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HIV remains prevalent, stigmatized, and requires parents to decide whether and how to disclose to their serostatus to their children. Teaching Raising And Communicating with Kids (TRACK), an intervention to support maternal disclosure of HIV status to children, demonstrated efficacy through a pilot and a full-scale multisite trial. In response to the limited availability of best practices for conducting multisite research and recognizing the importance of identification of key intervention components, the current manuscript presents the traditional elements of an implementation paper along with secondary data analyses to identify drivers of the intervention’s effects. Black, Latinx, and White mothers living with HIV (mean age = 39.27, SD = 7.89) and their children (51% female, mean age = 9.65, SD = 2.48) were recruited in Southern California and Atlanta (N = 176 dyads). Following baseline assessments, half were randomized to the intervention. Follow-up assessments occurred at 3, 9, and 15 months. Implementation and quality assurance protocols revealed the need for a broad range of recruitment and retention strategies, ongoing assessment of participants’ psychological distress, and joint initial training of study personnel with ongoing supervision. Based on linear growth modeling, key intervention components (i.e., parent–child communication, positive parent involvement and reinforcement, family routines) significantly contributed to disclosure self-efficacy, the primary intervention target. Lessons learned emphasized the need to balance fidelity to the research protocol with strategies for managing site-based differences and the importance of including all key intervention components for future implementation at clinical or community-based sites.

BackgroundThe Teaching, Raising, And Communicating with Kids (TRACK) intervention full-scale longitudinal efficacy trial was published in 2021 and was based on a previously successful pilot intervention published in 2011. The TRACK intervention assists mothers living with HIV (MLH) with serostatus disclosure to their young children. In the publication reporting the full-scale trial, TRACK MLH were four times more likely to disclose their HIV serostatus than controls, with the rate increasing to six times more likely applying GEE logistic regression. Intervention MLH showed improvements in communication, social support, family routines, and disclosure self-efficacy; they also demonstrated decreased anxiety and better physical and mental health scores; and their children reported significantly more decline in worry than controls.MethodsThis preprint presents recent analyses showing increases in the reported HIV disclosure rates over and above those reported in the full-scale trial, due to additional follow-up datapoints received after the 2021 publication.ResultsFor MLH in the intervention group, disclosure is 37.6% compared to 34.1% from the 2021 publication, and 12.1% in the control condition compared to 11%. Odds of disclosing if participants were in the intervention group are 4.39 (95% CI. = 2.0, 9.5) compared to 4.20 (95% CI. = 1.8, 9.3), with the intervention group 30% more likely to disclose compared to the 28% reported in 2021. Regarding site disclosure rates for the intervention group, the California disclosure rate is 43.6% compared to 35.9% previously reported; Georgia’s site rate remained unchanged.ConclusionsThese updates are now included in our final analysis dataset and show the intervention was more successful than previously reported.

Globally, over 36 million people are living with HIV, and 51% are women, most of whom are of childbearing age. Children of mothers with HIV exhibit more adjustment problems than their demographically similar peers. Using mixed methods, this study examined associations between mothers’ HIV stigma and their children’s functioning. As part of a multi-site study in Georgia and California, participants included 181 HIV-positive mothers and one of their 6- to 14-year-old children. Mothers reported on children’s psychological adjustment, their own anxiety, and their perceived HIV stigma. Children reported on parent-child relationship quality. Following the quantitative portion of the study, 14 mothers and 13 children who knew their mothers were HIV positive completed in-depth qualitative interviews addressing the impact of HIV disclosure on family relationships. Hierarchical regression analyses found that parent-child relationship quality, maternal anxiety, and HIV stigma were significantly associated with child adjustment difficulties. HIV stigma predicted child adjustment problems after accounting for the role of parent-child relationship and maternal anxiety. Most mothers and some children in the qualitative portion of the study discussed the impact HIV stigma on their lives. In all, despite efforts to decrease HIV stigma, it continues to affect the lives of those with the virus and their families. Interventions, then, should not only focus on the parent-child relationship and maternal anxiety when attending to child functioning in families affected by HIV, but should also target coping skills for mitigating the impact of stigma while continuing efforts to reduce HIV-related stigma.

Objective The Teaching, Raising, And Communicating with Kids (TRACK) study was a full-scale longitudinal efficacy trial of a previously successful pilot intervention, which aims to assist mothers living with HIV (MLH) with serostatus disclosure to their children. The study looked to test the key components of the theoretical model with a more diverse sample than that of the pilot. Method MLH (mean age = 39.27, SD 7.89) and their children (6-14 years) were recruited in Southern California and Atlanta and randomized to an intervention or wait-list control group (N = 176 dyads). TRACK used behavioral exercises within three individual sessions, with assessments at baseline, 3-, 9-, and 15-month follow-ups regarding HIV disclosure, targeted intermediate variables (communication, parental coping, family routines, and disclosure self-efficacy), and outcome variables for MLH's health and mental health, children's mental health, and family relationships/functioning. Results TRACK MLH were four times more likely to disclose their HIV serostatus than controls, with the rate increasing to six times more likely applying generalized estimating equation (GEE) logistic regression. Intervention MLH showed improvements in communication, social support, family routines, and most significantly, disclosure self-efficacy. Intervention MLH demonstrated decreased anxiety and better mental health scores; their children reported significantly more decline in worry than controls. This full-scale trial, over and above the pilot, showed the intervention improved outcomes across multiple sites, and found all targeted intermediate variables improved in the intervention group relative to the control group. Conclusions TRACK helped mothers to disclose their status to their children and improved mental health outcomes, especially anxiety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parents are the first-line healthcare providers for their children and, thus, need to identify and treat symptoms, including knowing whether and how to seek treatment from healthcare professionals. In addition to the tangible resources necessary to address childhood illness, parents' health literacy skills impact their treatment decisions. The current study considered data gathered through focus groups (N = 9 groups) and key informant interviews (N = 13) to explore approaches to childhood illness and their implications for health literacy among Kenyan parents of young children (birth to age 5). Participants included parents, community health workers and community leaders (e.g. village elders) from the Kibera community in Kenya. Themes, resulting from the qualitative data analysis, were mapped onto the Research Triangle Institute's Health Literacy Skills Framework. Participants were well able to identify health risks, often turned to family and neighbors for medical advice, and relied on a range of resources to treat and prevent illnesses in their children. This range included reliance on traditional healers and religious leaders. Balancing cultural and medical viewpoints will be important considerations for interventions focused on supporting Kenyan parents' health literacy and skills to recognize and intervene when their children are sick.To better understand health literacy among Kenyan parents with young children, 91 individuals (parents, community leaders, healthcare providers) provided information about children’s common health concerns and how families address those concerns. The information is consistent with the Health Literacy Skills Framework and illuminated parents’ strengths along with the need to balance cultural and medical viewpoints to improve parents’ health literacy.

