CHILDREN AND ADOLESCENTS

Grant Title: Mental Health and Risk in HIV+ Youth and Seroreverters

Project Name: Project CASAH

Funding Source and Project Period: World AIDS Foundation; 2003 - 2006

Collaborating Institutions and Key Personnel:

HIV Center:
Principal Investigator: Claude Ann Mellins, Ph.D.
Co-Investigators: Elizabeth Brackis-Cott, PhD; Curtis Dolezal, Ph.D.;
Project Director: Elizabeth Brackis-Cott, Ph.D.
Consultant: Mary McKay, PhD. (Mt. Sinai School of Medicine)

Harlem Hospital Center:
Co-Principal Investigator: Elaine Abrams, M.D.

Jacobi Medical Center:
Co-Investigator: Andrew Wiznia, M.D.

Metropolitan Hospital:
Co-Investigator: Mahrukh Bamji, M.D.

Project Overview: With the advent of antiretroviral medication (ART), perinatally-infected children are reaching adolescence in large numbers. By 2001, over 10,000 children were estimated to be living with perinatally acquired HIV in the United States (US); 2,200 of them are adolescents, primarily of ethnic minority status living in low SES, urban communities. Substantive mental health and behavioral problems in these youth, including psychiatric disorders, sexual risk behavior, substance use, and non-adherence to ART, not only are detrimental to the the adolescent, but may place others at risk for HIV. Few studies of perinatally infected youth have documented their level of risk or examined predictors of risk behaviors. The role of HIV disease in this process is difficult to determine given the confluence of factors that place this population at risk for poor physical and mental health outcomes including neurocognitive deficits, HIV stigma, disclosure of child serostatus, maternal HIV and substance use, poverty, inner-city stress, and disrupted family attachments. Longitudinal studies with comparisons groups are needed to identify the critical factors influencing risk behavior in order to inform effective interventions for the growing number of perinatally HIV-infected adolescents in the US, as well as the much larger number of these youth from resource poor countries where access to preventive treatments is extremely limited.

This five-year, longitudinal study of 200 perinatally HIV-infected adolescents and 150 seroreverters from similar socio-demographic backgrounds, ages 9 - 16 years, residing in New York City, one of the HIV epicenters in the US. Each of the 350 youth and their 350 primary caregivers will be interviewed at baseline and 18-month follow-up. Given the rapid changes that occur in adolescence, an 18-month time period will allow us to follow the youth prospectively and to examine the factors that differentially influence behavior at different stages of adolescence, without substantively increasing the risk of attrition. The study is guided by a modified version of Ewart's Social Action Theory (SAT), a theoretical model of health behavior that focuses on Behavioral Health Outcomes and their determinants. Behavioral Health Outcomes include behaviors typically defined as "mental health" (emotional and behavioral functioning) and "health behaviors" (adherence to ART, and avoidance of sexual risk behavior and drugs). Determinants consist of the individual's self-regulation processes and the larger social, family, and environmental context. SAT is particularly suitable for assessing determinants of risk behavior in inner-city youth affected by multiple life stressors and HIV disease. Contextual and social influences are often left out of risk behavior models. In this study, we emphasize the importance of the child's HIV status, psychiatric functioning, and family process factors in influencing Behavioral Health Outcomes.

Publications and Presentation Abstracts:
None to date.