中国艾滋病致孤儿童生长发育与营养水平及心理健康研究

目的调研中国艾滋病致孤儿童生长发育、营养水平与心理健康状况,为政策制定提供依据。方法按性别、年龄1：1匹配,调查96对艾滋病致孤儿童与非孤儿的身心健康水平,并进行差异比较。结果孤儿组BMIz评分与肩胛下皮褶厚度显著低于非孤儿（P〈0．01）,消瘦明显。孤儿组自尊量表（SES）总分更低,而抑郁问卷（BDI）总分更高（P〈0．05）。男性孤儿身心健康弱势明显,女性组间未见显著性差异。结论中国艾滋病致孤儿童的身心健康脆弱性显著,需探索可持续性更强的孤儿抚养策略,并进行以心理支持为核心的综合健康干预,而且对男性孤儿应给予更多关注。     

非洲艾滋孤儿现状及对我国的警示

作为全世界艾滋病流行最严重的地区，非洲集中了全世界80％的艾滋孤儿。非洲艾滋孤儿的生存现状比较凄惨，他们面临着生存、健康、教育、歧视等诸多方面的问题。针对艾滋孤儿存在的问题，许多非洲国家的政府采取了相应措施对艾滋孤儿救助，并取得了一定成效。近年来，中国的艾滋孤儿问题日益突出。如不引起足够重视，将会影响社会稳定和经济发展。中国政府可以借鉴非洲政府成功的经验，找出适合中国艾滋孤儿的救助模式。     

我国部分农村地区受艾滋病影响的儿童社会心理健康状况定性研究

目的通过儿童和儿童抚养人的视角，初步了解中国部分农村地区父母感染艾滋病对儿童社会心理健康的影响。方法采用半结构化访谈的方法，对19名受艾滋病影响的儿童，20名儿童抚养人以及8名社区关键知情人进行调查。结果大多数儿童存在害怕、焦虑、悲伤、自卑等心理问题。针对儿童的歧视现象仍然存在，主要表现为对儿童的孤立、漠视和拒绝。儿童依赖抚养人和同伴获得心理上的支持。结论受艾滋病影响的儿童心理健康问题不容忽视，应该采取适当的干预措施改善这些儿童的心理健康状态。     

凉山艾滋病致孤儿童主观幸福感与学校联系感同伴关系和失眠的关系

目的了解凉山州艾滋病致孤儿童主观幸福感现况,探讨其主观幸福感与学校联系感、同伴关系和失眠程度的关系。方法纳入孤儿571名,非孤儿979名,调查社会人口学特征、主观幸福感量表、失眠严重程度指数、学校联系感量表。通过构建结构方程模型分析变量间的关系。结果孤儿主观幸福感得分为(10.04±2.40),非孤儿(10.72±2.26),差异有统计学意义(P0.05)。结构方程模型显示,该地区儿童青少年的同伴关系是主观幸福感的直接保护因素,失眠程度是主观幸福感的直接危险因素,两者通过学校联系感影响主观幸福感的部分中介效应分别为0.180(P0.001,95%CI:0.132～0.237)和-0.069(P0.001,95%CI:-0.103～-0.044),中介效应分别占总效应的31.7%和27.4%。群组分析结果显示,是否孤儿是失眠程度与主观幸福感关系的调节因素。结论凉山艾滋病致孤儿童青少年主观幸福感较低,干预策略应考虑帮助儿童青少年建立良好的同伴关系以及增强学校联系感,并且缓解其失眠情况。     

居家艾滋病致孤及脆弱儿童关怀支持项目结果分析

目的评价卧龙区第三轮全球基金艾滋病项目中,居家艾滋病脆弱儿童关怀支持项目工作开展5年后的效果,为下一步工作方案的制订提供依据。方法对卧龙区全部18岁以下居家艾滋病致孤和脆弱儿童进行问卷调查。结果2004年12月和2008年12月分别调查儿童199人和123人。2004年和2008年接受过关怀支持的艾滋病致孤和脆弱儿童分别占93.97%和100%,对关怀支持项目满意度为47.24%和87.00%,下一步关怀需求中,需要生活补助、技能培训、心理健康的分别为36.18%、49.25%、47.24%和20.33%、60.98%、60.98%;两次调查结果的差异有统计学意义(P0.05)。结论卧龙区第三轮艾滋病项目中,居家致孤及脆弱儿童关怀支持项目取得了一定的成效,但存在着生活技能、心理关爱等需进一步加强的问题。     