Mothers living with HIV (MLH) must balance childcare, their illness, and oftentimes other mental health problems/stressors. It is important to understand how a maladaptive coping strategy, (alcohol use) is linked to poorer parenting practices. We assessed the relationship between mental health/coping (anxiety, depression, alcohol use, social support) and parenting/family dimensions (communication, parenting style/stress, family routines/cohesion) among 152 MLH. Mothers reporting more psychiatric symptoms and less social support also reported poorer parenting practices and interactions. Further, MLH who used more alcohol reported less parenting involvement and fewer family interactions. Alcohol use, even at subclinical levels, can negatively impact the parent-child relationship.

Black South Africans are disproportionately affected by HIV compared with White counterparts. In their unique social context, South African families affected by HIV are vulnerable to adverse psychosocial effects. U.S.-based and emerging South African research suggests mothers living with HIV may experience compromised parenting. In the United States, mother-child relationship quality has been associated with internalizing (anxiety, depression) and externalizing (delinquency, acting out) child behaviors. This study adds to South African research with emphasis on the role of the mother-child relationship among HIV-affected South Africans from multiple communities. Structural equation modeling examined relationships between maternal health and child adjustment, operating through mother-child relationship. The best-fitting model suggested maternal health influences youth externalizing behaviors through the mother-child relationship, but that maternal health is directly related to child internalizing problems. Findings support and extend previous results. Further research would benefit from investigating ways the unique South African context influences these variables and their interactions.

Mothers living with HIV (MLH) must navigate disclosing their serostatus to their children, but the longitudinal impact on families remains unknown. This study examined HIV disclosure, parenting, parenting stress, and child adjustment among 174 MLH-child dyads (aged 6-14; 35% Latinx; 57% Black/African American). Quantitative data were collected over four waves spanning 15 months. Qualitative data were collected with 14 families in which disclosure had occurred. Latent change score modeling revealed that disclosure led to improvements in parenting stress, communication, and relationship quality. Disclosure did not predict child adjustment. Qualitative themes contextualized these findings, revealing stability and improvements in family functioning. MLH should be supported in disclosing their serostatus to their children to minimize parenting stress and bolster parenting skills.

Background Preventing child maltreatment is a global mission of numerous international organizations, with parent support programs as the critical prevention strategy. In Kenya, 70 % of children are at risk of experiencing abuse and neglect, most often by their parents. Yet, there is a lack of evidence-based parent support programs, and a limited understanding of Kenya’s capacity and infrastructures (e.g., policies, funding, service agencies) to support and sustain such programs. Objective The purpose of this study was to assess systematically Kenya’s strengths and limitations to implement a parent support program using a mixed-methods study design. Participants and Methods Twenty-one community stakeholders from Kenya completed the World Health Organization’s (WHO) Readiness Assessment for the Prevention of Child Maltreatment to understand Kenya’s preparedness to undertake a prevention program. In addition, 91 participants (e.g., parents, community health workers, community leaders) took part in focus group discussions or individual interviews to understand existing support networks around parenting programs. Results Kenya’s overall ‘readiness’ score was comparable to the other countries that completed the WHO survey. The survey results revealed Kenya’s strengths and limitations across the ten readiness dimensions. Several themes emerged from the focus groups and interviews, including the diverse sources of support for parents, specific programs available for parents, and gaps in services offered. Conclusions The results document ways to build upon Kenyan’s existing strengths to facilitate implementation of an evidence-based prevention program. These results also highlight the significant need to understand local context when adapting parenting programs for low/middle income countries (LMICs).

Growing up with a mother living with HIV (MLH) is a unique experience for adolescents. Children in these families often thrive; however, many also exhibit behavioral health problems including HIV risk behaviors. Under a lens of youth risk reduction, we examined the role of protective parenting practices in their lives including parent-child communication about sex, parent-child relationship quality, parental monitoring, and mother-to-child HIV disclosure. For this exploratory study, we conducted four focus groups with MLH (n = 15) and 13 in-depth interviews with HIV-negative adolescent children of MLH. Participants were primarily African American and recruited from clinics and non-profit organizations in the southeastern United States. A thematic analysis of focus group and in-depth interview data revealed that mothers’ prior experiences with HIV and HIV-related risks often underlie their strengths as parents – for example, confidence in their ability to discuss sexual risk topics with their children as well as enhanced motivation to monitor their children’s whereabouts and exposure to risky environments. Nonetheless, many MLH face challenges, including problems with mother-to-child HIV disclosure and relationship disruptions, which likely hinder protective parenting. Implications of our findings include specific recommendations for adapting effective and culturally-informed prevention interventions for families affected by maternal HIV infection.

Nondisclosure of maternal HIV status to young children can negatively impact child functioning; however, many mothers do not disclose due to lack of self-efficacy for the disclosure process. This study examines demographic variations in disclosure self-efficacy, regardless of intention to disclose, and assesses the relationship between self-efficacy and child adjustment via the parent–child relationship among a sample of HIV+ mothers and their healthy children (N = 181 pairs). Mothers completed demographic and self-efficacy measures; children completed measures assessing the parent–child relationship and child adjustment (i.e., worry, self-concept, depression). Across demographics, few mothers reported confidence in disclosure. Results from covariance structural modeling showed mothers endorsing higher self-efficacy had children who reported better relationship quality, and, in turn, reported fewer adjustment difficulties; higher levels of disclosure self-efficacy also directly predicted fewer adjustment problems. Findings offer support for interventions aimed at providing mothers with skills to enhance confidence for disclosing their HIV status.

Maternal illness is a stressor that can disrupt family processes and contribute to negative child outcomes, and researchers have considered family variables that mediate or moderate the maternal illness-child outcome relationship. Through reliance on a diverse sample (ethnically and racially, as well as geographically), the current study expands prior literature with a focus on parent-child conflict. Specifically, associations between aspects of HIV positive mothers' illness and mother-child conflict were explored. One goal of the study was to determine if there were direct or indirect associations with aspects of mothers' HIV and mother-child conflict. HIV-positive mothers (N = 136) provided CD4 count and completed measures assessing their perceived level of physical functioning, depressive symptoms, HIV health-related anxiety, and mother-child conflict with their healthy school-age children. Path analysis considered the pattern of relationships across variables. Results showed maternal vitality and depressive symptoms were directly associated with mother-child conflict. CD4 cell count and health-related anxiety operated indirectly through maternal depressive symptoms. Mediation analyses further assessed the influence of maternal CD4 cell count on mother-child conflict behavior; results indicated an indirect effect was mediated by vitality. HIV health-related anxiety and vitality separately showed indirect effects on mother-child conflict, mediated by maternal depressive symptoms. These findings are the first to focus on mother-child conflict among children affected by maternal HIV and highlight the need for screening and intervention to address depressive symptoms among HIV-positive mothers.

