Adapting a Family-Based HIV Prevention Program for HIV-Infected Preadolescents and Their Families

Summary

This article describes a family-based HIV prevention and mental health promotion program specifically designed to meet the needs of perinatally-infected preadolescents and their families. This project represents one of the first attempts to involve perinatally HIV-infected youth in HIV prevention efforts while simultaneously addressing their mental health and health care needs. The program, entitled CHAMP+ (Collaborative HIV Prevention and Adolescent Mental Health Project-Plus), focuses on: (1) the impact of HIV on the family; (2) loss and stigma associated with HIV disease; (3) HIV knowledge and understanding of health and medication protocols; (4) family communication about puberty, sexuality and HIV; (5) social support and decision making related to disclosure; and (6) parental supervision and monitoring related to sexual possibility situations, sexual risk taking behavior and management of youth health and medication. Findings from a preliminary evaluation of CHAMP+ with six families are presented along with a discussion of challenges related to feasibility and implementation within a primary health care setting for perinatally infected youth.     

Voices from the Community

Summary

When community members are allowed to participate in the planning and implementation process of a program, they are empowering themselves and their community. The CHAMP Family Program uses a collaborative programming approach with a focus on building the capacities of community members to deliver a family-based HIV prevention program. The CHAMP Program has a Collaborative Board that oversees all aspects of the research project. Using an empowerment framework, this article explores Community Board members' perspectives on their experience in working on CHAMP. Recommendations to researchers in the form of ten key ingredients for community collaboration are presented. The key points primarily focus on building trust with the community, recognizing community strengths, developing skills, building intragroup relations, and involving the community as partners from the beginning to the end.     

Correlates of Participation in a Family-Based HIV Prevention Program

Abstract

This study examines the relationship between contextual factors and attendance in a family-based HIV prevention program for low-income, urban, African-American women and their children. Participants' motivations to become involved, their concerns about discussing sex-related issues with their children, recruiters' perceptions of respondents' understanding of the program, and environmental stressors were examined. Participants' level of motivation and recruiters' success in improving respondents' understanding of the program were significant correlates of attendance. Stressors experienced by the family and concerns around talking with children about sex were not significantly associated with participation. Recommendations to enhance involvement in family-based HIV prevention programs are made.     

Family-Based HIV Preventive Intervention

Summary

Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youth's exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smith, & Henry, 2003). This often translates into three concrete programmatic features: (1) Contextual relevance; (2) Developmental-groundedness; and (3) Systemic Delivery. Because families are considered to be urban youth's best hope to grow up and survive multiple dangers in urban neighborhoods (Pequegnat& Szapocznik, 2000), centering prevention within families may ensure that youth receive ongoing support, education, and messages that can increase their capacity to negotiate peer situations involving sex. This paper will present preliminary data from an HIV/AIDS prevention program that is contextually relevant, developmentally grounded and systematically-delivered. The collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP) is aimed at decreasing HIV/AIDS risk exposure among a sample of African American youth living in a poverty-stricken, inner-city community in Chicago. This study describes results from this family-based HIV preventive intervention and involves 88 African American pre-adolescents and their primary caregivers. We present results for the intervention group at baseline and post intervention. We compare post test results to a community comparison group of youth. Suggestions for future research are provided.     

Mental Health and HIV Risk Among African American Adolescents

Summary

The family system is integral to adolescent mental health and HIV risk. However, few studies have addressed family variables and adolescent outcomes among African American families. This study tested a longitudinal model of parenting, adolescent mental health, and adolescent HIV risk, among a community sample of low-income, urban African American families from the Collaborative HIV prevention and AdolescentMental Health Project (CHAMP). Consistent with general adolescent population data, we expected less parental monitoring, greater psychological control and less positive parenting to increase risk for adolescent depression and conduct problems. We hypothesized that these variables would in turn increase rates of HIV risk. We followed one hundred and thirty-four African American youth and theirmaternal caregivers as part of the CHAMP project. Study variables included: positive parenting, parental monitoring, psychological control, adolescent distress, conduct problems, and recent HIV risk. We examined the relationship among these variables via longitudinal path analysis. Age was strongly associated with increased adolescent HIV risk. Contrary to hypotheses, more parental psychological control was marginally associated with less HIV risk, while positive parenting was marginally associated with greater HIV risk. Adolescent depression was associated with more conduct problems, but unrelated to HIV risk. Thus, parenting practices generally considered negative might actually be protective among some lower SES African American families. This underscores the importance of extending studies of family context and adolescent risk behaviors to diverse social and ethnic groups. Designing prevention programs for diverse groups will require articulating culturally specific effects for different parenting practice.     

