Stacey Alicea

Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: a qualitative investigation

Abstract Introduction. While the roll-out of antiretroviral therapy in South Africa should lead to a reduction in mother to child transmission, mortality and orphaning, it will also be accompanied by a large number of children entering adolescence and adulthood with a chronic infectious disease. Adolescence is a particularly vulnerable period for HIV-infected people in relation to mental health problems and engagement in high-risk behaviours, including non-compliance with medical treatment. The goal of this qualitative study was to develop an understanding of the psychosocial challenges as well as protective influences promoting socio-emotional coping in HIV+ adolescents in order to inform mental health promotion and HIV prevention programming for this population in South Africa. Method. In-depth qualitative interviews were conducted with HIV+ adolescents (25) and caregivers of HIV+ children (15) at a large HIV/AIDS Clinic in South Africa. Data were analysed thematically using NVivo8 software. Results. Psycho-social challenges for adolescents included dealing with loss of biological parents in the case of orphans; coming to terms with their HIV+ status including identity difficulties; external stigma and discrimination; and disclosure difficulties. For caregivers, disclosure and lack of financial, family and social support emerged as key challenges. Medication, HIV information, a future orientation and social support was identified as important for coping and general well-being of adolescents, with financial and social support emerging as key for promoting supportive caregiving contexts. Conclusion. While HIV+ adolescents in South Africa experience similar concerns to those in high-income countries, socio-emotional coping may be compromised by increased levels of loss due to the late roll-out of ARVS and challenges to caregiving contexts including poverty, stigma and minimally supported foster care arrangements. There is a need for mental health promotion programmes for adolescents to adopt an ecological approach, strengthening protective influences at the individual, interpersonal, community and policy levels.

Gender and the effects of an economic empowerment program on attitudes toward sexual risk-taking among AIDS-orphaned adolescent youth in Uganda.

PURPOSE This article examines gender differences in attitudes toward sexual risk-taking behaviors of acquired immune deficiency syndrome (AIDS)-orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda. METHODS Adolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n=135) or a control condition (n=142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education. RESULTS Findings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk-taking behavior, in a different way and to a lesser extent than boys. CONCLUSIONS Future research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms.

The VUKA family program: Piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa

An increasing number of adolescents born with HIV in South Africa are on antiretroviral treatment and have to confront complex issues related to coping with a chronic, stigmatizing and transmittable illness. Very few evidence-based mental health and health promotion programs for this population exist in South Africa. This study builds on a previous collaboratively designed and developmentally timed family-based intervention for early adolescents (CHAMP). The study uses community-based participatory approach as part of formative research to evaluate a pilot randomized control trial at two hospitals. The paper reports on the development, feasibility, and acceptability of the VUKA family-based program and its short-term impact on a range of psychosocial variables for HIV + preadolescents and their caregivers. A 10-session intervention of approximately 3-month duration was delivered to 65 preadolescents aged 10–13 years and their families. VUKA participants were noted to improve on all dimensions, including mental health, youth behavior, HIV treatment knowledge, stigma, communication, and adherence to medication. VUKA shows promise as a family-based mental and HIV prevention program for HIV + preadolescents and which could be delivered by trained lay staff.

The Development and Implementation of Theory-Driven Programs Capable of Addressing Poverty-Impacted Children's Health, Mental Health, and Prevention Needs: CHAMP and CHAMP+, Evidence-Informed, Family-Based Interventions to Address HIV Risk and Care

This article describes a program of prevention and intervention research conducted by the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project; McKay & Paikoff, 2007) investigative team. CHAMP refers to a set of theory-driven, evidence-informed, collaboratively designed, family-based approaches meant to address the prevention, health, and mental health needs of poverty-impacted African American and Latino urban youth who are either at risk for HIV exposure or perinatally infected and at high risk for reinfection and possible transmission. CHAMP approaches are informed by theoretical frameworks that incorporate an understanding of the critical influences of multilevel contextual factors on youth risk taking and engagement in protective health behaviors. Highly influential theories include the triadic theory of influence, social action theory, and ecological developmental perspectives. CHAMP program delivery strategies were developed via a highly collaborative process drawing upon community-based participatory research methods in order to enhance cultural and contextual sensitivity of program content and format. The development and preliminary outcomes associated with a family-based intervention for a new population, perinatally HIV-infected youth and their adult caregivers, referred to as CHAMP+, is described to illustrate the integration of theory, existing evidence, and intensive input from consumers and healthcare providers.