PURPOSE: Black South African women and girls face high rates of violence victimization, including physical, sexual, and emotional abuse in childhood and intimate partner violence (IPV) in adulthood. U.S.-based research suggests that violence victimization predicts parenting difficulties, but this relation has not been examined in a South African context. METHOD: Among a sample of 99 Black South African female caregivers, we examined rates of child abuse, IPV, and cumulative trauma, and we explored the associations between caregivers’ victimization history and current parenting quality (i.e., parent-child relationship quality & parental involvement with child). Caregivers completed self-report questionnaires using ACASI software. RESULTS: Hierarchical regression analyses revealed that caregivers reporting childhood physical or sexual abuse were less involved with their children. Caregivers with a history of emotional abuse reported significantly worse parent-child relationship quality. Cumulative trauma was associated with worse parental involvement and parent-child relationship quality. CONCLUSIONS: Results reveal relatively high rates of interpersonal violence victimization among this convenience sample of Black South African women, as well as unique relations between forms of victimization and specific parenting practices. The findings highlight the importance of behavioral parent training interventions with a focus on specific assessment of parents’ victimization experiences.

This study examined risk factors to determine associations with commercial sexual exploitation of children and youth (CSEC) in a convenience sample of adolescents living in the slums in Kampala, Uganda. Individual-level factors included demographic, adverse experiences (ever living on the streets; victim of dating violence, parental abuse, or rape), and behavioral risk (social media, alcohol use, age at first intercourse). Parental-risk factors included parent alcohol use and approval attitudes toward youth sex. Analyses included those who self-reported sexually active adolescents ( n = 593) of whom 39% reported CSEC history. CSEC was significantly associated with being female (odds ratio [ OR] = 6.85, 95% confidence interval (CI) = [4.22, 11.12]), living on the streets ( OR = 2.68; 95% CI = [1.65, 4.36]), using social media ( OR = 1.48; 95% CI = [0.94, 2.35]), being a victim of physical dating violence ( OR = 1.74; 95% CI = [1.08, 2.80]), and ever being raped ( OR = 4.03; 95% CI = [2.51, 6.47]). Further analyses suggested differential risk associates among females and males. This study contributes to our knowledge of risk factors for CSEC among adolescents living in high-risk circumstances in low-resource countries and suggests that preventive efforts should prioritize adolescents with a history of living on the streets who engage in social media, use alcohol, and have a history of trauma.

The TRACK-II program is a multi-site, community-based randomized controlled trial evaluating an intervention to assist mothers living with HIV (MLH) in disclosing their HIV status to their young children. Many participants—both mothers and children—reported significant depression and/or suicidal ideation, a phenomenon that presented ethical challenges. This article focuses on participants at one site (Atlanta). Through the vignette of “Jordan,” we describe ethical challenges that may arise when faced with the responsibility of maximizing participants’ safety while maintaining the boundaries of the researcher role. Guided by community psychology values, our team has taken measures within our role as researchers to empower and protect children and mothers endorsing suicidal ideation. For example, we have relied on relationships with community-based organizations and AIDS service organizations to connect HIV-affected families to mental health services. Further, we have expanded our system of documentation in order to follow up adequately with families at risk, and we track family resources in order to promote a strengths-based framework. We have solicited families’ feedback about their supports and needs in order to understand how we may best serve them by connecting them to the resources they report needing most and empowering them to care for themselves.

This study examined South African early adolescent youth (aged 10-14 years) and their female caregivers ( N = 99 dyads) participating in an HIV prevention intervention over a period of 8 months. We examined youth perceptions of neighborhood cohesion, safety, and collective monitoring as they related to concurrent and longitudinal associations with youth (externalizing behavior and hope about the future) and family (parent-youth relationship quality, parental involvement, and parental responsiveness to sex communication) functioning while controlling for baseline characteristics. Neighborhood perceptions were significantly associated ( p < .05) with short- and longer term outcomes. Gender differences suggested a greater protective association of perceived neighborhood conditions with changes in functioning for boys versus girls. Unexpected associations were also observed, including short-term associations suggesting a link between better neighborhood quality and poorer family functioning. We account for the culture of this South African community when contextualizing our findings and conclude with recommendations for interventions targeting neighborhood contexts.

Black South African youth are disproportionately affected by HIV, and risky sexual behaviors increase youths' vulnerability to infection. U.S.-based research has highlighted several contextual influences on sexual risk, but these processes have not been examined in a South African context. In a convenience sample of Black South African caregivers and their 10-14-year-old youth (Mage = 11.7, SD = 1.4; 52.5% female), we examined the relation between parenting and youth sexual risk within the context of community-level processes, including neighborhood quality and maternal social support. Hypotheses were evaluated using structural equation modeling. Results revealed that better neighborhood quality and more social support predicted positive parenting, which in turn predicted less youth sexual risk. There was a significant indirect effect from neighborhood quality to youth sexual risk via parenting. Results highlight the importance of the community context in parenting and youth sexual risk in this understudied sample. HIV prevention-interventions should be informed by these contextual factors.

Mothers living with HIV (MLWH) experience stressors inherent to parenting, often within a context characterized by poverty, stigma, and/or limited social support. Our study assessed the relationship between parenting stress and child perceptions of family functioning in families with MLWH who have healthy school-age children. MLWH and their children ( N = 102 pairs) completed measures addressing parenting stress and perceptions of family functioning (i.e., parent–child communication, family routines, and family cohesion). We used covariance structural modeling to evaluate the relationship between these factors, with results showing greater maternal parenting stress associated with poorer family functioning outcomes (reported by both the child and the mother). Findings offer support for the parenting stress–family functioning relationship by providing the child perspective along with the maternal perspective, and point to the need for interventions aimed at minimizing the impact of maternal parenting stress on family functioning.

Much of the research on child sexual abuse focuses on negative outcomes. This brief report explores a potentially protective parenting behavior among black South African female caregivers with and without a child sexual abuse history. Using cross-sectional baseline data, we hypothesized that caregiver child sexual abuse history would be positively associated with caregiver-youth sex communication and this relationship would be strongest for girls. Youth whose caregiver experienced child sexual abuse were more likely to report communicating with their caregiver about sex than youth whose caregivers did not experience child sexual abuse; however, this relation did not hold for caregiver reported communication. Child sexual abuse survivors' ability and decision to discuss sex with their youth has the potential to protect youth from sexual risk and demonstrates resilience among a group rarely acknowledged for positive parenting practices.

