Family to Family: Psychoeducation to Improve Children's Outcomes in HIV+ Families

HIV has a negative intergenerational impact on families, particularly children with HIV+ parents. In order to improve the social, behavioral and mental health outcomes for families affected by HIV, we have designed the Family-to-Family (F2F) intervention that includes the critical, universal, program components identified by the NIMH Intervention Workgroup. All efficacious intervention programs: frame the problem by providing information and shaping beliefs; enhance skills; establish supportive relationships; and remove environmental barriers to behavior change (e.g., HIV testing, ARV). We aim to evaluate a generic intervention approach including these components that is culturally-tailored to families affected by HIV in a specific country, Thailand.

Families in Thailand need such an intervention: 1 in 4 elderly adults in Thailand will raise an AIDS orphan, even with a relatively low national seroprevalence rate (1.2%, I million adults). Thailand has a rising seroincidence. This research will design and evaluate an intervention for improving the long-term adjustment of families with HIV. We will intervene with HIV+ parents and family caregivers to improve the outcomes for families living with HIV.

The Specific Aims for the proposed study are:

• To compare the outcomes over time of the school-age children of families in the intervention and SC conditions in each of the following domains: a) mental health symptoms; b) behavioral adjustment, and c) relationships with HIV+ parents, caregivers, and peers.
• As intermediate outcomes, to compare the outcomes over time of the HIV+ parent in the intervention and the SC condition in terms of: health status; HIV transmission acts; parenting behaviors and bonds with children; and mental health symptoms.
• As intermediate outcomes, to compare the outcomes over time of the partners and caregivers (about 80% grandparents) in the intervention and the SC condition in terms of: health status; mental health symptoms; caregiver burden; relationships with their HIV+ adult children, their school-age grandchildren, and bonds.
• To compare the intermediate outcomes among those in the intervention and SC condition on disclosure and stigma-related stress.
• To compare the influence of background factors on the impact of the intervention over time: age and gender of the HIV+ parent, the school-age child's age and gender, physical proximity in the living situation of the HIV+ parents and family caregivers, mode of initial transmission for acquisition of HIV (IDU, sexual acts), income and initial quality of relationships.

Inclusion criteria

• HIV+ or family member of HIV+ person
• living with one or more school-age children aged 12-17;
• Informed consent;
• Disclosure of serostatus to at least one family member

Exclusion criteria

• No school-age children living at home; or
• No disclosure of the serostatus to any family member; or
• Inability to give informed consent or refusal