Edward Morse

The Family Health Project: psychosocial adjustment of children whose mothers are HIV infected.

: The psychosocial adjustment of 87 inner-city African American children 6-11 years old whose mothers were HIV infected was compared with that of 149 children from a similar sociodemographic background whose mothers did not report being HIV infected. Children were not identified as being HIV infected. Mother reports, child reports, and standardized reading achievement scores were used to assess 4 domains of adjustment: externalizing problems, internalizing problems, cognitive competence, and prosocial competence. The results indicated that, on average, children from both groups had elevated levels of behavior problem scores and low reading achievement scores when compared with national averages. Relative to children whose mothers were not infected, those whose mothers were HIV infected were reported to have more difficulties in all domains of psychosocial adjustment. Potential family processes that may explain the findings are discussed.

Childhood sexual abuse and age at initiation of injection drug use

OBJECTIVES We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users. METHODS We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories. RESULTS The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection. CONCLUSIONS Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with postvictimization services for children and adolescents.

The impact of maternal HIV infection on parenting in inner-city African American families.

Parenting behavior and its association with child psychosocial adjustment were examined in inner-city African American families. Participants included 86 HIV-infected women and their noninfected children and 148 HIV-seronegative women and their noninfected children. Interview data were collected concerning maternal physical health, parenting behaviors, and child psychosocial adjustment. The results indicated that mother-child relationship quality and monitoring were important parenting factors for adaptive child psychosocial functioning. HIV-infected mothers reported poorer mother-child relationship quality and less monitoring of their childrens activities than did noninfected mothers, suggesting that maternal HIV infection may disrupt effective parenting. Directions for future research and clinical implications are discussed.

Determinants of subject compliance within an experimental anti-HIV drug protocol

A study of subject compliance within an experimental anti-HIV drug protocol was conducted with 40 asymptomatic HIV seropositive persons participating in a double-blind, placebo controlled trial of the effectiveness of ZDV. Subject compliance was assessed through the use of study nurse independent ratings. The 20 most compliant and 20 least compliant subjects were surveyed at a 6-month interval using a self-report instrument designed to assess perceived social support and other psychosocial factors thought to effect compliance. Results indicated that more adherent subjects lived further from their treatment site, did not live alone, saw their study nurse as supportive, and were more likely to depend on a significant other for a wide range of social, economic, and emotional support. Implications for the practical use of these findings are discussed and suggestions for future research are proposed.

African-American Women and Self-Disclosure of HIV Infection: Rates, Predictors, and Relationship to Depressive Symptomatology

Unlike the prevalence rate of AIDS diagnoses for men, the prevalence rate for women has not reached a plateau. Moreover, the rate of AIDS diagnosis for African-American women is 17 times higher than for White women. In the context of considerable stress, these women must grapple with the question of to whom they can disclose their HIV diagnosis with minimal risk of negative consequences. This study examines patterns of disclosure to significant others, predictors of disclosure, and the relationship between disclosure and psychological functioning. Analyses indicated that women disclosed at varying rates to six different categories of others. Disclosure to mothers (66%) was most common, followed by disclosure to partners (56%). Rates of disclosure to children (28%) and fathers (25%) were lowest. Womens illness status predicted disclosure to father and friends. Only disclosure to partner was significantly related to womens psychological functioning: Fewer symptoms of depression were evident in women who had disclosed their HIV status to their partners compared to those who had not disclosed.

Noninfected children of HIV-infected mothers: A 4-year longitudinal study of child psychosocial adjustment and parenting*

The purposes of this study were to compare, across 4 years, the psychosocial adjustment of noninfected children (ages 6 to 11 at first assessment) whose mothers are and are not HIV-infected, examine differential changes of the two groups of children across the 4 years, and examine the role of parenting on the childs adjustment. Children of HIV-infected mothers reported more depressive symptoms across the four assessments than children whose mothers were not infected. Evidence for differential change of child psychosocial adjustment across assessments for the two groups did not emerge. Parenting variables, particularly the mother-child relationship, were related to child adjustment in both groups. Many of the findings suggest that mothers and children often provide unique perspectives. Prevention and intervention implications are considered.

