Enhancing the Emotional Well-Being of Perinatally HIV-Infected Youth Across Global Contexts

Introduction: Increased access to antiretroviral treatment worldwide makes it more possible for children diagnosed with HIV before their 15th birthday to age into adolescence and beyond. Many HIV+ youth navigate stressors including poverty and resource scarcity, which may converge to produce emotional distress. For over a decade, Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP) investigators partnered with youth, caregivers, providers, and community stakeholders to address the health, mental health, and risk-taking behaviors of perinatally HIV-infected youth. This paper explores the mental health needs of aging cohorts of HIV+ youth, across three global contexts, New York (USA), Buenos Aires (Argentina), and KwaZulu-Natal (South Africa), to inform the development and implementation of a combination of HIV care and prevention supports for HIV+ youth. Methods: Analysis of data pooled across three countries involving HIV+ early adolescents and their caregivers over time (baseline and 3-month follow-up) was conducted. Univariate and multivariate analyses were applied to data from standardized measures used across sites to identify mental health needs of youth participants. The impact of the site-specific versions of a family-strengthening intervention, CHAMP+ US, CHAMP+ Argentina, CHAMP+ SA, was also examined relative to a randomized standard of care (SOC) comparison condition. Results: Analyses revealed mental health resilience in a large proportion of HIV+ youth, particularly behavioral functioning and overall mental health. Yet, significant numbers of caregivers across country contexts reported impaired child emotional and prosocial well-being. Significant site differences emerged at baseline. Involvement in the CHAMP+ Family Program was related to significant improvement in emotional well-being and a trend towards enhanced prosocial behavior relative to SOC across global sites. Conclusions: Ongoing partnerships with youth, family, and provider stakeholders across global sites helped to tailor programs like CHAMP+ to specific contextual needs. This has global intervention research and care implications as cohorts of HIV+ children age into adolescence.