There is an estimated 100,000 children orphaned by AIDS in China, but data on the care arrangement of these orphans are limited. In this study, we examine the relationship between AIDS orphans' care arrangement and their psychosocial well-being among a sample of AIDS orphans in rural China. A total of 296 children who lost both parents to AIDS participated in the study, including 176 in orphanages, 90 in kinship care and 30 in community-based group homes. All participants completed a cross-sectional survey assessing their traumatic symptoms, physical health and schooling. Data reveal that the AIDS orphans in group homes reported the best outcomes in three domains of psychosocial well-being, followed by those in the orphanages and then the kinship care. The differences in psychosocial well-being among the three groups of children persist after controlling for key demographic characteristics. The findings suggest that the appropriate care arrangement for AIDS orphans should be evaluated within the specific social and cultural context where the orphans live. In resource-poor regions or areas stricken hardest by the AIDS epidemic, kinship care may not sufficiently serve the needs of AIDS orphans. Community-based care models, with appropriate government and community support preserving the family style and low child-to-caregiver ratio may constitute an effective and sustainable care model for the best interest of the AIDS orphans in developing countries.

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This study was designed to evaluate potential preventive effects of a cultural adaption of the Focus on Kids (FOK) program among Chinese adolescents through a quasi-experimental intervention trial in Nanjing, China. High school students were assigned to either experimental groups (n = 140) or control groups (n = 164) by schools (with three schools in each condition). The participants completed a confidential questionnaire at baseline and 6-month post-intervention with a follow-up rate of 94.4% (287 of 304). The outcome measures included HIV knowledge, HIV-related perceptions based on the protection motivation theory, stigmatizing attitude toward people living with HIV/AIDS (PLWHA), intentions of health-related risk behaviors and sexual intercourse in the previous 6 months. Results showed a significant intervention effect at 6-month post-intervention in increasing HIV knowledge, decreasing perceptions of response cost associated with abstinence and reducing stigmatizing attitudes toward PLWHA, after controlling for key demographic characteristics and relevant baseline measures. Further mediation analysis suggested that HIV knowledge mediated the effect of intervention on stigma reduction. Findings from this study support the feasibility and initial efficacy of the cultural adaptation of FOK HIV prevention program among high school students in China.

With the increasing number of AIDS orphans in China, the government has been building AIDS orphanages since 2004 to accommodate some of those children who have lost both parents to AIDS. However, no data are available regarding the quality of this model of institutional care of AIDS orphans in China. This study, based on qualitative data from children and workers in AIDS orphanages, examines the daily lives, needs, and feelings of orphans and explores the advantages and disadvantages of institutionalized care of AIDS orphans in China. The current study was conducted in 2006-2007 in two rural counties of central China. Data in the current study included individual in-depth interviews with 23 children who lost both of their parents to HIV=AIDS (ages 8 to 17 years) living in AIDS orphanages and 5 AIDS orphanage workers. Findings in this study reveal that children living in orphanages mostly felt that the living conditions were better than the families they lived with after the death of their parents. However, according to the children and orphanage workers, the institutional care has some disadvantages, such as administrative restraints, limited psychological guidance, stigma, lack of education on AIDS, and financial burdens of the operation. Implications for intervention programs include continuing support from the government and nongovernmental organizations, improvements in administrative styles, and the need of incorporating psychological support within the institutions.

Depression can result in poor adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV), and social support can help mitigate the negative relationship. However, little is known about how depression and social support synergistically influence ART adherence over time. The current study aims to explore longitudinal associations between them and examine which sources of social support can play a mediating role between depression and ART adherence over time. A randomized controlled clinical trial was conducted between 2013 and 2016 in Guangxi, China. The study sample was composed of 319 PLHIV who were randomized into control condition and provided data at baseline and at least one of the six follow-ups. The results revealed negative associations of depression with ART adherence over time, and a mediating effect of perceived support from spouse/partner or children. Interventions to promote ART adherence should focus on strengthening PLHIV's relationships with their spouse/partner and children, promoting collaborative provider-patient relationships, and enhancing peer support among PLHIV.

We designed this study to assess parental, behavioral, and psychological factors associated with tobacco use among Chinese adolescents. The data were collected from 995 middle school students in Nanjing, China. Both smoking experimentation and current smoking (smoking in the past 30 days) were assessed among the study sample. Psychosocial measures include family structure, problem behaviors, social influence of smoking (both parental and friends' approval of smoking), depressive symptoms, social alienation, self-esteem, parental monitoring (social monitoring and academic monitoring) and parenting style (responsiveness and demandingness). Among the study sample (mean age 15.16 years and 50% females), 24% ever smoked and 15% smoked in the past 30 days. Advanced age, male gender, low family SES, low school performance and low educational aspiration were associated with both smoking experimentation and current smoking. Depressive symptoms, social alienation, low selfesteem, low social and academic monitoring, problem behaviors, low maternal and paternal responsiveness, peer smoking, parent smoking, and parental and friends' approval of smoking were positively associated with current smoking among Chinese adolescents. Future tobacco use prevention efforts among Chinese adolescents need to consider the parental, behavioral, and psychological correlates identified in the current study.

This study compares psychosocial well-being between paternal and maternal orphans in rural China in a sample (N = 459) of children who had lost one parent to HIV and who were in family-based care. Measures included academic marks, education expectation, trusting relationships with current caregivers, self-reported health status, depression, loneliness, posttraumatic stress, and social support. No significant differences were found between maternal and paternal orphans, except that paternal orphans reported better trusting relationships with caregivers than maternal orphans. Children with a healthy surviving parent reported significantly better depression, loneliness, posttraumatic stress, and social support scores than children with a sick parent. Analyses revealed significance with regard to orphan status on academic marks and trusting relationships with caregivers while controlling for age, gender, surviving parent's health status, and family SES. Findings underscore the importance of psychosocial support for children whose surviving parent is living with HIV or another illness.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. In addition, significant differences in the impact of maternal and paternal death on the wellbeing of AIDS orphans have been found in some African studies. Some studies indicated that children who lost their mother (maternal orphans) were more vulnerable to poor schooling outcomes than children who lost their father (paternal orphans), and the loss of fathers was correlated with poor household socioeconomic status (Case & Ardington, 2006;Case, Paxson, &. Ableidinger, 2004;Nyamukapa & Gregson 2005;Yamano & Jayne, 2004). On the contrary, several studies conducted in South Africa found that paternal orphans were more likely to be behind in school (Parikh et al., 2007;Timaeus & Boler, 2007). NIH Public AccessAlmost all of the existing studies on the impact of maternal and paternal death on the wellbeing of AIDS orphans were conducted in Africa and focused primarily on family socioeconomic status and educational outcomes with mixed findings. Limited data are available regarding other important aspects of child well-being between paternal and maternal orphans. To the best of our knowledge, no published studies have compared the psychological well-being between paternal and maternal AIDS orphans in Asian countries, including China. Previous studies in China suggested that both double AIDS orphans (children who lost both of their parents to HIV) and single AIDS orphans (children who lost one of their parents to HIV) were exposed to more trauma, poor...