或无法再供养他们的未成年人生活在更容易受到剥削和暴力的情况下。虽然艾滋病毒大流行使许多儿童陷入危机，但在资源匮乏的环境中，缺乏减轻儿童心理社会影响的干预措施。必须在世界上艾滋病毒负担最重的地区设计、试点和评估应对艾滋病大流行对儿童影响的方案。这项申请是通过R21机制提交的，目的是评估受艾滋病毒影响的儿童的心理健康状况，并试行一项干预措施，以支持这些儿童并防止产生负面的心理社会后果。这项拟议的研究将在海地农村的哈佛医学院附属健康伙伴(PIH)项目的6个卫生设施中进行。妊高征的临床工作一直是全世界艾滋病毒治疗的典范，因为它是在一个资源匮乏的国家提供抗逆转录病毒治疗的首批地点之一。通过PEPFAR和全球抗击艾滋病、结核病和疟疾基金的资金，向社区成员免费提供药物和服务。在全面初级保健和艾滋病毒护理和治疗的背景下，将选择受艾滋病毒影响的儿童进行可行性研究，以检查：1)受艾滋病毒影响的儿童中精神症状的患病率、心理社会功能水平和艾滋病毒危险行为；2)艾滋病毒阳性的父母和/或儿童的照顾者的应对技能、社会支持和精神症状；3)儿童的心理社会功能与收集的儿童和成人变量的关系。最后，将试行一项针对受艾滋病毒影响的儿童的团体干预措施，以便为一项更大的R01研究产生初步数据，该研究旨在预防受HLV影响的儿童的不良结局。

DESCRIPTION (provided by applicant): 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.