Objective To assess the efficacy of an intervention designed to promote resilience in young children living with their HIV-positive mothers. Design/Methods HIV-positive women attending clinics in Tshwane, South Africa and their children, aged 6 - 10 years, were randomised to the intervention (I) or standard care (S). The intervention consisted of 24 weekly group sessions led by community care workers. Mothers and children were in separate groups for 14 sessions, followed by 10 interactive sessions. The primary focus was on parent-child communication and parenting. Assessments were completed by mothers and children at baseline and 6, 12 and 18 months. Repeated mixed linear analyses were used to assess change over time. Results Of 390 mother-child pairs, 84.6% (I:161 & S:169) completed at least two interviews and were included in the analyses. Children's mean age was 8.4 years and 42% of mothers had been ill in the prior three months. Attendance in groups was variable: only 45.7% attended >16 sessions. Intervention mothers reported significant improvements in children's externalizing behaviors (β=-2.8, P=0.002), communication (β=4.3, P=0.025) and daily living skills (β=5.9, P=0.024), while improvement in internalizing behaviors and socialization was not significant (P=0.061 and 0.052 respectively). Intervention children reported a temporary increase in anxiety but did not report differences in depression or emotional intelligence. Conclusions This is the first study demonstrating benefits of an intervention designed to promote resilience among young children of HIV-positive mothers. The intervention was specifically designed for an African context, and has the potential to benefit large numbers of children, if it can be widely implemented

Prior investigations suggest that maternal HIV/AIDS poses significant challenges to young children. This study investigates the relationships between mothers’ psychological functioning, parenting, and children’s behavioral outcomes and functioning in a population of women living with HIV (N = 361) with a child between the ages of 6 and 10 years in Tshwane, South Africa. Utilizing path analysis, findings revealed that maternal depression is related to increased parenting stress and parent–child dysfunction, maternal coping is related to parenting style, and maternal coping, parenting style and stress, and parent–child dysfunction are associated with children’s behavior and functioning, with parenting emerging as an important mediator. These findings suggest that interventions for women living with HIV and their children should not only address maternal psychological functioning (depression and coping), but should also focus on parenting, promoting a positive approach.

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Adults with HIV are living longer due to earlier diagnosis and increased access to antiretroviral medications. Therefore, fewer young children are being orphaned and instead, are being cared for by parents who know they are HIV-positive, although they may be asymptomatic. Presently, it is unclear whether the psychological functioning of these young children is likely to be affected or, alternatively, whether it is only when a mother is ill, that children suffer adverse effects. We thus aimed to compare the behavior and psychological functioning of young children (ages 6–10 years) of HIV-positive and HIV-negative mothers. We also aimed to examine the association between HIV status disclosure and child outcomes. This study uses cross-sectional data from the baseline assessment of a randomized controlled trial conducted in Tshwane, South Africa. Participants (n=509) and their children were recruited from area health clinics. Among the 395 mothers with HIV, 42% reported symptoms of HIV disease. Multivariate linear regression models suggested that after adjusting for socio-demographic characteristics, children of HIV-positive mothers had significantly greater externalizing behaviors than children of HIV-negative mothers. Importantly, children whose mothers were symptomatic had greater internalizing and externalizing behaviors compared with children of HIV-negative mothers, but this was not true for children of asymptomatic mothers. Additionally, among children of HIV-positive mothers, those who had been told their mothers were sick compared with children who had been told nothing had less internalizing and externalizing behaviors and improved communication and daily living skills. This study therefore provides evidence that maternal HIV disease can affect the behaviors of young children in South Africa but, importantly, only when the mothers are symptomatic from their disease. Furthermore, results suggest that disclosure of maternal illness but not HIV status was associated with improved behavior and psychological functioning among young children.

Frequency domain analysis techniques have been used in the heart rate variability (HRV) study, and its interpretation has been associated with both clinical investigation and diagnosis. Fast Fourier Transform (FFT) and Autoregressive (AR) based periodograms have been the most commonly used approaches. This work compares these two methods with the Lomb-Scargle (LS) periodogram, which is intended to deal with unevenly sampled data, the HRV. A simulated data with known frequency band amplitude was generated to compare these three methods. Once the HRV signal is an unevenly sampled signal, the LS periodogram seemed to be an interesting choice, presenting less noise estimates in comparison with the other methods. However, additional investigations applying this technique and comparing it with the other approaches in real data are still necessary.

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This paper describes the process of developing a parallel intervention for HIV-positive mothers and their young children (6-10 years) with a view to strengthening the relationship between them. Strong mother-child relationships can contribute to enhanced psychological resilience in children. The intervention was developed through action research, involving a situation analysis based on focus group discussions; intervention planning, piloting the intervention and a formative evaluation of the intervention. Participants supplied feedback regarding the value of the intervention in mother-child relationships. The findings obtained from the formative evaluation were used to refine the intervention. Two parallel programmes for mothers and children (15 sessions each) were followed by 10 joint sessions. The intervention for mothers focused on maternal mental health and the strengthening of their capacity to protect and care for their young children. The intervention for children addressed the development of their self-esteem, interpersonal relationships and survival skills. The formative evaluation provided evidence of good participation, support and group cohesion. Qualitative feedback indicated that the activities stimulated mother-child interaction. A similar intervention can easily be applied elsewhere using the detailed manual. The insights gained and lessons learnt related to mother and child interaction within an HIV-context that emerged from this research, can be valuable in other settings, both in Sub-Saharan Africa and elsewhere.

This paper explains how teachers in schools function as resources to buoy resilience in the face of human immunodeficiency virus/acquired immune deficiency syndrome-compounded adversities. We draw on participatory reflection and action data from a longitudinal study with teachers (n = 57, 5 males, 52 females) from six schools in three South African provinces. The study tracks the psychosocial support offered by teachers following their participation in the Supportive Teachers, Assets and Resilience project. Verbatim interview transcriptions were thematically analysed and three themes (as well as subthemes and categories) emerged: (i) Teachers use resources to promote resilience in schools [teachers use (a) systems and (b) neighbourhood health and social development services to identify and refer vulnerable cases]; (ii) Teachers form partnerships to promote resilience in schools [teacher partnerships include (a) children and families, (b) community volunteers and (c) community organizations, businesses and government] and (iii) School-based support is offered to vulnerable individuals [by means of (a) vegetable gardens, (b) emotional and health support and (c) capacity development opportunities]. We conclude that teachers can promote resilience in schools by establishing networks with service providers that function across systems to support vulnerable groups. We theorize that the core of systemic networks is relationships, that relationship-driven support networks mitigate the effects of cumulative risk and school-based networks can enable schools to function as resilience-promoting resources.