Sally Mason

Validation of a brief stigma-by-association scale for use with HIV/AIDS-affected youth in South Africa

Abstract This study validated a brief stigma-by-association scale for use with South African youth (adapted from the HIV Stigma-by-Association Scale for Adolescents). Participants were 723 youth (364 male, 359 female) from poor urban communities around Cape Town. Youths completed the brief stigma-by-association scale and measures of bullying victimisation and peer-problems, as well as inventories measuring symptoms of depression and anxiety. Exploratory analyses revealed that the scale consists of two subscales: (1) experience of stigma-by-association and (2) consequences of stigma-by-association. This two factor structure was obtained in the full sample and both the HIV/AIDS-affected and unaffected subgroups. The full stigma-by-association scale showed excellent reliability (α = 0.89–0.90) and reliabilities for both subscales were also good (α = 0.78–0.87). As predicted, children living in HIV/AIDS-affected households obtained significantly higher stigma-by-association scores than children in non-affected households [F(1, 693) = 46.53, p<0.001, partial η 2=0.06] and hypothesized correlations between stigma-by-association, bullying, peer problems, depression and anxiety symptoms were observed. It is concluded that the brief stigma-by-association scale is a reliable and valid instrument for use with South African youth; however, further confirmatory research regarding the structure of the scale is required.

Intergenerational and interconnected: Mental health and weil-being in grandparent caregiver families

Research shows that a substantial number of grandparent caregivers are caring for children with developmental delays or emotional or behavioral problems, and that many caregivers have clinical levels of depression. This study explores grandparent-caregiver families’ mental health needs as well as use of and barriers to accessing mental health services. Interviews with families revealed unmet mental health needs and an interconnectedness between grandchildrens and their grandparent caregivers’ well-being. In the survey component, service providers described problems highly consistent with those reported by grandmothers, including school-related or attention-related concerns among children and depression, stress, and frustration among grandparents. Findings suggest implications for practitioners and policymakers regarding service access, expectations about services, and the fit between clients’ needs and the services available.

Putting a face on HIV infection/AIDS in older adults: A psychosocial context

Summary: Older HIV‐1‐seropositive individuals largely have not been investigated with respect to their psychosocial characteristics. In this article, the authors review research reported to date regarding the psychosocial context of this growing subgroup of HIV‐1‐infected individuals. Specifically, the authors consider the characteristics of mood state, life stressor burden, social support network, and coping strategies that individuals older than 50 years are more likely to adopt in adjusting to HIV‐1 infection. The authors also separately consider issues of caregiving burden. Data supporting a theoretically based stressor‐support‐coping model are presented and related to targeting psychotherapeutic interventions for this age group.

Developing a measure of stigma by association with African American adolescents whose mothers have HIV

Objectives: African American urban adolescents are one of the fastest growing groups of children affected by their mother’s HIV status. These children experience HIV stigma by association with their HIV-positive mothers. Stigma may contribute to adverse outcomes for these teens. Methods: The authors describe a multistage process of scale construction, cognitive interviewing, and pilot testing to develop a measure reflecting an African American adolescent’s experience of HIV stigma when mother has HIV. Results: The resulting measure has 23 items with good reliability. An additional item suggested by qualitative data will be added to the measure and used in further testing. Conclusions: Potential uses of the measure are discussed. Intervention approaches for reducing stigma’s impact among HIV-affected African American adolescents are briefly outlined.

“No Matter What I Do They Still Want Their Family”: Stressors for African American Grandparents and Other Relatives

Grandparents and other relatives increasingly assume the role of primary caregiver to minor children. This study interviewed family members caring for children whose parents were not available due to parental incarceration, other involvement in the criminal justice system, and substance abuse-related issues. Interviews with 25 African American women examined the impact of caregiving including stress and depression. Stress included caregiver issues related to finances, time allocation, care responsibilities, and concerns about the absent parent, as well as issues specific to the children related to school concerns, child behavior, and emotional problems. These stresses were examined along with caregiver depression scores using the Center for Epidemiological Studies Depression Scale, which indicated more depression related to caregiver illnesses, older caregivers, and care for older and a larger number of children. This study suggests that caring for these children is both challenging and stressful, and caregivers are at risk for depression and other mental health concerns. Health and service providers should carefully assess the needs of caregivers when determining the needs of families where children are under care of nonparental relatives. Family-based services are needed that include caregiver supports as well as support for children.

