Mental health concerns similar for HIV-affected and HIV-positive children in Rwanda

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

Betancourt T, Scorza P, Kanyanganzi F, Fawzi MC, Sezibera V, Cyamatare F, Beardslee W, Stulac S, Bizimana JI, Stevenson A, Kayiteshonga Y. Paediatrics. 2014 Jul 5. [Epub ahead of print]

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. 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. 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. The mental health of HIV-affected children requires policy and programmatic responses comparable to HIV-positive children.

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Editor’s notes: The successes of prevention of mother-to-child transmission programmes have led to a substantial increase in the number of HIV-affected children in sub-Saharan Africa. While the physical health trajectory of these children has been the subject of much research, far less is known about their mental health status. In Rwanda investigators found that, relative to HIV-unaffected children, HIV-positive and HIV-affected children both had similarly compromised mental health and functioning. Many of these differences could be explained by the fact that these latter groups were more likely to have experienced the death of a caregiver and not to have their mother as their primary caregiver. These results make us consider not only the need for psychosocial services for the children of HIV-positive adults, but also to consider parity of services regardless of the child’s own HIV status.

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