Adapting A Family-Based HIV Prevention Program for Homeless Youth and Their Families: The HOPE (HIV prevention Outreach for Parents and Early adolescents) Family Program

As rates of HIV infection increase in adolescents, it is important to provide prevention programs targeting this population. Homeless adolescents living with their families in shelters are at greater risk of participating in risky sexual behavior and incurring negative health outcomes. A family-based HIV-prevention pilot study was conducted with eight homeless families in a New York City shelter to explore (1) the perceived impact of family communication, parental monitoring, family understanding of puberty, sexually transmitted diseases, and HIV on preventing risky behavior for the participating youths and (2) the feasibility of conducting such a program within the shelter system. Qualitative and quantitative results indicate increased family communication, parental monitoring, and decreased parental depressive symptoms.

Project Step-Up Feasibility of a Comprehensive School-Based Prevention Program

Inner-city, low-income Black and Latino youth are at high risk for developing severe behavioral difficulties and dropping out of high school. After-school programs are excellent resources for targeting these issues, yet most focus on middle school populations, address either academic or socioemotional issues rather than a combination of efforts, and struggle to engage at-risk youth. This article presents feasibility data regarding mental health needs and participation in Project Step-Up, a secondary prevention high school program targeting socioemotional and academic domains with linkages provided to mental health resources for hard-to-engage youth. Results indicate that participants exhibit preservice mental health needs at greater rates than manifested in the general population, yet demonstrate attendance and retention rates exceeding those typically reported by after-school programs. Participation differences by race/ethnicity indicate Project Step-Up’s success at engaging Black and Latino youth. Study limitations, curriculum revisions, and planned future evaluations are further discussed.

HIV+ and HIV– youth living in group homes in South Africa need more psychosocial support

Orphans and vulnerable youth who live in group homes are at risk of poor mental health and sexual and drug-using behaviors that increase the risk of HIV transmission. This study explores factors related to this risk among youth living in group homes (“children’s homes”) for orphans and vulnerable children in South Africa, a country afflicted by high levels of parental loss due to HIV. The study explores (1) knowledge and attitudes about HIV, (2) social support, (3) communication with group home caregivers, and (4) the relevance of an existing evidence-based HIV prevention and mental health promotion program to situations where sexual and drug risk behaviors can occur. In-depth qualitative individual interviews were conducted with 20 youth (age 10–16 years) residing in two children’s homes in Durban, South Africa. Content analysis focused on critical themes related to coping and prevention of risk activities. Respondents exhibited inconsistent and incomplete knowledge of HIV transmission and prevention. They displayed positive attitudes toward people living with HIV, but reported experiencing or witnessing HIV-related stigma. Participants witnessed substance use and romantic/sexual relationships among their peers; few admitted to their own involvement. While relationships with childcare workers were central to their lives, youth reported communication barriers related to substance use, sex, HIV, and personal history (including parental loss, abuse, and other trauma). In conclusion, these qualitative data suggest that evidence-based HIV prevention programs that bring caregivers and youth together to improve communication, HIV knowledge, social support, youth self-esteem, and health care, reduce sexual and drug risk behaviors, and strengthen skills related to negotiating situations of sexual and substance use possibility could benefit youth and childcare workers in children’s homes.

The Effects of Sexual Expectancies on Early Sexualized Behavior Among Urban Minority Youth

This study examines the effects of different types of sexual expectancies on early sexual behavior among racial/ethnic minority young adolescents. African American and Latino participants between 11 and 13 years old were recruited through schools and community-based agencies in the South Bronx, New York (N = 223). Multiple logistic regression analyses were used to predict early sexual behavior outcomes, which included engagement in sexual possibility situations, kissing, and sexual touching. The moderating effect of gender was examined using multiplicative interaction terms. Higher expectations categorized as personal/parental and romantic/peer expectancies related to the negative consequences of sexual intercourse decreased the odds of engagement in early sexual behavior; whereas higher academic/career and sexual health expectancies did not. Gender moderated the relationships between personal/parental expectancies and engagement in sexual possibility situations and romantic/peer expectancies and kissing. Social workers formulating sexual health promotion and HIV prevention programs for racial/ethnic minority young adolescents should focus on personal/parental and romantic/peer expectancies in favor of negative expectancies regarding academic/career achievement, pregnancy, and HIV. Social work interventions to delay sexual debut should include a family-based component and should be sensitive to gender differences in sexual expectancies.