Family-based HIV Research Articles

Common elements of family-based HIV interventions for adolescents.

Family-based interventions are an efficacious and effective way to prevent negative developmental outcomes for adolescents. This article reviews the family-based interventions that have been found to be efficacious in improving protective factors and reducing HIV-related risks and behaviors in parents and their adolescents. The review is the foundation for an examination of the common elements across the efficacious family-based interventions. There are a number of common strategies and elements encompassing these evidence-based interventions that provide direction about effective practices for families that can assist providers and clinicians to incorporate evidencebased content or elements and processes into their work with families.

Reliability and Validity of the Dyadic Observed Communication Scale (DOCS)

We evaluated the reliability and validity of the Dyadic Observed Communication Scale (DOCS) coding scheme, which was developed to capture a range of communication components between parents and adolescents. Adolescents and their caregivers were recruited from mental health facilities for participation in a large, multi-site family-based HIV prevention intervention study. Seventy-one dyads were randomly selected from the larger study sample and coded using the DOCS at baseline. Preliminary validity and reliability of the DOCS was examined using various methods, such as comparing results to self-report measures and examining interrater reliability. Results suggest that the DOCS is a reliable and valid measure of observed communication among parent-adolescent dyads that captures both verbal and nonverbal communication behaviors that are typical intervention targets. The DOCS is a viable coding scheme for use by researchers and clinicians examining parent-adolescent communication. Coders can be trained to reliably capture individual and dyadic components of communication for parents and adolescents and this complex information can be obtained relatively quickly.

Parent–Adolescent Communication About Sex in Rural India

In this article, we examine parent-adolescent communication about sex among rural Indian youth and their parents. We conducted in-depth interviews (N = 40) with mothers, fathers, and adolescent boys and girls aged 14 to 18 years in a rural community in Maharashtra, India. In the context of key cultural factors, including gender-related norms, we explore issues of sexual health and critically assess widely held beliefs that Indian parents are unwilling or unable to discuss sex-related topics with their children. Our findings suggest that despite communication barriers, e.g., lack of knowledge and cultural proscriptions, Indian families are interested in and willing to communicate about sex-related topics. Future research should seek to determine the viability of family-based HIV prevention interventions for Indian adolescents.

Intervention Outcomes Among HIV-Affected Families Over 18 Months

We evaluate the efficacy of a family-based intervention over time among HIV-affected families. Mothers living with HIV (MLH; n = 339) in Los Angeles and their school-aged children were randomized to either an intervention or control condition and followed for 18 months. MLH and their children in the intervention received 16 cognitive-behavioral, small-group sessions designed to help them maintain physical and mental health, parent while ill, address HIV-related stressors, and reduce HIV-transmission behaviors. At recruitment, MLH reported few problem behaviors related to physical health, mental health, or sexual or drug transmission acts. Compared to MLH in the control condition, intervention MLH were significantly more likely to monitor their own CD4 cell counts and their children were more likely to decrease alcohol and drug use. Most MLH and their children had relatively healthy family relationships. Family-based HIV interventions should be limited to MLH who are experiencing substantial problems.

Recruiting and Retaining High-Risk Adolescents into Family-Based HIV Prevention Intervention Research

The purpose of this study was to examine the effectiveness of evidence-based recruitment and retention strategies for a longitudinal, family-based HIV prevention intervention study targeting adolescents in psychiatric care by (1) determining consent rate (recruitment), rate of participation at the first intervention session (retention), and follow-up attendance rate (retention); and (2) examining socio-demographic factors, family-level processes, sexual risk-related indices, and intervention factors (i.e., treatment arm) associated with study retention. Only one-third of the families contacted ultimately enrolled in the study. 81% of those enrolled participated in the workshop and 72% attended the booster sessions with no significant differences between families on any variable based on attendance. Retention over 1 year was 85% and did not differ by treatment arm. Strategies employed were successful at retaining families once they were enrolled. Findings highlight barriers to enrollment for adolescents in psychiatric care and suggest that it may be critical to integrate HIV prevention programs within community-based mental health services in order to counteract recruitment challenges.