Our study seeks to untangle systemic influences on specific family dynamics understudied in a non-Western context. Specifically, we examine the associations between caregivers’ perceptions of neighborhood cohesion, neighborhood safety, and social support, and one aspect of parenting relevant to the South African community from which data were drawn, caregiver–youth communication about sex. Multivariate regression models demonstrate interactive relationships among our variables of interest (p ≤ .05). For caregiver–youth dyads (N = 99), living in a neighborhood caregivers perceived to be relatively cohesive or safe was associated with differential relationships (i.e., conditional effects; p ≤ .07) between caregiver social support and youth report of communication about sex. Our findings indicate that neighborhood and social-level influences on parenting are not universal. Moreover, cross-cultural adaptations of family-based behavioral interventions to prevent HIV should consider the role of caregiver social support within diverse neighborhood contexts.

The purpose of this study was to examine a model of the relationships between parenting deficits and skills, along with child outcomes, in a sample of mothers living with HIV (MLH) and their 6 to 14 year old children. Sixty-two MLH (61% Latina, 26% black, 3% white, & 10% multiracial) and their well children (age 6 - 14) were recruited from the greater Los Angeles, California, region to participate in an intervention (IMAGE: Improving Mothers' parenting Abilities, Growth, and Effectiveness) designed to assist MLH with parenting and self-care skills. Constructs examined included parenting deficits, parenting skills, and child outcomes. Covariance structural modeling was used for the analyses. Covariance structural modeling confirmed the hypothesized set of construct associations. As predicted, fewer parenting deficits were associated with better parenting skills, which, in turn, were associated with better child outcomes. This study delineated further the parenting issues with which MLH struggle, providing information on the interventions needed for this population. MLH who have little confidence they can enact parenting skills and limited knowledge of basic parenting practices appear to be less likely to provide family routines consistently, monitor their children, or to engender family cohesion or a close parent-child relationship. Such parenting skills were found to be associated with child functioning.

Caregiver–youth communication about sex protects youth against HIV/AIDS, and caregivers who believe that sex knowledge is important are more likely to talk to their youth about sex. However, caregivers who experience barriers to communication about sex may not talk to their youth about sex even if the caregiver believes that sex education is important. The Theory of Planned Behaviour predicts that an actor has perceived control is necessary for behavioural change. This study therefore hypothesised that caregivers’ perceived control moderates the relationship between caregiver attitudes about youth sex knowledge and caregiver–youth communication about sex. Results from a sample of 99 female South African caregivers of adolescent (10–14 year old) youth supported our hypothesis, indicating that caregiver attitudes about providing youth with sex knowledge positively predict communication about sex only when caregivers have perceived control. This finding illustrates the importance of perceived control in predicting caregiver–youth communication, and therefore has implications for family-based interventions aimed at improving caregiver–youth communication about sex.Keywords: HIV, family, caregivers, perceived control, parental attitudes, parent–child communicationAfrican Journal of AIDS Research 2014, 13(1): 31–36

Our study examined factors influencing the effectiveness of a parent-based HIV prevention intervention implemented in Cape Town, South Africa. Caregiver-youth dyads (N = 99) were randomized into intervention or control conditions and assessed longitudinally. The intervention improved a parenting skill associated with youth sexual risk, parent–child communication about sex and HIV. Analyses revealed that over time, intervention participants (female caregivers) who experienced recent intimate partner violence (IPV) or unsafe neighborhoods discussed fewer sex topics with their adolescent children than caregivers in safer neighborhoods or who did not report IPV. Participants with low or moderate decision-making power in their intimate relationships discussed more topics over time only if they received the intervention. The effectiveness of our intervention was challenged by female caregivers’ experience with IPV and unsafe neighborhoods, highlighting the importance of safety-related contextual factors when implementing behavioral interventions for women and young people in high-risk environments. Moderation effects did not occur for youth-reported communication outcomes. Implications for cross-cultural adaptations of parent-based HIV prevention interventions are discussed.

A pilot study was conducted to assess the effects of the IMAGE pilot intervention (Improving Mothers' parenting Abilities, Growth, and Effectiveness) on mothers living with HIV (MLH). Based on Fisher and Fisher's IMB model [1992. Changing AIDS risk behavior. Psychological Bulletin, 111, 455-474], the intervention focused on self-care and parenting behavior skills of MLH that affect maternal, child, and family outcomes. A randomized pre-test-post-test two-group design with repeated assessments was used. MLH (n = 62) and their children aged 6-14 (n = 62; total N = 124) were recruited for the trial and randomized to the theory-based skills training condition or a standard care control condition. Assessments were conducted at baseline with follow-ups at 3, 6, and 12 months. Maternal, child, and family outcomes were assessed. Results show significant effects of the intervention for improving parenting practices for mothers. The intervention also improved family outcomes, and showed improvements in the parent-child relationship. IMAGE had a positive impact on parenting behaviors, and on maternal, child, and family outcomes. Given MLH can be challenged by their illness and also live in under-resourced environments, IMAGE may be viewed as a viable way to improve quality of life and family outcomes.

One group often overlooked by HIV prevention efforts is adolescent children of mothers living with HIV (MLH). Despite their potential vulnerability, very few evidence-based prevention programs exist for this population in the United States (U.S.) and elsewhere. The current study introduces a parent-based program adapted for families affected by HIV for the purpose of preventing adolescent HIV infection. Following a structured process of adaptation, 12 African American MLH-adolescent dyads were recruited from HIV clinics and non-governmental organizations in a southeastern U.S. city to participate in a feasibility pilot evaluation of the adapted program (Moms Stopping It Now! [Ms. Now]). The intervention consisted of group and individual sessions implemented in a university setting and at participants' homes, respectively. We determined feasibility through assessing participant acceptability and signs of intervention efficacy. Quantitative and qualitative process data revealed high levels of acceptability, as participants were largely satisfied and engaged with Ms. Now, and were willing to attend most sessions. In addition, positive intervention effects approaching medium to large effect sizes were observed for some protective parenting outcomes, including increases in parent-child relationship quality, parental monitoring, maternal HIV disclosure self-efficacy, and communication about maternal HIV infection. Other outcomes, namely communication about sex topics, did not show positive shifts due to ceiling effects and may be indicative of the pre-existing strengths these MLH possess. Ms. Now's approach and further refinement is discussed in the context of strengthening families affected by HIV. Moreover, we recommend that policy aimed at program development consider jointly targeting these populations (MLH and adolescents) due to the unique benefits of family intervention.