受艾滋病影响儿童心理健康干预方法探索

目的探索能够有效促进受艾滋病影响儿童心理健康的干预策略。方法选取河南省某县受艾滋病影响的10～15岁儿童45名,进行为期10个月的综合心理支持,干预前后进行问卷调查测量干预效果。结果干预前有焦虑不安等负性心理体验的儿童占44.4%(20/45),干预后下降到20.0%(9/45);症状自评量表SCL-90测量的强迫症状、人际关系敏感、抑郁、焦虑以及偏执等各个因子,干预之后均显著改善。结论综合心理支持对于促进受艾滋病影响儿童的心理健康具有积极意义。     

受艾滋病影响儿童的关怀需求及干预措施的研究现状

通过收集近年相关文献,综述了受艾滋病影响儿童所面临的生长发育、学习、生活、心理等诸多问题,以及针对这些问题所采取的政策、医疗、教育、生活、心理等干预措施。受艾滋病影响儿童主要存在生活、教育和心理关怀需求,应开展综合干预措施,特别是开展对受艾滋病影响儿童的心理关怀研究,以探讨适合不同关怀需求的干预模式。     

艾滋病致孤儿童在“阳光家园”安置模式下的心理状况调查

目的深人了解河南省阳光家园中艾滋病致孤儿童的心理状况。方法用调查问卷和深度访谈的方式，对河南三处阳光家园中的100名艾滋病致孤儿童进行调查。结果有效问卷91份。91名艾滋病致孤儿童对自己的日常生活总体而言感到幸福，但仍有不满意的地方；他们对伙伴关系非常重视，但对陌生人交往的态度不积极，也缺乏足够的长辈性质的关怀；近7成的孩子的个性特征中包含了内向的因素，有的孩子对管理人员和资助者缺乏感恩的心。     

认知行为疗法改善受艾滋病影响儿童自我意识水平的个案研究

正受艾滋病影响儿童更容易产生消极的社会心理和认知结果[1],迫切需要在对这些儿童的物质救助基础上进一步开展心理干预[2]。本研究拟对一名凉山州自我意识水平较低的受艾滋病影响儿童使用认知行为疗法进行心理咨询,目的是探究认知行为疗法对受艾滋病影响儿童自我意识水平的改善作用及其可行性,为受艾滋病影响儿童心理健康提供有效的干预方法。     

中原地区受AIDS影响的儿童心理健康水平的现况研究

目的 评定中原地区受艾滋病(AIDS)影响的儿童心理健康水平,为改善他们的心理状况提供客观依据.方法 选用SCL-90量表进行问卷调查,应用SAS 8.0进行统计分析.结果 共调查受艾滋病影响的初中生120人,其中双孤儿童33人,单孤儿童43人,受AIDS影响的双亲儿童44人.AIDS致双孤儿童的SCL-90总分(161.36±41.17)分,明显高于AIDS致单孤儿童的(137.37±33.32)分和受AIDS影响的双亲儿童的(141.82±39.36)分.AIDS单孤儿童中女孩的总分(147.07±34.75)明显高于男孩(119.27±21.50).结论 受AIDS影响的儿童心理问题比较严重,在为其提供心理支持的过程中,应根据不同类型、不同性别的特点,进行有针对性地干预.     

Assessing the health status of young AIDS and other orphans in Kampala, Uganda

The huge number of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) orphans is an important feature of the epidemic in sub-Saharan Africa. There are few and conflicting data on the effects of being orphaned on health and nutrition in the highly affected HIV endemic areas of Africa. This study reports findings from a cross-sectional survey on associations between orphan status and health and nutrition parameters in young children of urban Uganda. A high prevalence of orphans was reported from a central Kampala community, with 41% being attributed to HIV/AIDS. Although there was a higher prevalence of self-reported morbidity in orphans than non-orphans, there were no differences in reported treatment seeking behaviour and measured anthropometric parameters. Hence it seems that the extended family system still manages to care for young orphans. Paying school fees for older children should be the primary target for HIV/AIDS impact mitigation programs in urban Uganda.     

