Structural Ecosystems Therapy for recovering HIV-positive women: Child, mother, and parenting outcomes.

Abstract

This study presents results of a subgroup analysis from a randomized trial to examine whether Structural Ecosystems Therapy (SET), a family intervention intended to improve medication adherence and reduce drug relapse of HIV-seropositive (HIV+) women recovering from drug abuse, provided benefits for families with children. Data from 42 children and 25 mothers were analyzed at baseline, and 4, 8, and 12 months post-baseline. Results of longitudinal Generalized Estimating Equations analyses suggested that SET was more efficacious than the Health Group (HG) control condition in decreasing children's internalizing and externalizing problems and reducing mothers' psychological distress and drug relapse. Children in SET reported improvements in positive parenting as compared to the children in HG, but there were no differences in mother-reported positive parenting, or parental involvement as reported by either the children or mothers. These findings suggest that family interventions such as SET may be beneficial for mothers and children. An adaptation of SET specifically for families with children could further enhance benefits and improve acceptability and cost-effectiveness. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript (CDC, 2009) estimates that 26% of all new HIV/AIDS diagnoses are among women. A sizable proportion of HIV seropositive (HIV+) women are mothers. The HIV Cost and Services Utilization Study surveyed a nationally representative sample of HIV+ adults receiving health care in 1996 and 1997. Of 840 women in the sample, 60% had minor children living with them (Schuster et al., 2000).Children of HIV+ mothers have been found to be at risk for internalizing and externalizing problems (e.g., Forehand et al., 2002;Tompkins & Wyatt, 2008), although some studies have not found significantly increased risk for children of HIV+ mothers when compared with demographically similar controls (e.g. Lester et al., 2010). Studies have also demonstrated that children of HIV+ mothers are detrimentally affected by maternal substance abuse (Lester et al., 2009; Rotheram-Borus & Stein, 1999). Children with duallydiagnosed parents appear to derive greater adverse effects from the parent's substance abuse than from HIV (Cowgill et al., 2007;Leonard, Gwadz, Cleland, Vekaria, & Ferns, 2008).Research has demonstrated the linkages between parenting processes and child outcomes in families affected by parental HIV and/or substance abuse. Studies with demographically comparable groups of children with HIV+ and HIV-mothers have found less close parentchild relationships (Forehand et al., 2002;Kotchick et al., 1997) and less monitoring (Forehand et al., 2002) in families with HIV+ mothers, which in turn were connected to less favorable child outcomes. Lester et al. (2010), however, while finding that family processes were associated with children's internalizing and externalizing problems, also found that children with HIV+ mothers reported more positive maternal bonds than children not in HIV-affect...

The relationship between social support and anxiety among caregivers of children in HIV-endemic South Africa

“…This may be particularly important in situations of limited formal mental health facilities and low uptake of existing services, such as that of South Africa. On the one hand, social support components could be included within broader health programmes, for example through support groups, health providers or interventions aimed at strengthening existing networks (Davies, Hortona, Williams, Martin, & Stewart, 2009; Mason & Vazquez, 2007; Mitrani, McCabe, Robinson, Weiss-Laxer, & Feaster, 2010). On the other, there may be opportunity for existing informal support networks and initiatives to serve as a platform for psycho-educational initiatives and higher uptake of formal health services.…”

“They give us hope”: HIV-positive caregivers' perspectives on the role of social support for health

“…Home-based carers or other support providers recruited by health programmes should be individuals with characteristics that allow them to relate to the caregivers’ situations and provide empathy without stigmatising. Interventions aiming to strengthen existing ‘informal’ networks, and/or improve caregivers’ interaction with family and friends, may be useful, but are resource-intensive (Mitrani, et al, 2010) and probably not a feasible or appropriate option in many low-resourced settings. Broader access to support groups, e.g.…”

“…Similarly, studies evaluating applied social support interventions among HIV-positive caregivers are few and fairly recent, and derive mainly from the developed world; moreover, they have not shown conclusive results (Davies, Hortona, Williams, Martin, & Stewart, 2009; S. Mason & Vazquez, 2007; Mitrani, McCabe, Robinson, Weiss-Laxer, & Feaster, 2010). It is clear that there is much scope for research aimed at informing support interventions and policy in HIV-endemic contexts of Southern Africa and beyond.…”

A discussion of HIV/AIDS family interventions: implications for family‐focused nursing practice

“…Koniak-Griffin et al 2003, Dancy 2006, Wamoyi et al 2010) have the likelihood of motivating family members to adopt preventive behaviours (Perrino et al 2000, Kohler et al 2007 and raise self-esteem among women dealing with childhood trauma (Lesser et al , 2007. substance abuse) should be a priority (Mitrani et al 2009(Mitrani et al , 2010, especially among families living in poverty (Bhana et al 2010). Likewise, HIV/AIDS-FIs with a focus on tertiary prevention may be helpful for high-risk individuals or families dealing with mental health issues related to life vulnerabilities and stressors that put them at increased risks of acquiring HIV.…”