An estimated 33 million people were living with HIV in 2007 (UNAIDS, 2008). Women account for half of all people living with HIV, and this percentage has remained stable for the past several years. Thus, women are one of the groups now at the forefront of HIV, and are most often the primary caregivers in families (Weiner, Battles, & Heilman, 1998). An HIV diagnosis impacts not only mothers as individuals, but also affects how they care for their families (Schmidt & Goggin, 2002). Many mothers choose not to tell their young children about their HIV-positive status. However, not disclosing can negatively impact mothers’ physical and psychological functioning. For example, mothers living with HIV (MLHs) who had not disclosed reported sometimes skipping medications because they are afraid their children will observe them and suspect something is wrong, and were more likely to miss medical appointments (Mellins et al., 2002; Murphy, Steers, & Dello Stritto, 2001). Another study found disclosure related to improved well-being, particularly when the first-disclosure experience was positive, which may lessen fear of future disclosure (Chaudoir & Quinn, 2010). Many MLH report that they choose not to disclose for fear of burdening their children (e.g., Palin et al., 2009). However, nondisclosure is no guarantee of positive child outcomes. One study found that adolescents who are not informed about their mothers’ HIV status can be left with feelings of resentment, and broken trust and anger because they were unable to address their parent’s illness openly, express their feelings, ask questions, and receive direct answers (Wood, Chase, & Aggleton, 2006). Among younger children whose mothers have chosen not to disclose, research indicates elevated levels of anxiety (Forsyth, Damour, Nagler, & Adnopoz, 1996; Murphy, Kaufman, & Swendeman, 1998), perhaps due to guilt they feel for a disordered family environment whose source they cannot identify. Children who found out their mothers’ serostatus report they knew something was wrong but felt unable to ask about the cause (Nagler, Adnopoz, & Forsyth, 1995). Women who had known their diagnoses longer were more likely to have children who were aware of their illness (Kirshenbaum & Nevid, 2002), For MLH who do disclose to their young children, two findings have been fairly consistent: They are less likely to disclose to younger children and more likely to disclose to female children (e.g., Armistead, Tannenbaum, Forehand, Morse, & Morse, 2001; for a full review of factors affecting MLH disclosure, see Murphy, 2008). MLHs who have disclosed report significantly lower levels of depression than mothers who have not disclosed (Wiener et al., 1998), less use of concealment to manage HIV-related stigma, stronger social support (Letteney, 2006), and stronger family cohesion. However, disclosure may cause short-term stress among mothers and children. For example, parents reported their children reacted to their HIV disclosure with depression (39%), and anxiety (11%), although parents reported improved adjustment over time for the majority of children (Nostlinger, Bartoli, Gordillo, Roberfroid, & Colebunders, 2006). This is consistent with findings by Murphy, Roberts, and Hoffman (2006), where most children were upset immediately following disclosure, but the majority adjusted over time. Whether maternal HIV disclosure may vary by race/ethnicity has been investigated in a number of studies. For example, Tompkins, Henker, Whalen, Axelrod, & Comer (1999) reported children of White and African American mothers were more likely to be aware of the mother's HIV status than were children of Latina women, but suggest this difference may be accounted for, at least in part, by the younger age of the Latino children. Corona et al. (2006) reported more English speaking compared to Spanish speaking parents disclosed their HIV status to their child; however, after controlling for factors including age of child and level of social isolation, language was no longer associated with disclosure. In a sample of predominantly African American and Latina HIV positive women, disclosers and non-disclosers were similar in most sociodemographic characteristics including race, marital status, religion and employment (Letteney & LaPorte, 2004). Other studies have not found ethnicity and/or acculturation to be related to serostatus disclosure (Lettney, 2006; Murphy et al., 2001; Rice, Comulada, Green, Arnold, & Rotheram-Borus, 2009). The Parents And children Coping Together (PACT) study was designed to longitudinally assess MLHs and their well children age 6 -- 11 years of age. Throughout the course of the study (now in its 13th year), the UCLA research team has investigated maternal disclosure (Murphy, Marelich, & Hoffman, 2002; Murphy et al., 2001). Mothers who disclosed reported higher levels of social support in their lives than non-disclosing mothers. Children of disclosing mothers displayed lower levels of aggressiveness (by mothers report), and lower levels of negative self-esteem (by child report), compared to children of non-disclosing mothers. Across the course of the PACT study, a number of MLH disclosed to their children. An analysis of depression and anxiety scores for the children who were unaware of their mothers serostatus at baseline and who were disclosed to at any of the follow-up points was conducted (Murphy, 2008). Children showed significant improvement on the mental health variables at the assessment following disclosure (which gave them time to adjust potentially if they were immediately distressed by the disclosure). They had significantly fewer depression symptoms and showed a trend for lower anxiety. To obtain more information about the process and content of maternal disclosure, the PACT research team conducted in-depth, qualitative interviews with mothers (N = 47) and children (N = 41). Overall, 51% of the children had no immediate reaction to their mothers HIV disclosure. The other 49% of the children expressed an emotional reaction. Anxiety was the most common reaction, with children expressing concern about their mother's health and how long she would live. Most of these reactions were short term, however, a few children (N = 7) displayed acting out behavior over time. Thus, most of the children adjusted, but a small percentage had maladaptive reactions that were sustained. The majority of the mothers who disclosed (77%) explicitly told their children not to tell other people (Murphy, Roberts, & Hoffman, 2002). The children understood this, as they were aware of the stigma associated with HIV/AIDS. Very few of the MLHs identified "safe people" with whom their child could talk. Children sworn to secrecy have been shown to demonstrate more externalizing problems and poorer social competence (Tompkins, 2007). Finally, the majority of PACT MLH had no regrets about disclosing (Murphy, Roberts, & Hoffman, 2003). However, many were sorry they had not planned for the event, but, rather, blurted out the news during an emotional time. Mothers deemed it crucial to have a plan for what to say when disclosing. They reported hoping for education to provide them with skills and information so that they would be better able to share appropriately with their children, indicating a need for assistance at this critical time. The Teaching, Raising And Communicating with Kids (TRACK) pilot intervention was developed based on the quantitative and qualitative disclosure studies conducted during Murphy's PACT study. Derlega et al.’s (2004) Model of HIV-Disclosure provided a conceptual framework for studying self-disclosure decisions and outcomes, which for TRACK was applied to the family context. The first factor in the model is the social environment in which the MLH and child live; the second factor focuses on individual, temporal, and relational contexts. These factors affect the endorsement of reasons for and against disclosure, which then leads to disclosure outcomes for both the mother and child. Consistent with family system theory (e.g., Alexander, Sexton, & Robbins, 2002), the intervention targets the relationship context, including intrafamilial communication and parenting skills, specifically as they apply to disclosure. By significantly improving parent skills and self-efficacy in these areas, the intervention was expected to increase steps toward disclosure and disclosure itself, as well as positively affect outcomes associated with disclosure (i.e., mother and child functioning). Thus, for all of the intervention MLHs, we anticipated improving relationship context variables (Figure 1, middle box) and the disclosure outcomes for those mothers who chose to disclose. This small pilot study focuses on the changes in the relationship context variables and the disclosure outcomes (Figure 1, last box) from the model. The specific aims of the intervention were to: (1) enhance family communication and parenting skills specific to disclosure; (2) increase readiness to disclose HIV serostatus, and increase disclosure itself (primary outcome); (3) improve MLH mental-health indicators over time (it was anticipated that MLH anxiety and depression scores might be poorer immediately following disclosure but that these would decrease over time); (4) improve child mental health indicators over time (it was anticipated that child depression, anxiety, and self-concept may actually be poorer around the time of disclosure, but would improve over time); and (5) improve the parent-child relationship and family functioning. Figure 1 Conceptual Diagram of Proposed Intervention Effects for Maternal HIV Disclosure (Based on Integrative Disclosure Theory; Derlega, Winstead, Greene, Serovich, & Elwood, 2004)