艾滋病对中国儿童影响的研究

目的了解和认识艾滋病对中国儿童的影响。方法利用方差分析等方法,提出一个多层次的分析框架,设计以儿童成长为核心的家庭调查表及儿童访谈提纲,并进行实地调查。结果受艾滋病影响儿童的家庭人均生产收入减少;救助活动对改善艾滋病孤儿家庭的经济状况起到了一定的作用;父母存活的受艾滋病影响儿童的缺课率最高;受艾滋病影响儿童感受到心理压力和忧伤。结论艾滋病对儿童的影响主要反映在儿童的生活环境、生存状况和身心健康三个层面。在这三个层面,受艾滋病影响儿童与非艾滋病家庭的儿童存在明显的差异。     

Young Malawians on the interaction between mental health and HIV/AIDS

Previous research has identified high levels of mental health problems among people affected by HIV. This study surveys specifically adolescents in southern Malawi on their experience of the impacts of living with HIV or AIDS on one's mental health. At the same time, the study explores the link between mental health problems and subsequent HIV-risk behaviour. Short texts relating everyday scenarios that depicted symptoms of three mental health problems (i.e.depression, anxiety and HIV-related brain impairment) formed the basis of in-depth discussions in 12 existing groups of secondary school students, orphans and vulnerable children, teenage mothers, and out-of-school youths, in both rural and urban settings. The responses show that these young people recognised the mental health sequelae of HIV/AIDS as impacting upon many aspects of one's life. The young people traced these 'interruptions' and 'disruptions' through deteriorating psychological and socio-economic conditions. They showed awareness of a two-way interaction between HIV/AIDS and mental illness, indicating that the latter can increase thoughts of suicide and HIV risk-taking behaviour. More importantly, they identified a number of locally derived community interventions, which if supported by statutory health and education services, can significantly ameliorate their situations. The findings provide avenues for practical integration of mental health provision within HIV prevention, education and care initiatives.     

Caregiver role in HIV medication adherence among HIV-infected orphans in Tanzania

Youth living with HIV in sub-Saharan Africa face numerous challenges in adhering to HIV treatment. The AIDS epidemic has left many of these youth orphaned due to AIDS-related death of one or both parents. It is imperative to understand the family context of youth living with HIV in order to develop responsive interventions to improve adherence to antiretroviral therapy. We conducted qualitative in-depth interviews with 17 HIV-infected AIDS orphans, ages 13–24 years, screened positive for mental health difficulties according to the Patient Health Questionaire-9 (PHQ-9) or UCLA PTSD Reaction Index (PTSD-RI), and receiving outpatient HIV care at an adolescent medical clinic in Moshi, Tanzania. Treatment-related support varied by orphan status. Paternal orphans cared for by their biological mothers and maternal orphans cared for by grandmothers described adherence support such as assistance taking medication and attending clinic. Double orphans did not report adherence support. Several maternal and double orphans faced direct interference from caregivers and household members when they attempted to take their medications. Caregivers play a significant role in treatment adherence and must be considered in interventions to increase medication adherence in HIV-infected orphans. Findings from this study informed caregiver participation in Sauti ya Vijana (The Voice of Youth), a mental health intervention for youth living with HIV in Tanzania.     

Household displacement and health risk behaviors among HIV/AIDS-affected children in rural China

When parents die of or are infected with HIV, children might have to leave their own household and be displaced to other living arrangements and some may even be displaced multiple times. The objective of this study is to examine the association between household displacement and health risk behaviors among AIDS orphans (children who have lost one or both of their parents to HIV/AIDS) and vulnerable children (children living with HIV-infected parents) in rural China. The sample consisted of 1015 children (549 AIDS orphans, 466 vulnerable children) in family-based care. The children were assigned to three displacement groups according to the number of household displacement (i.e., none, once, at least twice) after their parents became ill or died of HIV/AIDS. Cigarette smoking, alcohol use, violence, public property destruction, suicidal ideation, and suicide attempt were used to assess the health risk behaviors of these children. Both bivariate and multivariate tests were used to assess the differences in health risk behaviors among displacement groups. The findings indicated that children who were displaced at least twice were more likely to report a higher frequency of public property destruction and suicide ideation than those who were never displaced or displaced once. Multivariate analysis revealed that public property destruction, suicide ideation and suicide attempt were significantly associated with the household displacement among these children, controlling for gender, age, child status (AIDS orphans vs. vulnerable children), and the duration of household displacement. Results in the current study suggest that a stable living environment was important for both AIDS orphans and vulnerable children in communities with a high prevalence of HIV/AIDS. The government, community, and other agencies need to make efforts to avoid frequent household displacement among these children after the HIV-related infection or death of their parents.     