New roles for families in child welfare: Strategies for expanding family involvement beyond the case level

This paper examines the strategies and approaches child welfare agencies used to integrate meaningful family involvement into their service delivery systems, under the Children's Bureau Improving Child Welfare Outcomes Through Systems of Care demonstration initiative. Through a series of retrospective interviews with child welfare agency staff, systems of care project staff, family members actively involved in implementing the systems of care initiative, and local program evaluators, researchers investigated the family involvement planning and capacity building activities of child welfare agencies during the initiative's implementation. Findings indicate that child welfare agencies' capacity building efforts primarily centered on human resource development, focusing on three areas: program staffing, family engagement, and agency buy-in. These findings illustrate the importance of developing the capacity of child welfare agency staff and family members before fully implementing family involvement programs and activities. Although more research is needed to document the impact of family involvement, the lessons learned from these grant communities' experiences provide critical information and can inform development of policies and practices to help child welfare and other child- and family-serving systems promote and implement meaningful and sustainable family involvement.     

Transferring a University-Led HIV/AIDS Prevention Initiative to a Community Agency

Summary

Given the urgent need for HIV/AIDS interventions that will reverse current infection trends among urban minority youth, identifying effective and socially relevant approaches is of primary concern. HIV/AIDS prevention initiatives that are housed in, and led by, communities may address the limits of laboratory-based inquiry for this complex and socially-situated health issue. In this article, we describe the process of moving a researcherled, HIV/AIDS prevention research program—the Collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP)—from a university laboratory to a community mental health agency with the goal of strengthening program access, effectiveness, and sustainability over time. We outline the framework, timeline, and responsibilities involved in moving the program, research, and technology from its original university base to a local community agency. From the challenges faced and lessons learned during this complex transfer process, we hope to enhance understanding of ways in which we can narrow the gap between academic and community leadership of HIV/AIDS prevention research.     

Implementing solutions to barriers to on-site HIV testing in substance abuse treatment: A tale of three facilities

Due to the scarcity of resources for implementing rapid onsite HIV testing, many substance abuse treatment programs do not offer these services. This study sought to determine whether addressing previously identified implementation barriers to integrating on-site rapid HIV testing into the treatment admissions process would increase offer and acceptance rates. Results indicate that it is feasible to integrate rapid HIV testing into existing treatment programs for substance abusers when resources are provided. Addressing barriers such as providing start-up costs for HIV testing, staff training, addressing staffing needs to reduce competing job responsibilities, and helping treatment staff members overcome their concerns about clients’ reactions to positive test results is paramount for the integration and maintenance of such programs.     

Changing Directions in HIV Prevention: The Move Toward a Psychosocial Model

ABSTRACT

Although some HIV prevention programs have been successful in helping gay and bisexual men change their sexual behaviors, rates of HIV infection continue to increase. In an attempt to address this problem, social workers need to move beyond traditional HIV prevention approaches to a psychosocial model of HIV prevention. Based on the work of previous researchers, this approach assumes that a combination of individual, psychological, and social factors contribute to risky sex in gay and bisexual men. Because social workers are trained to view problems from a psychosocial framework, they are already in a position to develop programs incorporating the psychosocial model. This article examines the psychosocial model of HIV prevention and the various psychosocial factors that may contribute to high-risk sexual behavior and concludes with examples of prevention research that have already incorporated the model.     

Birth Mothers Now Birth Grandmothers: Intergenerational Relationships in Open Adoptions

Abstract

Despite growing trends in openness between birth and adoptive families, little is known about what happens when adopted children become parents and birth mothers become birth grandmothers. These new and unique relationships between birth mothers and their grandchildren were examined through intensive case study analyses of in-depth interviews with birth mothers who placed infants for adoption more than 25?years ago (N?=?11). Findings revealed enjoyment in their role as grandmothers and emphasized the significant role the adult adoptee (parent) played in influencing communication with their grandchild and families’ incorporation of technology-mediated contact to overcome geographic barriers. Implications for practitioners, policy makers, and researchers are discussed.     

A Commentary on the Triadic Theory of Influence as a Guide for Adapting HIV Prevention Programs for New Contexts and Populations

Summary

The purpose of this paper is to illustrate how the Collaborative HIV Prevention and Adolescent Mental Health Project-South Africa (CHAMPSA) began and to present some of the results from this South African version of CHAMP. This paper informs readers of a number of lessons about international program translation. The first important lesson is that there are universal principles of health behavior change that seem to be useful across cultures. The implementation of these principles, however, needs to be informed by an in-depth understanding of local cultural contexts. The second important lesson is that it is possible to undertake large-scale, scientifically sophisticated community-based prevention research in developing countries through international collaborative research projects. It is the authors' hope that this mixture of science, service, and business will inspire other public health, community mental health, research, and business professionals to develop international prevention interventions that can be shown to be effective, and disseminated on a wide scale.     