Predictors of change in the number of sexual topics parents discussed and responsiveness during sex communication with their preadolescent after participating in a five-session sexual risk reduction intervention for parents were examined. Data were from 339 African American parents of preadolescents enrolled in the intervention arm of a randomized-controlled trial of the Parents’ Matter! Program (PMP). Four categories of predictors of success were examined: time and resource constraints, personal characteristics, the parent-child relationship, and parent perceptions of child readiness for sex communication. There were only sporadic associations between success and time and resource constraints for either outcome. Parent perception of child readiness for sex communication was positively associated with discussions of sex topics (b = 1.11, confidence interval [CI]: 0.24-1.97) and parental responsiveness (b = .68, CI:0.22-1.15). Although parents face time and resource constraints, most attended at least four sessions, and demographics such as income had limited effects on program success. In 2006, persons aged 13-29 accounted for the largest number of new HIV infections (Centers for Disease Control and Prevention [CDC], 2008). In addition, an estimated one out of four adolescent girls between the ages of 14 and 19 in the United States is infected with at least one of the most common sexually transmitted infections, or STIs (human papillomavirus [HPV], chlamydia, herpes simplex virus, and trichomo

South Africa has one of the highest HIV-infection rates in the world, yet few studies have examined disclosure of maternal HIV status and its influence on children. This study provides descriptive information about HIV disclosure among South African mothers and explores whether family context variables interact with maternal HIV disclosure to affect children's functioning. A total of 103 mothers, who self-identified as living with HIV and who were the primary caregivers of a child between the ages of 11 and 16, were interviewed. A total of 44% of mothers had disclosed, and those who had most typically perceived children's reactions to disclosure to be sadness and worry. Widows and married mothers were more likely than single mothers to disclose their HIV status. Disclosure to children significantly predicted externalizing, but not internalizing, behaviors. Family variables had direct but not interactive effects on child functioning. This study highlights the complexity of disclosure-related decisions and the importance of addressing the family context.

Research has established that both exposure to community violence and family functioning are predictive of various forms of psychological distress in adolescents. This study examined whether predictors in this area interact in such a way that the relation of community violence exposure to psychological distress in serious male juvenile offenders is moderated by caregiver-adult support and caregiver control. A heterogeneous sample of 116 male incarcerated adolescents (aged 12-18) was administered measures evaluating exposure to community violence, caregiver-adult support and control, and different forms of psychological distress. As expected, a significant caregiver-adult support by violence exposure interaction was found for alcohol/drug use and depression/anxiety. The implications of the findings for understanding and treating serious male juvenile offenders are discussed.

The purpose of the current study was to examine communication about sexual topics between preadolescents and their mothers and fathers. Participants were 135 African-American mothers, fathers, and their 9- to 12-year-old offspring. Each member of the triad completed a 10-item measure of communication about risk factors for sexual activity, sexual communication, and sexual risk prevention. A majority of parents and their preadolescents reported communication had occurred about most topics. Mothers and fathers were equally likely to communicate with sons whereas mothers were more likely to communicate with daughters than were fathers. Based on the study results, preadolescence may be the optimal time for parents to provide sexual risk prevention messages to their children before sexual behaviors are initiated.

This pilot study evaluated the impact of STARBRIGHT World (SBW), a computerbased psychoeducational intervention, on youth with sickle cell disease. Thirtyseven African American caregiver-child dyad...

The purpose of this study was to determine whether parental variables predict abstinence above and beyond the influence of peer variables in a sample of African American adolescent females (n = 568). In order to determine predictors of abstinence, hierarchical logistic regressions were conducted for the entire sample, the younger adolescent girls, and the older adolescent girls. Results indicated that for the total sample and older adolescents, both parental sexual attitudes and parent-adolescent relationship quality predicted abstinence after accounting for the variance associated with peer variables. For the younger girls, perceived parental attitudes were the only significant predictor. These findings suggest that adolescent sexual risk reduction interventions may benefit from including parents, stressing the importance of articulating parental sexual attitudes, and highlighting the significance of the parent-adolescent relationship.

Adolescent sexual activity in the United states is prevalent and occurring increasingly early, particularly among minority groups. Other risk behaviors (e.g., alcohol consumption) often co-occur with sexual behavior. By examining the association of risk and adaptive behaviors with precursors of sexual behavior--specifically, sexual intentions--it may be possible to identify preadolescents who are at increased risk for early sexual initiation.Data from 1,090 black fourth and fifth graders and their parents from the Parents Matter! Program were used in logistic regression analyses to assess covariation between preadolescents' risk and adaptive behaviors, and their intentions to initiate sexual intercourse in the next year.Risk and adaptive behaviors, as reported by both preadolescents and parents, were associated with sexual intentions; the findings were not qualified by youth's gender. Alcohol consumption and having been in trouble with the police were the primary youth-reported risk behaviors associated with the odds of intending to have intercourse (odds ratios, 2.3 and 1.8); the preadolescent's being in trouble at home was the primary parent-reported risk behavior (2.1). In both sets of reports, performing well on schoolwork was associated with reduced odds of intending to engage in sex (0.5 - 0.6).Risk and adaptive behaviors are markers of sexual intentions among black preadolescents. Prevention programs can use these behaviors to identify black youth who may be at high risk for early sexual initiation.