The impact of parental HIV/AIDS on children's cognitive ability in rural China

This study examined the impact of parental HIV/AIDS on children's cognitive ability. Cross-sectional data were collected from 1625 children aged 6–18 years, including 755 AIDS orphans, 466 vulnerable children, and 404 comparison children in rural China. Participants completed measures of demographic information and the assessment of cognitive ability (verbal comprehension ability and perceptual reasoning ability). Results showed that the cognitive ability was lower among children affected by HIV/AIDS than comparison children. Double orphans living in kinship care performed better on verbal comprehension ability than children living in orphanage or group home, but not on perceptual reasoning ability. Older children (≥15 years old) scored higher on verbal comprehension ability and younger children (≤11 years old) scored higher on perceptual reasoning ability. Boys scored higher than girls on perceptual reasoning ability but not on verbal comprehension ability. Future studies should explore factors that may hinder the development of cognitive ability of children affected by HIV/AIDS and provide appropriate intervention in this regard.     

Stigma Against Children Affected by AIDS (SACAA): Psychometric Evaluation of a Brief Measurement Scale

The current study was designed to develop and evaluate a brief scale measuring perceived public stigma against children affected by HIV/AIDS. The participants include 755 children who have lost one or both parents to HIV/AIDS (AIDS orphans), 466 children facing the potential of losing their parents to HIV/AIDS (vulnerable children), and 404 comparison children who did not have HIV-related illness or death in their families. The data in this study demonstrated that the SACAA scale provides a psychometrically sound measure of perceived stigma against children affected by AIDS in China. The SACAA scale is a reliable measure for children of both genders, at different developmental stages, and for both children affected by HIV/AIDS and comparison children. Known-group validation and correlation analysis demonstrate excellent construct validity of this brief SACAA scale. The SACAA score was positively associated with psychopathological symptoms and negatively associated with psychosocial well-being among participating children.     

Links between teacher assessment and child self - assessment of mental health and behavior among children affected by HIV/AIDS

Teachers are considered to be one of the most important influences in the lives of students. Teachers' assessments of students may be a primary source of information on children's mental and behavioral health; however, this topic has received little attention in research. We examined this issue through linking teachers' ratings of students and mental and behavioral outcomes of children affected by HIV. The hypothesis is that teacher ratings will be predictive of specific child mental and behavioral health outcomes. A quantitative cross-sectional design with self-administered paper-and-pencil instruments was used. The sample included 1221 children (aged 6–18, grades 1–11) affected by HIV including 755 orphans who lost one or both parents to AIDS and 466 vulnerable children living with HIV-infected parents in a central province of China. The corresponding teacher sample included 185 participants. Each child completed an assessment inventory of demographic information and mental and behavioral health measures. Teachers completed a questionnaire about children's school performance. SEM analyses revealed a good model fit according to all fit indices: comparative fit index = 0.93, root mean square error of approximation = 0.07, and standardized root mean square residual = 0.04. Structural equation modeling revealed that problem ratings by teachers were positively associated with child loneliness and behavioral problems, social competence ratings by teachers were negatively related to child depression, and personal growth and social interaction ratings by teachers were negatively related to child loneliness, depression, and trauma. The current study represents a unique contribution to the field in that it recognizes that teachers can be a valuable source of information on children's psychological health. Results from this study have implications for health prevention and intervention for children and families suffering from HIV/AIDS.     

The impact of HIV/AIDS on the living arrangements and well-being of elderly caregivers in rural Uganda

As the HIV/AIDS epidemic continues to devastate the sub-Saharan Africa region, the demand for care and support services to persons infected and affected by the disease is proliferating. Currently providing the bulk of this much-needed care and support are elderly persons. However, limited work has been done to examine how such care and support impacts the well-being of elderly caregivers. Using qualitative data from elderly respondents in two Ugandan districts, Kamuli and Luwero, this article examines changes in the household structure and living arrangements of older persons (50 years and above) after they take on caregiving responsibilities for persons suffering from AIDS-related illnesses and orphans and vulnerable children (OVC) affected by HIV/AIDS. The findings show that elderly caregivers face drastic disruptions of living arrangements, including prolonged travels and absences from their homes to care for the sick. There is also a sharp increase in their household size as they take on more OVC. The implications of such changes on the older persons' health and well-being are discussed.