Addressing Urban African American Youth Externalizing and Social Problem Behavioral Difficulties in a Family Oriented Prevention Project

Summary

The current article examines the secondary effects of an inner-city Community-University Collaborative HIV-Prevention and Adolescent Mental Health Family Program (CHAMP) in reducing externalizing (i.e., aggressive and rule-breaking behavior) and social problem behaviors for children with significant levels of externalizing behavior. Data were provided by parents for a sample of 50 youth assigned to the CHAMP Family Program and 299 comparison children. Among the CHAMP Family Program participants at pretest, 40% (n = 20) of parents reported their children exhibited significant levels of externalizing behavior. Among the comparison group, 38% (n = 113) of parents reported their children exhibited significant levels of externalizing behavior. There was a significant reduction in child externalizing scores for children in the CHAMP Family Program from pretest to posttest, bringing their mean scores of externalizing behavior from clinical to sub-clinical levels. Posttest only comparisons revealed that children in the CHAMP Family Program had significantly lower externalizing behavior scores than children in the comparison group. Analyses of child social problems indicated mixed results. Implications for urban mental health and prevention programs are discussed.     

In This Together

SUMMARY

Both epidemiologically and psychologically, the reigning self-interest paradigm of HIV prevention is growing increasingly obsolete, which will likely only increase with wider use of combination therapies. While self-interest notions form the core of most American HTV prevention theory and practice, data indicate that self-interest models increasingly fail both negative and positive gay men. There is an urgent need for broader, more emotionally-resonant prevention concepts. Diverse consistent, and significant data on behaviors including condom use, partner choice, volunteerism, and caretaking imply that values jof altruism and other-centered motivators may play central, strong roles in gay men'S HIV safety decisions. Values of “prevention! altruism” remain little understood, researched, or appreciated. Data show that sexual risk is inherently dyadic, gay men'S risk is increasingly relational, and a clear majority of gay men consistently manage sexual risk. Yet we understand little of the values of men who are largely safe, instead of those most risky, and less about how their values of nurturance and caretaking, ethics, hopes for collective survival, or relations with friends and community help support them in staying safe. A wide range of implications of prevention altruism are suggested and diverse research directions proposed to define a new domin of “Prevention caretaking.”     

Parents' perceptions of a school-based prevention education program

There are few studies of parents' views about prevention education in general, or about specific prevention education activities. Yet, their perceptions are important because families are a primary socialization source, and because parents' opinions can either reinforce or countermand the message of prevention education programs. This article is an analysis of parents' views of the Drug Abuse Resistance Education (D.A.R.E.) program based on a statewide survey of adults from rural, suburban, and urban communities who had a child participate in the program within the past year. Parent involvement and knowledge of D.A.R.E. was high. Generally, parents were very positive about D.A.R.E., especially when they viewed the D.A.R.E. officer as an effective educator. This article suggests that much more research on parents' views and support of prevention education program needs to be conducted, especially within the context of how their perceptions may mediate the influence of the prevention effort on young people's attitudes and behaviors about substance use.     

Understanding barriers to healthy behaviors in black college men

Objective: Due to the short life expectancy of black men, it is important to understand what impacts health behaviors in this group so that interventions and programs can be developed to improve their health behaviors which may help in increasing the life expectancy of black men. The purpose of this study was to understand what perceived barriers exist for black college men that prevent them from engaging in healthy behaviors. Participants and Methods: Thirty-five black male students at a southern Historically Black College and University participated in five focus groups and four interviews. A qualitative analysis was used to analyze data for similar themes and codes. Results: Perceived barriers to engaging in healthy behaviors appear to be influenced by image, food cost, and education. Cues to action for not engaging in healthy behaviors appear to be related to role models. Conclusions: Black college men are not adequately informed or educated about elements that can impact their health and how they can improve it. College administrators and researchers should develop interventions that include elements of increasing health knowledge and age-appropriate role models to improve health behavior change among this group.     

Older Persons Parenting Children Who Have Lost a Parent Due to HIV

ABSTRACT

This article reviews scholarship regarding older relatives raising minor children in order to highlight the situation of caregivers raising minor children who have lost a parent because of HIV. HIV-af-fected families are a relatively new type of intergenerational grouping which deserve a closer examination. It is likely that the phenomenon of HIV-affected custodial caregiving grandparents will increase, and it is vital that policy makers, practitioners, and researchers explore their needs and assets. The particular challenges of HIV-affected grandfamilies are explored, then policy and practice issues are addressed in light of their particular relevance for HIV-affected surrogate parents.