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HIV and child mental health: a case-control study in Rwanda.

Authors :: Betancourt T
Scorza P
Kanyanganzi F
Fawzi MC
Sezibera V
Cyamatare F
Beardslee W
Stulac S
Bizimana JI
Stevenson A
Kayiteshonga Y
Source :: Pediatrics [Pediatrics] 2014 Aug; Vol. 134 (2), pp. e464-72.
Publication Year :: 2014
Abstract: Background: The global HIV/AIDS response has advanced in addressing the health and well-being of HIV-positive children. Although attention has been paid to children orphaned by parental AIDS, children who live with HIV-positive caregivers have received less attention. This study compares mental health problems and risk and protective factors in HIV-positive, HIV-affected (due to caregiver HIV), and HIV-unaffected children in Rwanda.<br />Methods: A case-control design assessed mental health, risk, and protective factors among 683 children aged 10 to 17 years at different levels of HIV exposure. A stratified random sampling strategy based on electronic medical records identified all known HIV-positive children in this age range in 2 districts in Rwanda. Lists of all same-age children in villages with an HIV-positive child were then collected and split by HIV status (HIV-positive, HIV-affected, and HIV-unaffected). One child was randomly sampled from the latter 2 groups to compare with each HIV-positive child per village.<br />Results: HIV-affected and HIV-positive children demonstrated higher levels of depression, anxiety, conduct problems, and functional impairment compared with HIV-unaffected children. HIV-affected children had significantly higher odds of depression (1.68: 95% confidence interval [CI] 1.15-2.44), anxiety (1.77: 95% CI 1.14-2.75), and conduct problems (1.59: 95% CI 1.04-2.45) compared with HIV-unaffected children, and rates of these mental health conditions were similar to HIV-positive children. These results remained significant after controlling for contextual variables, there were no significant differences on mental health outcomes groups, reflecting a potential explanatory role of factors such as daily hardships, caregiver depression, and HIV-related stigma [corrected].<br />Conclusions: The mental health of HIV-affected children requires policy and programmatic responses comparable to HIV-positive children.<br /> (Copyright © 2014 by the American Academy of Pediatrics.)