“Like being in a cage”: stigma as experienced by adolescents whose mothers are living with HIV

Stigma affects not only the person living with HIV, but also, by association, their family members. Stigma-by-association may contribute to adverse outcomes for children of parents living with HIV. We interviewed 27 African-American adolescents, 13–18 years old, who were not HIV-positive but whose mothers were living with HIV. As part of a broader study, adolescents responded to four open-ended questions regarding their experience of HIV stigma-by-association. Their responses were analyzed using ATLAS.ti to identify themes. About half of the teens had not told anyone their mother’s HIV status but had heard peers make fun of or insult people with HIV. Anticipating stigma, teens used a range of strategies from being silent and vigilant to brushing off insults as ignorance and refusing to feel shame. In some instances, these strategies strained peer interactions and reinforced the mother/teen connection. With guidance, mothers may be well positioned to coach children and teens to identify stigma situations, manage those situations, and ultimately reduce stigma’s impact on both adolescent and mother. Group interventions with HIV-affected teens, with or without parental involvement, can ameliorate the strained peer relationships which teens described, reducing their isolation and empowering them with knowledge and decision-making skills.

Identified problems and service utilization patterns among kinship families accessing mental health services

Abstract This study examined the mental health problems and service utilization patterns of kinship families who accessed services in an urban outpatient child psychiatry clinic. A random sample of children who completed the intake process during a calendar year yielded 47 children, or 19% of the sample, whose primary caregiver was a relative, other than a biological parent; approximately half of those families were involved with the child welfare system. Data from an administrative database and from medical records describe the diagnoses, identified problems, and services used by the kinship families. Academic or school-related problems emerged as an identified problem in approximately half of the kinship cases, but school intervention was not a primary target for clinicians. The kinship sample was also compared with a random stratified sample of children who were living with primary caregivers other than kin. Kinship families were more likely to be African-American, but few differences were found between kin and non-kin cases on diagnoses and frequency, duration, or type of services received. The findings suggest that collaboration with schools might increase the engagement and retention of kinship families in mental health services.

Developing and testing a framework for evaluating the quality of comprehensive family assessment in child welfare

Over the last decade, Comprehensive Family Assessment (CFA) has become a best practice in child welfare. Comprehensive Family Assessments go beyond risk assessment to develop a full picture of the childs and familys situation. When appropriately synthesized, assessment information can lead to a clear articulation of the patterns of child or family functioning which are related to child abuse and maltreatment or which can be strengthened to facilitate change. This study defines and provides concrete examples of dimensions of quality in child welfare assessment reports that are consistent with the CFA guidelines and best practices embraced by child welfare agencies, courts, and other key stakeholders. Leveraging a random assignment design, the study compares the quality of reports written by a caseworker alone versus those written by a caseworker paired with a licensed Integrated Assessment (IA) screener. Findings are discussed in the context of the dual professional model and factors contributing to the timely completion of high quality assessment reports.

Focused and Motivated: A Psychoeducational Group for Parents Living With HIV

To understand the beneficial aspects of a psychoeducational group, parents living with HIV participated in two telephone interviews. Twelve parents answered open-ended questions about program processes, components, and activities. Study participants identified five processes: focused and motivated; learn from each other; share freely with people who understand; support and care about each other; respect each others privacy; and protect each other. The identified knowledge areas—self-care, parenting, and goal-setting—were consistent with the programs focus. Components noted were those activities designed to develop comfort between participants, share ideas, and practice skills. Goal-setting and monitoring progress represented a primary task that brought focus to the groups endeavors and around which knowledge was shared and feedback and support were provided, strengthening the bonds between the participants. As people with HIV are living longer, programming can take a future orientation, supporting parents in raising children and leading productive lives.

Introduction: HIV testing, disclosure, and human rights

This issue contains articles about two consequential and interconnected topics—HIV testing and HIV disclosure. HIV testing became available in 1985 in high resource countries, originally to screen the blood supply, but soon after used for medical diagnosis of HIV infection. Since its inception, testing has been controversial with debates over whether testing should be mandatory or voluntary, conducted routinely or with informed consent, and results kept confidential or not. Some practitioners questioned why HIV should be an exception to other forms of medical testing, which were done without the person’s informed consent with results shared extensively. Others, especially public health officials, argued that the stigma and fear attached to HIV made confidentiality and voluntary testing essential in encouraging people to test. Early in the epidemic, many argued that, without a treatment, the main value of testing was in the post-test counseling. This counseling emphasized prevention messages, which were relevant to whether the person tested positive or negative. In fact, knowing one’s status, whether positive or not, is associated with adopting preventive behaviors (World Health Organization, 2012). As HIV disease progressed from a terminal illness to a chronic, manageable disease, testing was essential to obtaining treatment early in the disease process. Organizations such as the World Health Organization (WHO) and the Centers for Disease Control developed similar testing guidelines. Current WHO guidelines state that testing should be voluntary, confidential, with informed consent, include counseling about the test and prevention, and have a connection to prevention services for those who are negative and to medical care for those who test positive (World Health Organization, 2015). Treatment and testing are, of course, connected with treatment being the logical outcome of testing, as long as antiretrovirals are readily available. Given initiation of medication, people living with HIV can reduce their viral load. A reduced viral load can greatly increase longevity as well as potentially reduce transmission of the virus through sexual and needle-sharing behavior. For pregnant women, testing positive means access to medication, which will greatly reduce the risk of transmission to the baby. none defined