Patricia Morse

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.

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.

The role of community risks and resources in the psychosocial adjustment of at-risk children: An examination across two community contexts and two informants

Relative to the attention given to the family, the larger environmental context in which children live has received little attention. This study examined 277 African American children from single-parent families living in two community contexts: rural and urban. Resources and risks within each community were compared across communities. Furthermore, the relations of community, community environment (a resource-risk index), and the interaction of these two variables to child psychosocial adjustment were examined. Finally, the role of informant (mother or child) was examined. The results indicated that the mothers and children from the urban community reported more risks than those from the rural community. The community environment, but not community (rural vs. urban), related consistently to child psychosocial adjustment but only when the same informant (mother or child) reported both the resource-risk index and child psychosocial adjustment. Community did not qualify this relationship. Implications for prevention and intervention programs are considered.

Orphans of the AIDS epidemic in the United States: Transition-related characteristics and psychosocial adjustment at 6 months after mother's death

This study has two purposes: (1) to describe the characteristics related to the transition to orphanhood for children whose mothers die from AIDS and (2) to examine the psychosocial adjustment of these children at six months following maternal death. Twenty orphans and a control sample of 40 children from the same neighbourhoods, as well as their mothers or care-givers, served as participants. Two assessments occurred: (1) prior to the death of the mother in the orphan group and (2) six months after her death. The results indicated that relatives, particularly maternal grandparents, became the new care-giver of the orphans, no more than one residential move had occurred following the mothers death, and the new care-givers were providing a stable home environment. Child psychosocial adjustment did not change following maternal death.

Mother Knows Best? Mother and Child Report of Behavioral Difficulties of Children of HIV-Infected Mothers

Children of HIV-infected mothers have more psychosocial adjustment difficulties than do those of noninfected mothers. In this study, child psychosocial adjustment in children of HIV-infected women is examined across the three stages of HIV-infected: asymptomatic, symptomatic and AIDS. Participants were 99 HIV-infected women and 148 noninfected women. Children were not identified as being HIV infected. Mother and child reports of behavioral difficulties are compared, and competing hypotheses about mother report of child behavior difficulties are tested. Results indicate an ascending linear trend for child report of internalizing and externalizing difficulties from the noninfected stage through increasingly severe stages of HIV-infection. According to mother report, child externalizing and internalizing difficulties are nonlinear, as mothers report an increase through the infected symptomatic stage, then a decrease in the AIDS stage. Implications for assessment, prevention and intervention in families with maternal HIV infection are discussed.

Predictors of Adopting Motivational Enhancement Therapy

Substance abuse counselors have shown limited success in adopting evidence-based practices (EBPs). The purpose of this paper is to identify the barriers and facilitators of adopting an EBP called motivational enhancement therapy (MET). One hundred thirty-six predominantly female (60%) African American (68%) addiction counselors representing over 40 agencies completed surveys before and after participating in a 2-day MET training. Based on stepwise regressions, 10 variables predicted gains in MET knowledge, attitudes, and/or skills: high consistency of MET with organization’s philosophy, being Caucasian, being younger, low self-efficacy, high practitioner self-perceived cultural competency, low adherence to the 12-step treatment philosophy, viewing MET as challenging to learn, high workload, fewer colleagues in same MET training, and working in a smaller organization. Implications for social work practice are discussed.

Children whose mothers are HIV infected : Who resides in the home and is there a relationship to child psychosocial adjustment?

This study examined who resides in the home when a mother is HIV infected and whether this relates to child psychosocial adjustment. Participants were 249 inner-city African American women, 40% of whom were HIV infected, and their 6- to 11-year-old children. HIV-infected women in the symptomatic-AIDS stage were more likely than noninfected mothers to have more adults, particularly a grand-mother or aunt of the child and more adults per child residing in the home. Only the ratio of adults-to-children in the home was related to child adjustment, and this occurred primarily when mothers were in the symptomatic-AIDS stage of infection.