HIV and Child Mental Health: A Case-Control Study in Rwanda

Abstract

BACKGROUND: The global HIV/AIDS response has advanced in addressing the health and well-being of HIV-positive children. Although attention has been paid to children orphaned by parental AIDS, children who live with HIV-positive caregivers have received less attention. This study compares mental health problems and risk and protective factors in HIV-positive, HIV-affected (due to caregiver HIV), and HIV-unaffected children in Rwanda. METHODS: A case-control design assessed mental health, risk, and protective factors among 683 children aged 10 to 17 years at different levels of HIV exposure. A stratified random sampling strategy based on electronic medical records identified all known HIV-positive children in this age range in 2 districts in Rwanda. Lists of all same-age children in villages with an HIV-positive child were then collected and split by HIV status (HIV-positive, HIV-affected, and HIV-unaffected). One child was randomly sampled from the latter 2 groups to compare with each HIV-positive child per village. RESULTS: HIV-affected and HIV-positive children demonstrated higher levels of depression, anxiety, conduct problems, and functional impairment compared with HIV-unaffected children. HIV-affected children had significantly higher odds of depression (1.68: 95% confidence interval [CI] 1.15–2.44), anxiety (1.77: 95% CI 1.14–2.75), and conduct problems (1.59: 95% CI 1.04–2.45) compared with HIV-unaffected children, and rates of these mental health conditions were similar to HIV-positive children. These results remained significant after controlling for contextual variables. CONCLUSIONS: The mental health of HIV-affected children requires policy and programmatic responses comparable to HIV-positive children.

Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda

“…Covariates that were included in the analysis are described in detail by Betancourt et al 2014 25 and were as follows: sex, age, socioeconomic status, depressive symptoms among caregivers (Hopkins Symptom Checklist-25), 35 posttrauma symptoms for caregivers (PTSD Checklist by Weathers et al), 36 parental alcohol use (Alcohol Use Disorder Identification Test), 37 social services access, 38 “good” parenting, 33 family trust/connection (kwizerana), 33 self-esteem (Self-esteem scale by Connor et al), 39 social support (items derived from social support scale developed by Barrera and Ainlay), 40 parental monitoring, 33 hopefulness (Life Satisfaction/Hopefulness scale), 41 prosocial behaviors, 33 harsh punishment (derived from a measure developed by United Nations Children’s Fund), 42 daily hardships, 38 intimate partner violence (Conflict Tactics Scale), 43 and perceived stigma (HIV Stigma by Association scale). 44 All study questionnaires were administered verbally with trained research assistants.…”

A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania

“…Despite the numerous psychosocial and mental health difficulties confronted by HIV-positive adolescents, there is a dearth of literature exploring the mental health burden encountered by these youth in SSA, with notable exceptions from South Africa focused on children orphaned by HIV/AIDS (both HIV-positive and negative) [9–11, 19–25] and adolescents in Rwanda [26] and Zambia [27]. To our knowledge, only one prior study in Zimbabwe has explored the psychosocial context of HIV-positive adolescents experiencing mental health problems [28].…”

Risk and protective factors for suicidal ideation and behaviour in Rwandan children

“…As global attention to children directly and indirectly affected by HIV/AIDS expands, greater understanding is needed on suicide risk among children living with HIV, children affected by HIV (children with an HIV-positive (HIV+) caregiver or a caregiver who died due to AIDS), and those unaffected by HIV, and the risk and protective factors that may influence this risk. This study is a secondary analysis of existing data from a case-control study conducted to compare mental health problems among children living with HIV, children affected by HIV, and children unaffected by HIV (15). The matched nature of the design allows us to examine suicidal ideation and behavior and how these experiences may be associated with HIV status.…”