Adapting a Family-Based HIV Prevention Program for Homeless Youth and Their Families: The HIV Prevention Outreach for Parents and Early Adolescents Family Program

As rates of HIV infection increase in adolescents, it is important to provide prevention programs targeting this population. Homeless adolescents living with their families in shelters are at greater risk of participating in risky sexual behavior and incurring negative health outcomes. A family-based HIV-prevention pilot study was conducted with eight homeless families in a New York City shelter to explore (1) the perceived impact of family communication, parental monitoring, family understanding of puberty, sexually transmitted diseases, and HIV on preventing risky behavior for the participating youths and (2) the feasibility of conducting such a program within the shelter system. Qualitative and quantitative results indicate increased family communication, parental monitoring, and decreased parental depressive symptoms.

Using Social Networks to Recruit an HIV Vaccine Preparedness Cohort

To evaluate a social network approach to develop an adolescent cohort for HIV vaccine preparedness and investigate characteristics that influence recruitment. We summarize baseline data from a prospective cohort study that included 4 sessions over 6 months. Fifty-nine HIV-infected adolescent and adult patients of a family-based HIV clinic named significant others and indicated willingness to involve them in this study. Sixty-two adolescent and adult significant others not known to be HIV infected were enrolled. Logistic regression was used to estimate factors associated with willingness. Participants identified 624 social network members including 276 adolescents (44%). Network member's awareness of the index's HIV positivity (P < 0.01) and older age (P = 0.05) affected willingness. Respondents were less willing to invite drug-risk alters (P = 0.006). Adolescents were willing to invite more adolescents than were adults (P < 0.0001). Adolescents younger than 18 years old reported fewer sexual and drug-using risk behaviors than expected. HIV-infected patients are willing to recruit their social networks, provided concerns about disclosure of HIV status are addressed. Using social networks to identify and recruit adolescent populations is appropriate and feasible for vaccine preparedness activities, future vaccine trials, and other prevention programs, but procedures are needed to selectively identify and retain high-risk youth.

Cultural Factors and Family-Based HIV Prevention Intervention for Latino Youth

Latino youth are the fastest growing ethnic group in the United States and are at considerable risk for HIV and other sexually transmitted infections (STIs), given that they have an earlier onset of sexual activity and use condoms less consistently than European American adolescents. Theorists and scholars have emphasized the importance of taking culture into account in sexuality interventions with Latino adolescents, yet few culturally tailored interventions have been developed for this population. Given the emphasis on familismo and collectivism among Latinos, family-based programs are likely to be well received and could contribute to long-term maintenance of adolescent safety. In this synthesis of the relevant literature, cultural factors that have been identified as relevant to Latino sexuality are reviewed and implications for family-based intervention with Latinos are addressed.

India-U.S. collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV prevention intervention for rural Indian youth

India-U.S. collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV prevention intervention for rural Indian youth

Parents Know and Parents Matter; Is It Time to Develop Family-Based HIV Prevention Programs for Young Men Who Have Sex with Men?

We examined the potential for a family-based HIV prevention approach for gay and bisexually identified young men who have sex with men (MSM). The majority of our urban, ethnically diverse sample disclosed their sexual orientation to parents, who were generally supportive. Family connectedness significantly decreased the odds of an HIV positive status.

Correlates of Participation in a Family-Based HIV Prevention Program

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.

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.

Creating Mechanisms for Meaningful Collaboration Between Members of Urban Communities and University-Based HIV Prevention Researchers

Summary This article provides a description of a Community/University Collaborative Board, a formalized partnership between representatives from an inner-city community and university-based researchers. This Collaborative Board oversees a number of research projects focused on designing, delivering and testing family-based HIV prevention and mental health focused programs to elementary and junior high school age youth and their families. The Collaborative Board consists of urban parents, school staff members, representatives from community-based agencies and university-based researchers. One research project, the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project) Family Program Study, an urban, family-based HIV prevention project will be used to illustrate how the Collaborative Board oversees a community-based research study. The process of establishing a Collaborative Board, recruiting members and developing subcommittees is described within this article. Examples of specific issues addressed by the Collaborative Board within its subcommittees, Implementation, Finance, Welcome, Research, Grant writing, Curriculum, and Leadership, are detailed in this article along with lessons learned.

