Psychosocial Intervention in HIV-Affected Children in Haiti

描述（由申请人提供）：全球估计有1500万儿童因艾滋病失去了父母中的一方或双方。然而，对孩子的压力远在孩子成为孤儿之前就开始了。有记录表明，父母感染艾滋病毒的儿童会遭受严重的心理困扰。艾滋病大流行对感染艾滋病毒的儿童造成的不利影响，与他们在父母健康恶化时所经历的情绪困扰和日益严重的经济贫困有关。在受艾滋病毒影响的儿童中，耻辱、上学困难和辍学、营养状况恶化、缺乏住所以及获得保健的机会不足都是有据可查的。此外，父母已经死亡或不能再抚养他们的未成年人更容易受到剥削和暴力。虽然艾滋病毒流行病使许多儿童陷入危机，但在资源贫乏的环境中，缺乏减轻对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、试行和评价解决艾滋病流行病对儿童影响的方案。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，并试点一项干预措施，以支持这些儿童并防止消极的社会心理后果。拟议的研究将在哈佛医学院附属的海地农村卫生伙伴项目的6个卫生设施中进行。PIH的临床工作已成为全世界艾滋病毒治疗的典范，因为它是在资源贫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。在综合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，以审查：1)受艾滋病毒影响的儿童中精神症状的流行程度、心理社会功能水平和艾滋病毒风险行为；2)艾滋病毒阳性儿童的父母和/或照顾者的应对技能、社会支持和精神症状；3)儿童心理社会功能与收集的儿童和成人变量的关系。最后，一项针对艾滋病毒感染儿童的群体干预将进行试点，为一项更大的R01研究提供初步数据，该研究旨在预防艾滋病毒感染儿童的不良结局。

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.