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Background: The rearing environment of human immunodeficiency virus (HIV)-infected children is often compromised, putting these children at additional risks. Positive caregiving may ameliorate the impact of adverse circumstances and promote attachment security. The goal of the present study was to examine the attachment relationships of HIV-infected children in biological families and institutions; to examine the effects of HIV infection and institutional rearing on attachment security and indiscriminate friendliness; and to assess the role of caregiving in the face of HIV-related adversities. Methods: We studied 64 Ukrainian uninfected and HIV-infected children reared in families and institutions (mean age 50.9 months). Physical and cognitive development of children as well as attachment-related domains and indiscriminate friendliness were assessed. Results: Institutional care but not the presence of HIV was associated with lower levels of attachment security and higher levels of indiscriminate friendliness. On average, the level of indiscriminate friendliness among institution-reared children was more than twice as high as among family-reared children. Only 24% of institution-reared children had clearly developed attachment patterns, as opposed to 97% among family-reared children. Controlling for physical and cognitive development, type of care (institution or family), and HIV status, positive caregiving was associated with higher levels of attachment security. Indiscriminate friendliness was associated with lower levels of attachment security among family-reared children, but with higher levels of positive caregiving among institution-reared children. Conclusions: Etiology and function of indiscriminate friendliness may differ for family-reared versus institution-reared children. The findings of this study suggest the necessity of early interventions improving the quality of care for HIV-infected children. (Contains 3 tables and 1 figure.)

To study the effects of perinatal HIV-1 infection and early institutional rearing on the physical and cognitive development of children, 64 Ukrainian uninfected and HIV-infected institutionalized and family-reared children were examined (mean age = 50.9 months). Both HIV infection and institutional care were related to delays in physical and cognitive development, with a larger effect of the rearing environment. Family care, even of compromised quality, was found to be more favorable for children's physical and cognitive development than institutional care. The impact of the quality of child care on physical and cognitive development is discussed in light of future interventions. (Contains 4 tables and 2 figures.)

The rearing environment of human immunodeficiency virus (HIV)-infected children is often compromised, putting these children at additional risks. Positive caregiving may ameliorate the impact of adverse circumstances and promote attachment security. The goal of the present study was to examine the attachment relationships of HIV-infected children in biological families and institutions; to examine the effects of HIV infection and institutional rearing on attachment security and indiscriminate friendliness; and to assess the role of caregiving in the face of HIV-related adversities. We studied 64 Ukrainian uninfected and HIV-infected children reared in families and institutions (mean age 50.9 months). Physical and cognitive development of children as well as attachment-related domains and indiscriminate friendliness were assessed. Institutional care but not the presence of HIV was associated with lower levels of attachment security and higher levels of indiscriminate friendliness. On average, the level of indiscriminate friendliness among institution-reared children was more than twice as high as among family-reared children. Only 24% of institution-reared children had clearly developed attachment patterns, as opposed to 97% among family-reared children. Controlling for physical and cognitive development, type of care (institution or family), and HIV status, positive caregiving was associated with higher levels of attachment security. Indiscriminate friendliness was associated with lower levels of attachment security among family-reared children, but with higher levels of positive caregiving among institution-reared children. Etiology and function of indiscriminate friendliness may differ for family-reared versus institution-reared children. The findings of this study suggest the necessity of early interventions improving the quality of care for HIV-infected children. [ABSTRACT FROM AUTHOR]

To study the effects of perinatal HIV-1 infection and early institutional rearing on the physical and cognitive development of children, 64 Ukrainian uninfected and HIV-infected institutionalized and family-reared children were examined (mean age = 50.9 months). Both HIV infection and institutional care were related to delays in physical and cognitive development, with a larger effect of the rearing environment. Family care, even of compromised quality, was found to be more favorable for children's physical and cognitive development than institutional care. The impact of the quality of child care on physical and cognitive development is discussed in light of future interventions.

To study the effect of institutional rearing on physical growth and stress regulation we examined 16 institution-reared children (3-6 years old) in Ukraine and compared them with 18 native family-reared children pair-matched on age and gender. Physical growth trajectories were examined on the basis of archival medical records and current measurements of height, weight, and head circumference. Stress regulation was studied on the basis of diurnal salivary cortisol sampled six times during 1 day. 31% of institution-reared children were stunted at 48 months whereas none of the family-reared children were. Substantial delays in physical growth were observed in institution-reared children especially during the first year of life. From 24 months onwards a tendency for improvement in physical growth was evident among the temporarily stunted institution-reared children, with complete catch-up in weight and partial catch-up in height by the time of assessment. Chronically stunted institution-reared children demonstrated persistent severe growth delays. Institution-reared and family-reared children showed similar patterns of diurnal cortisol production with decreases over the day. However, temporarily stunted institution-reared children had a significantly higher total daily cortisol production than both chronically stunted institution-reared children and family-reared children. These data confirm previous findings regarding physical growth delays and stress dysregulation associated with institutional care, but also point to differences in cortisol production between stunted and non-stunted institution-reared children.