Diane Melvin

The child in the family—responding to AIDS and HIV

This study examines the psychosocial needs of children with AIDS and HIV infection based on a cohort of 18 infected children. Fifteen of the children live with their mothers, nine of whom are single mothers. For 14 children the mother is HIV +ve and for a further 8 the father is also HIV +ve. Many children have siblings (10), but only one of these is infected. Close family and grandparents are rarely involved in care and only one child, the oldest, is aware of parental and personal HIV status. Where children attend school or preschool centres none have been informed of the childs HIV infection. Cultural issues are prevalent, especially marked when English is not the first language (n = 10) which renders obstacles for counselling and developmental appraisal. Children in this group are hospitalized more frequently than the parents. Child and parental hospitalization is problematic. Three case situations arising in this group are described in some detail to highlight the nature of the emotional challenges facing carers and service providers.

Coping and psychological adjustment in adolescents with vertically acquired HIV

Abstract Children with vertically acquired HIV face the challenges of adolescence in addition to the demands of coping with their illness. The relationship between coping and psychological adjustment has been widely studied in adults and children with chronic diseases but it is poorly understood in adolescents with HIV. This study aimed to identify whether a UK sample of adolescents with vertically acquired HIV had poor psychological adjustment and to clarify the relationship between coping and psychological adjustment in this sample. Thirty adolescents with vertically acquired HIV (aged 11–17) filled in questionnaires of coping and psychological adjustment and a correlational design was used to determine if specific coping styles were related to quality of psychological adjustment. Results showed that younger children had lower levels of psychological adjustment than older adolescents, although as a group the adolescents scored within normal ranges. Psychological adjustment was significantly related to two coping styles, Ventilating feelings and Being humorous. Exploratory analysis examined the extent of HIV disclosure in this sample and the degree of satisfaction felt about the nature of communication about the diagnosis. The results showed that participants had few confidants but were satisfied with the nature of communication about their status. The level of satisfaction was not related to adjustment. On the basis of the results, potential clinical implications for adolescents with vertically acquired HIV who might be struggling not only with the challenging demands of adolescence but also with their illness are discussed. The need to adopt a developmental approach to coping and psychological adjustment is emphasized.

Bereavement: A Framework for those Working with Children

This article aims to describe psychological factors which help or hinder coping with bereavement in childhood. Children can and do cope with the death of those close to them if they know what is happening and have the appropriate support to cope. However, children suffering from loss are likely to be in the care of adults who are also grieving and there is a need to support the adults and to mobilize other resources for the child. We discuss the timing and appropriateness of interventions from all those working with children and, in particular, for the child mental health and other specialist services in supporting children and families through the process of bereavement.

The effectiveness of communication groups in day nurseries

This project, run by a speech and language therapist and a clinical psychologist, took place in three inner city day nurseries. A group of children over whose communication there was concern were assessed on both formal (verbal and non-verbal) and informal (observational) measures. At each nursery these children were divided into two matched groups: intervention and control. The intervention consisted of communication groups run jointly with nursery staff. These small groups focused on promoting communication through play. On reassessment the children attending the communication groups had made significantly more improvement than the controls on both formal and informal measures. In particular, the number and quality of childrens interactions, their underlying ability to focus on tasks and their knowledge of basic concepts appeared to benefit from the intervention. The study, therefore, provides strong evidence for the efficacy of such interventions in enhancing communication development in a real-life setting.

HIV-associated neurocognitive disease: case studies and suggestions for diagnosis and management in different patient subgroups.

The incidence of HIV-associated dementia has decreased significantly with the introduction of combination antiretroviral therapy; however, milder or more subtle forms of neurocognitive disorders associated with HIV appear to remain common. There is a lack of consensus on when to screen and on which methods are most appropriate for identifying patients at risk of neurocognitive impairment. Multiple factors (demographic, social, genetic, psychological and medical) can play a role in its aetiology and progression, including potential central nervous system toxicity of antiviral therapy. It is important to identify these factors in order to apply relevant management strategies. In this review, we discuss a series of case studies that address some of the challenges presented by the diagnosis and management of HIV-associated neurocognitive impairment in different patient types.

‘I don’t even know how to start that kind of conversation’: HIV communication between mothers and adolescents with perinatally acquired HIV:

Young people with perinatally acquired HIV are now surviving into late adolescence and adulthood. We explored HIV communication within mother/adolescent dyads following naming of the adolescents’ HIV. Five adolescents with perinatally acquired HIV (14–16 years) and their biological mothers were interviewed separately. HIV communication between mothers and children was rare. Discussion most commonly related to biomedical aspects of HIV. Onward HIV disclosure was discouraged by mothers, which often contrasted with adolescents’ beliefs. Discussing emotional and sexual aspects of HIV was mutually avoided. Culturally sensitive support and guidance should be offered to families about discussing HIV, considering potentially differing perspectives.

Anxiety and depression symptoms in young people with perinatally acquired HIV and HIV affected young people in England

ABSTRACT Adolescents with perinatal HIV (PHIV) may be at higher risk of anxiety and depression than HIV negative young people. We investigated prevalence of anxiety and depression symptoms in 283 PHIV and 96 HIV-affected (HIV-negative) young people in England recruited into the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. We used Hospital Anxiety and Depression Scale (HADS) scores and linear regression investigated predictors of higher (worse) scores.115 (41%) and 29 (30%) PHIV and HIV-affected young people were male, median age was 16 [interquartile range 15,18] and 16 [14,18] years and 241 (85%) and 71 (74%) were black African, respectively. There were no differences in anxiety and depression scores between PHIV and HIV-affected participants. Predictors of higher anxiety scores were a higher number of carers in childhood, speaking a language other than English at home, lower self-esteem, ever thinking life was not worth living and lower social functioning. Predictors of higher depression scores were male sex, death of one/both parents, school exclusion, lower self-esteem and lower social functioning. In conclusion, HIV status was not associated with anxiety or depression scores, but findings highlight the need to identify and support young people at higher risk of anxiety and depression.

A Sharing Experience: Development of a Group for Families Affected by HIV Infection.

Abstract The Establishment and Development of a Support Group For the Parents of Children Infected and/or Affected By HIV Infection are Described. The Group is Hospital-based, Meeting Monthyly Since April 1992, Facilitated by Professionals But With A Self-Help and Peer-Support Emphasis. The Planning, Setting and Running of The Group are Explained Changes in Group Membership and the Themes and Processes Which Have Emerged Over the First Year of the Group are Further Explored. Seueral Factors are Identified Which have Contributed to The Success of This Group in Meeting a Part of The Complex Support Needs fo Some Families Living With HIV Infection.