This prospective study examined the association between perceived neighborhood violence and maternal monitoring and the moderating role of 2 sources of social support (coparents and friends/neighbors) among low-income African American single mothers. Mothers' ratings of neighborhood violence were associated with monitoring both concurrently and longitudinally; however, this association was qualified by each source of social support. When neighborhood violence is perceived as being high by mothers, high levels of social support from coparents and from friends and neighbors are associated with more maternal monitoring. The findings point to the importance of understanding the social context in which African American single mothers live when developing and implementing parenting prevention and intervention programs targeting high-risk families.

We present a discussion of the literature addressing retention of ethnic minority samples in longitudinal studies. In addition, we describe the retention procedures implemented in the Parents Matter! Program (PMP), a community-based sexual risk reduction intervention for African American families. Finally, the results of PMP's retention strategies are presented.

We present a discussion of some of the lessons the investigators learned during the development and implementation phases of the Parents Matter! Program (PMP). Lessons were learned that are relevant to various groups involved in large scale, multi-site, community-based intervention studies: investigators, community leaders, community members, project staff, and participants. Specific lessons learned include: (1) forge collaboration early: (2) maintain communication; (3) clearly delineate policies and procedures; and (4) develop proactive strategies. We also include a list of important questions to consider when contemplating similar projects.

HIV is on the rise among African-American women. AIDS-related stigma plays an important role in the lives of HIV-infected and non-infected African-American women. Among HIV-infected women, the decision to disclose HIV seropositive status is likely affected by perceived stigma. The first purpose of the study is to examine perceived AIDS-related stigma over a six year period and across two groups of African-American women: HIV-infected and non-infected. The second purpose of the study examines whether disclosure of HIV seropositive status moderates the relationship between stigma and psychological functioning. Participants were 98 HIV-infected and 146 non-infected African-American women, between the ages of 18 and 50. Data were collected at four points across six years. Results indicated that HIV-infected women perceived a significantly higher level of AIDS-related stigma than non-infected women at all four assessments. Perceptions of stigma did not significantly change over time for the entire sample or within either HIV group. Among HIV-infected women, as the level of perceived stigma increased, the level of disclosure and psychological functioning decreased. Regarding the hypothesized moderating relationship, at high, but not low, levels of disclosure, the relationship between stigma and distress was significant. Implications for health professionals' work with HIV-infected African-American women around the issue of disclosure and stigma are discussed.

African-American female adolescents living in urban areas are at increased risk for adverse adjustment outcomes. The present study accomplished two goals. First, the quality of the parent-adolescent relationship across age groups was examined for differences among younger (i.e., 12'14) versus mid-range (i.e., 15'16) versus older (i.e., 17'18) adolescents. Second, self-esteem was examined as a possible mediator of the relationship between the quality of the parent-adolescent relationship and adolescent psychological functioning in a sample of 608 African-American urban adolescent females. With regard to developmental shifts in the quality of the parent-adolescent relationship, midrange adolescents reported a significantly poorer relationship with their mother than older adolescents. Results also indicated that self-esteem partially mediated the relationship between parent-child relationship and adolescent psychological functioning. Mental health professionals can broaden their interventions that aim to improve adolescent psychological functioning by either focusing on the quality of the parent-adolescent relationship or adolescent self-esteem.

In an effort to expand the parental conflict literature beyond 2-parent and divorced families, this study examined the following questions: Is coparental conflict between single mothers and the individuals who assist them in raising their children associated with child adjustment, and do parenting skills mediate or moderate this association? The sample consisted of 238 African American mothers and their 7- to 11-year-old children. Data were collected at 2 time points separated by approximately 15 months. Results indicated that coparental conflict was associated with child adjustment both concurrently and longitudinally, and that this association was partially mediated, but not moderated, by parenting skills.

This study examined the unique and interactive roles of mother and teacher depressive symptoms in child adjustment in 277 African American single mother-headed families, as well as whether the associations differed depending on the age and gender of the child. Findings revealed a significant association between maternal depressive symptoms and child depressive symptoms in girls, but not boys. Moreover, the combination of higher levels of both mother and teacher depressive symptoms was associated with the highest level of child depressive symptoms and, for younger children, externalizing symptoms. The importance of considering the multiple social contexts in which children interact is discussed. Key Words: child depressive symptoms, child externalizing problems, maternal depressive symptoms, teacher depressive symptoms. Much has been written about the influence of maternal depression or depressive symptoms on the adjustment and development of children and adolescents. Several reviews of the literature leave little question that these children are at greater risk for a range of psychosocial adjustment difficulties (Cummings, DeArth-Pendley, Du Rocher Schudlich, & Smith, 2001; Forehand, McCombs, & Brody, 1987; Goodman & Gotlib, 1999; Kaslow, Deering, & Racusin, 1994). Children of mothers who are depressed or who manifest depressive symptoms are at greater risk for both internalizing and externalizing difficulties, as well as greater difficulties in peer relationships. Notably, the primary focus of this work has been married White families. Given the changing face of American families, the generalizability of this work to minority and disadvantaged families is questionable at best. Although there has been some speculation that maternal depressive symptoms may account for less variance in socially disadvantaged families as a result of the high levels of chronic stress they confront (e.g., Goodman & Brumley, 1990), research to date suggests otherwise. For example, research with divorced White families has demonstrated a link between maternal depressive symptoms and adverse child outcomes in motherheaded families (Forehand, McCombs Thomas, Wierson, Brody, & Fauber, 1990; Thomas & Forehand, 1993). More recently and directly relevant, Petterson and Albers (2001) found some evidence to suggest that maternal depressive symptoms are related more strongly to the adjustment of preschoolers living in disadvantaged families versus advantaged families, and that there is no evidence to support that the relationship is stronger in advantaged families. In an earlier study by our research group, we provided evidence supporting a similar model of family transmission of depressive symptoms for both White, middle class, intact families and African American, innercity, predominantly mother-headed families (Jones, Forehand, & Neary, 2001). Unfortunately, the assessment of child adjustment was confined to depressive symptoms in the Jones et al. study. Consistent with the view of developmental psychopathologists who argue the need to study a broad and developmentally appropriate range of outcomes of children at risk (Cicchetti, 1984; Goodman & Gotlib, 1999; Rutter & Garmezy, 1983), the preliminary purpose of this study was to extend our research on the adverse consequences associated with maternal depressive symptoms in single mother-headed African American families by examining two domains of child adjustment: externalizing problems and depressive symptoms. Some of our recent research, although not focusing specifically on maternal depressive symptoms, suggests that different domains of child adjustment may be differentially sensitive to such maternal symptoms (Jones, Forehand, Brody, & Armistead, 2002). Furthermore, relative to our earlier work (Jones et al., 2001), we enlarged our sample with the intent of making it more representative by including families living in both metropolitan and nonmetropolitan areas. …

