Behavior and psychological functioning of young children of HIV-positive mothers in South Africa

Abstract

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.

Positive parenting for positive parents: HIV/AIDS, poverty, caregiver depression, child behavior, and parenting in South Africa

“…Results are consistent with research in South Africa that has shown more child behavior problems in families with children orphaned by AIDS (Cluver, Gardner, & Operario, 2007) or AIDS-symptomatic mothers (Sipsma et al, 2013). Other research has linked child behavior problems to reduced parenting skills due to increased stress associated with HIV/AIDS (Murphy, Marelich, Armistead, Herbeck, & Payne, 2010).…”

“…Parental physical illness and child orphanhood have been shown to negatively affect positive parenting by decreasing engagement, disrupting family routines, and increasing parental absence and neglect (Armistead, Klein, & Forehand, 1995). In South Africa, HIV/AIDS-affected families are associated with increased poverty (Gillies, Tolley, & Wolstenholme, 1996), parental depression (Kuo, Operario, & Cluver, 2012), lack of social support (Casale, 2012), and increased child behavior problems (Sipsma et al, 2013). Since these factors are also associated with reduced positive parenting, they may play a mediating role in the association between HIV/AIDS and positive parenting (Andersen, 1992; Gershoff, 2007; Lovejoy, Graczyk, O'Hare, & Neuman, 2000; Pardini, 2008).…”

HIV-exposed infants

“…Some studies have demonstrated that maternal stressors associated with the onset of HIV symptoms can affect a child’s psychosocial adjustment [45,46] while other studies indicated that it is a mother’s illness or physical well being, not maternal HIV status that affects a child’s behavior (See Psychosocial paper in this series). [46] Of particular interest, is the relationship between a parent’s disclosure of their illness or HIV status and an HIV-E infant’s access to healthcare services, psychosocial adjustment and resilience. [46,47] Non-disclosure of a parent’s HIV status is associated with increased levels of depression and anxiety among HIV affected children.…”

“…[46] Of particular interest, is the relationship between a parent’s disclosure of their illness or HIV status and an HIV-E infant’s access to healthcare services, psychosocial adjustment and resilience. [46,47] Non-disclosure of a parent’s HIV status is associated with increased levels of depression and anxiety among HIV affected children. [48,49]…”

From patient to person

“…Additional communityoriented models can help to dissipate stigma, increase access to social and economic assistance, and reduce mental or psychological distress [51][52][53]. Generally, these models foster increased autonomy and self-reliance among clients and communities, directly enabling adherence and information sharing, and influencing behaviours within the community.…”