Motivators and Barriers to Participation of Ethnic Minority Families in a Family-Based HIV Prevention Program

Summary Involving low-income, ethnic minority families in lengthy HIV prevention programs can be challenging. Understanding the motivators and barriers to involvement may help researchers and practitioners design programs that can be used by populations most at risk for HIV exposure. The present study discusses motivators and barriers to involvement in the Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP), using data from a sample of 118 families that participated at varying levels in the twelve sessions of the program. Most participants chose motivators that reflect their perceptions of individual and/or family needs (“CHAMP might help me, mine, and other families”), and of characteristics of the program, such as CHAMP staff were friendly, CHAMP was fun. Among barriers to involvement, respondents expressed concerns about confidentiality, and about being judged by program staff. Respondents also reported experiencing many stressful events in their families (e.g., death and violence in the family) that may have been barriers to their involvement. Knowing these motivators and barriers, researchers and practitioners can enhance involvement in HIV prevention programs.

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.

Understanding Motivators and Challenges to Involving Urban Parents as Collaborators in HIV Prevention Research Efforts

Summary This study was designed to explore the experiences of urban parents in their role as Collaborative Board members as part of the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project) Family Program Study. The CHAMP Collaborative Board is comprised of urban parents, representatives from schools and community-based agencies and university-based researchers and is charged with overseeing the design, delivery and testing of a family-based HIV prevention program for pre and early adolescent youth. The current qualitative study, guided by the Theory of Unified Behavior Change, is meant to elucidate: (1) pathways to involvement by urban parents; (2) benefits and costs of participating in this collaborative HIV prevention research effort; and (3) the role of social relationships in influencing initial and ongoing participation by parent participants. Twenty-nine parent Collaborative Board members were interviewed for this study. In-depth interviews were audio recorded and ranged from 30 to 90 minutes in length. Transcripts were coded and analyzed using NUD*IST, computerized software used for examining narratives. Findings include community parent members identifying social support and learning opportunities as major reasons for involvement with the Collaborative Board. Prior involvement with other community-based projects and knowledge of at least one other person on the Board also influenced members to join the Board and remain involved over time. Further, recommendations for future collaborative partnerships are made. Findings have direct implication for participatory HIV prevention research activities.

Lessons Learned from African American Women about Participation in a Family-Based HIV Prevention Program

This study uses qualitative data from individual interviews with low-income, African American women (n = 92) between 19 and 35 years of age who participated in 12 two-hour sessions of a family-focused HIV prevention intervention. The study explores influences on three domains. At the individual domain, development of personal attributes and the perceptions that program staff was fair toward racial minorities appear to influence participation. At the program domain, staff friendliness and monetary incentive also influenced participation. At the social domain, influence of friends and emotional support influenced participation. Training staff to confront racism and to develop a culturally competent and friendly environment has the potential to increase attendance among participants at high risk for HIV exposure.

Parent-Centered Intervention: A Practical Approach for Preventing Drug Abuse in Hispanic Adolescents

Objective: The objective of the present article is to review and discuss Familias Unidas, an empirically supported, family-based, culturally specific drug abuse and HIV prevention intervention for Hispanic immigrant adolescents and their families. Method: The authors focus on engagement and retention as well as on intervention delivery. Conclusions: The present article serves as a guide for social workers and mental health practitioners in carrying out effective family-based adolescent substance use and HIV preventive interventions. Recommendations for and challenges to implementing the intervention in practice-based settings are discussed.

Intergenerational benefits of family-based HIV interventions.

The longitudinal impact of a family-based intervention on grandchildren of parents with HIV (PWH) is evaluated. Because PWH and their daughters demonstrated gains over 6 years when randomized to a coping skills intervention compared with a control condition, the adjustment of the PWH's grandchildren was also compared across conditions. Grandchildren in the intervention condition reported significantly fewer internalizing and externalizing behavioral symptoms compared with grandchildren in the control condition. There is weak evidence that grandchildren in the intervention condition had higher scores on measures of cognitive development and more positive home environments. These results suggest that there are possibly long-term, intergenerational benefits of an intervention for families coping with HIV.