A total of 63 males and 54 females from the southeastern United States who averaged 20 years of age (range=14–27) answered a questionnaire concerned with coming-out milestones, disclosure, and self-esteem for gay, lesbian, and bisexual youths. The mean ages for first awareness of same-sex attraction (11 years), first same-sex sexual contact (16 years), and first disclosure of their sexual identity (17 years) were similar to other recent young samples. The order of these milestones varied among subgroups of gays, lesbians, and bisexuals, and proportions who were out to one or both parents differed for bisexuals and African Americans. The findings suggest diverse individual trajectories as opposed to an invariant sequence of coming-out experiences and highlight the need for greater attention to individual differences in sexual orientation identity development.

HIV is impacting African-American women at alarming rates. Many of these women are poor and socially disadvantaged, resulting in a combination of stressors that impacts the quality of their lives. This study investigated whether coping style (i.e., problem-focused, emotion-focused) varies as a function of HIV status or stage of HIV-related illness. Secondly, we examined whether the use of a particular style is associated with three areas of functioning among HIV-infected women: general psychological distress, depressive symptomatology, and physical symptomatology. Ninety-nine HIV-infected women and 143 noninfected women completed measures assessing coping styles and functioning. No significant differences emerged in coping styles between the HIV-infected and noninfected women or for the groups when symptomatic women were examined separate from asymptomatic women. Greater emotion-focused coping was associated with less general psychological distress and depression specifically. Problem-focused coping interacted with illness stage to predict all areas of functioning. By identifying effective coping strategies among African-American women with HIV, mental health professionals can design empirical interventions that can help improve quality of life for these women.

Three models of risk were examined for 277 African American children from single-mother-headed homes: cumulative, additive, and indirect models. Risk factors were mother-reported community risks, inadequate income, maternal depressive symptoms, and inadequate parenting. Child-reported internalizing and externalizing difficulties served as dependent measures of adjustment. Whereas the cumulative risk model identified a subset of children within this group as at-risk for adjustment difficulties, only more proximal family variables (maternal depressive symptoms and inadequate parenting) accounted for unique variance in child outcomes (additive risk model). However, the more distal risk factors—community risk and inadequate income—were linked to both internalizing and externalizing difficulties through the proximal family variables (indirect effects model).

This study addressed two questions about single-parent African American families: Are parenting strategies associated with perceived risks in the environmental context? and Does the association between parenting and child adjustment depend on the context in which parenting occurs? Families (N = 277) resided in 2 communities that differed in violence-related risk: one rural (low risk) and one urban (high risk). Mother-reported monitoring and warm, supportive mother-child relationships and child-reported internalizing problems, externalizing problems, and social competence were examined. Mothers monitored their children more in the urban than the rural community. The warmth and supportive nature of the mother-child relationship did not differ across contexts. A warm, supportive mother-child relationship was associated with fewer internalizing and externalizing child behaviors in both contexts. Monitoring was associated with fewer problem behaviors only in the urban community.

The unique contributions that parenting processes (high levels of monitoring with a supportive, involved mother-child relationship) and classroom processes (high levels of organization, rule clarity, and student involvement) make to children's self-regulation and adjustment were examined with a sample of 277 single-parent African American families. A multi-informant design involving mothers, teachers, and 7- to 15-year-old children was used. Structural equation modeling indicated that parenting and classroom processes contributed uniquely to children's adjustment through the children's development of self-regulation. Additional analyses suggested that classroom processes can serve a protective-stabilizing function when parenting processes are compromised, and vice versa. Further research is needed to examine processes in both family and school contexts that promote child competence and resilience.

The purposes of this study were to compare, across 4 years, the psychosocial adjustment of noninfected children (ages 6 to 11 at first assessment) whose mothers are and are not HIV-infected, examine differential changes of the two groups of children across the 4 years, and examine the role of parenting on the child's adjustment. Children of HIV-infected mothers reported more depressive symptoms across the four assessments than children whose mothers were not infected. Evidence for differential change of child psychosocial adjustment across assessments for the two groups did not emerge. Parenting variables, particularly the mother-child relationship, were related to child adjustment in both groups. Many of the findings suggest that mothers and children often provide unique perspectives. Prevention and intervention implications are considered.

Objectives: Approximately 5.6 million South Africans are living with human immunodeficiency virus (HIV; UNAIDS 2010). Prevalence among Black adolescents and young adults is particularly alarming. This pilot study of an HIV preventive intervention targeting South African youth contributes to the growing body of research on culturally competent family-based interventions. Method: A total of 99 parent-child dyads were enrolled in an experimental repeated measures study using a wait-list control group. Our 6-session intervention targeted general parenting (relationship quality parental monitoring and involvement) gender roles and parent-youth communication about sex (content and quality). Parents and youth were assessed at baseline postintervention and 6-month follow-up. Eligibility included being the primary female caregiver of a 10- to 14-year-old child with whom they spent at least 4 nights a week and being able to participate in English or Xhosa. Results: Effect sizes with this small sample met or exceeded those of other family-based HIV interventions for youth in the United States and South Africa (e.g. Bell et al. 2008; Forehand et al. 2007). Parents reports at postintervention indicated larger effect sizes for general parenting than youths reports indicated. Parents reports showed medium to large effects for all sex communication outcomes at postintervention and the 6-month follow-up. Youth reports demonstrated small to medium effects for most communication variables and these effects lasted through the 6-month follow-up period. Conclusions: Intergenerational social networks (e.g. families) hold promise for HIV prevention among South African youth. A full efficacy trial with longer-term follow-up and attention to maintenance of effects is warranted.

Prevalence of unprotected sex and HIV‐antibody testing were examined in a sample of Southern gay, lesbian, and bisexual youth (n = 117). In addition, a new measure was tested in terms of its ability to distinguish youth who obtain HIV‐antibody testing from those who do not. Data were collected at a conference for these youth, as well as at a Gay and Lesbian Community Center in a Southeastern metropolitan area. Youth reported engaging in a wide range of risk behaviors, yet less than one half had been tested for HIV. Factor analysis was conducted for the new measure, which assessed beliefs about HIV testing in youth, and each factor was significantly different for youth who had been tested compared to those who had not. Gay, lesbian, and bisexual youth were at high risk for HIV infection and were often untested for HIV antibodies.