An increasing number of adolescents born with HIV in South Africa are on antiretroviral treatment and have to confront complex issues related to coping with a chronic, stigmatizing and transmittable illness. Very few evidence-based mental health and health promotion programs for this population exist in South Africa. This study builds on a previous collaboratively designed and developmentally-timed family-based intervention for early adolescents (CHAMP). The study uses community-based participatory approach as part of formative research to evaluate a pilot randomized control trial at two hospitals. The paper reports on the development, feasibility and acceptability of the VUKA family-based program and its short-term impact on a range of psychosocial variables for HIV+ pre-adolescents and their caregivers. A ten session intervention of approximately 3 months duration was delivered to 65 pre-adolescents aged 10-13 years and their families. VUKA participants were noted to improve on all dimensions, including mental health, youth behaviour, HIV treatment knowledge, stigma, communication and adherence to medication. VUKA shows promise as a family-based mental and HIV prevention program for HIV+ pre-adolescents and which could be delivered by trained lay staff.

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Introduction-While the roll-out of ART in South Africa should lead to a reduction in mother to child transmission (MTCT), mortality and orphaning, it will also be accompanied by a large number of children entering adolescence and adulthood with a chronic infectious disease. Adolescence is a particularly vulnerable period for HIV-infected people in relation to mental health problems and engagement in high risk behaviours, including non-compliance with medical treatment. The goal of this qualitative study was to develop an understanding of the psychosocial challenges as well as protective influences promoting socio-emotional coping in HIV+ adolescents in order to inform mental health promotion and HIV prevention programming for this population in South Africa.

Objectives-To test the effectiveness of the CHAMP among black South Africans in KwaZuluNatal, South Africa.Methods-A randomized control trial was conducted in KwaDedangendlale, South Africa, among youths (ages 9-13) and their families (245 intervention families rearing 281 children and 233 control families rearing 298 children). The CHAMPSA intervention targeted HIV risk behaviors by strengthening family relationship processes as well as targeting peer influences through enhancing social problem solving and peer negotiation skills for youths.Results-Among caregivers in the control and experimental conditions, significant intervention group differences were revealed regarding HIV transmission knowledge, less stigma toward HIVinfected people, caregiver monitoring-family rules, caregiver communication comfort, caregiver communication frequency and social networks. Among youths, data revealed that control and experimental groups were significantly different for children in AIDS transmission knowledge and less stigma toward HIV-infected people.Conclusions-CHAMPSA enhances a significant number individual, family and community protective factors that can help youths avoid risky behaviors leading to HIV-positive status. KeywordsSouth Africa; HIV/AIDS; prevention When the current research project began 5 years ago, South Africa had an estimated 5 million adults and children living with HIV/AIDS. 1 Despite numerous deaths, in 2005, this number had increased to an estimated 5.5 million. 2 Adolescents and young adults are at a particularly high risk of infection, as they evidence alarmingly high rates of both HIV prevalence and incidence. 3-6 For example, the HIV prevalence rate for males 15-19 years of age is 3.2%. For Send correspondence and reprint requests for J Natl Med Assoc. 2008;100:936-944 In addition to these protective factors, ethnographic information gathered to adapt CHAMP to South Africa 13-15 suggested that the dynamics of child abuse, stigma, grief from loss (from AIDS), and social capital were important risk and protective factors to consider. Thus, CHAMPSA was designed to benefit from pro-social peer and support networks by using multiple-family groups. 9,16-19Given the success of the CHAMP Family Program in the United States, 9,20 we hypothesize South-African adolescents in the CHAMPSA experimental condition will evidence enhanced outcomes on study measures relative to the youths in the comparison condition. Theoretical BasisThe Theory of Triadic Influence (TTI) 21 was used to guide the CHAMPSA program. Specifically, 7 community field principles were developed from the TTI 12,22,23 ( Figure 1) to underpin CHAMPSA. These 7 field principles were designed to guide academic/community partnerships to actualize the TTI and to base their intervention on sound scientific theory. Bell 9 suggests these 7 universal field principles of behavior change have been found to be effective in promoting resiliency and behavior change in youths in a number of communitybased projects. 12,24,25 Adaptation of CHAMP fo...