HIV Prevalence, Risk Behaviors, and High-Risk Sexual and Injection Networks Among Young Women Injectors Who Have Sex With Women

Women injection drug users who have sex with women (WSW IDUs) constitute 20% to 30% of American women IDUs.1 Compared with other women IDUs, WSW IDUs have higher HIV prevalence and incidence rates and a greater likelihood of engaging in high-risk injection and sexual practices with men.1–16 Previous reports suggested that WSW IDUs may be particularly likely to engage in drug injection and sex with men who have sex with men (MSM)1,2,5,6,9,17–19 and to be subordinated and isolated within drug users’ social milieus and more generally.1,20,21 Historical and generational factors may have changed some relationships as a consequence of the HIV epidemic itself, however. Ethnographic data from New York City and Boston, Mass, suggest that many older MSM IDUs and WSW IDUs who injected drugs together may have died earlier in the epidemic, which might reduce the extent to which WSW IDUs currently engage in drug injection and sex with MSM. To further examine HIV risk among WSW IDUs, we compared social situations, injection and sexual networks, and behaviors of young WSW IDUs with those of other young women IDUs.

Child resiliency in inner-city families affected by HIV: the role of family variables.

This study examined the role of family variables in child resiliency within a sample of African-American, inner-city children whose mothers are HIV-infected. Variables from three dimensions of the family were included: family structural variables, maternal variables, and mother-child (parenting) variables. The participants were 82 children between the ages of 6 and 11 and their HIV-infected mothers. Correlational analyses indicated that resiliency was associated only with three parenting variables: parent-child relationship, parental monitoring, and parental structure in the home. Hierarchical regression analyses indicated a multiplicative relationship between parental monitoring and parent-child relationship and between parental monitoring and parental structure in the home, suggesting that parenting variables potentiate each other. Clinical implications of the findings are considered.

Co-occuring psychiatric symptoms in children perinatally infected with HIV and peer comparison sample.

Objective: To compare the rates of psychopathology in youths perinatally infected with HIV (N = 319) with a comparison sample of peers (N = 256) either HIV-exposed or living in households with HIV-infected family members. Method: Participants were randomly recruited from 29 sites in the United States and Puerto Rico and completed an extensive battery of measures including standardized DSM-IV-referenced ratings scales. Results: The HIV+ group was relatively healthy (73% with CD4% >25%), and 92% were actively receiving antiretroviral therapy. Youths with HIV (17%) met symptom and impairment criteria for the following disorders: attention-deficit/hyperactivity disorder (12%), oppositional defiant disorder (5%), conduct disorder (1%), generalized anxiety disorder (2%), separation anxiety disorder (1%), depressive disorder (2%), or manic episode (1%). Many youths with HIV (27%) and peers (26%) were rated (either self- or caregiver report) as having psychiatric problems that interfered with academic or social functioning. With the exception of somatization disorder, the HIV+ group did not evidence higher rates or severity of psychopathology than peers, although rates for both groups were higher than the general population. Nevertheless, self-awareness of HIV infection in younger children was associated with more severe symptomatology, and youths with HIV had higher lifetime rates of special education (44 vs 32%), psychopharmacological (23 vs 12%), or behavioral (27 vs 17%) interventions. Youth-caregiver agreement was modest, and youths reported more impairment. Conclusion: HIV infection was not associated with differentially greater levels of current psychopathology; nevertheless, investigation of relations with developmental changes and specific illness parameters and treatments are ongoing.

Women who are HIV infected: The role of religious activity in psychosocial adjustment

The role of religious activity in the psychosocial adjustment of 205 inner-city African-American women, one-half of whom are HIV infected, was examined. Those who were HIV infected reported praying more but viewed prayer as less effective in coping with a chronic illness. Frequency of prayer predicted optimism about the future, whereas religious activity was not related to current depressive symptoms.