Pilot trial of a disclosure intervention for HIV+ mothers: The TRACK program.

Abstract

Objective-The Teaching, Raising, And Communicating with Kids (TRACK) program was a longitudinal pilot-trial intervention designed to assist mothers living with HIV (MLH) to disclose their serostatus to their young children (age 6 -12 years).Method-MLH and child dyads (N = 80 dyads) were recruited and randomized to intervention or control; the intervention group had three individual sessions and one follow-up phone call. The sessions focused on preparing MLH for disclosure through behavioral exercises utilizing Derlaga's model of HIV-disclosure. Both MLH and their child were assessed across multiple time-points (baseline, 3-, 6-, and 9-months) regarding disclosure of HIV status, and specific outcome variables (i.e., relationship context, mother's health, child's mental health, and family outcomes).Results-MLH in the intervention group were six times more likely to disclose their HIV status than those in the control group (O.R. 6.33, 95% C.I.: 1.64 -24.45), with 33% disclosing in the intervention group compared to 7.3% in the control group. MLHs in the intervention group showed increases in disclosure self-efficacy across time, increased communication with their child, and improvement in emotional functioning. Children of MLHs in the intervention group exhibited reductions in depression and anxiety, and increases in happiness.Conclusions-TRACK was found to be successful in helping MLH disclose their HIV status to their children, with positive outcomes noted for both MLH and their children. KeywordsHIV; mothers; intervention; disclosure An estimated 33 million people were living with HIV in 2007 (UNAIDS, 2008. Women account for half of all people living with HIV, and this percentage has remained stable for the past several years. Thus, women are one of the groups now at the forefront of HIV, and Correspondence: Debra A. Murphy, Ph.D., Health Risk Reduction Projects, Department of Psychiatry, UCLA, 11075 Santa Monica Blvd., Suite 200, Los Angeles, Phone: (310) 312-0552, dmurphy@mednet.ucla.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/ccp NIH Public Access Author Manuscript J Consult Clin Psychol. Author manuscript; available in PMC 2012 April 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript are most often the primary caregivers in families (Weiner, Battles, & Heilman, 1998). An HIV diagnosis impacts not only mothers as individuals, but also affects how they care for their families (Schmidt & Goggin, 2002).Many mothers choose not to tell their young children about their ...

National Institutes of Health investment in studies of HIV disclosure to children

“…The Teaching, Raising, And Communicating with Kids (TRACK) programme was developed and evaluated in a small pilot randomized control trial [13]. Mothers in the intervention group were six times more likely to disclose than mothers in the control arm, with roughly one-third of the mothers in the intervention arm disclosing, while only 7.8% of mothers in the control arm disclosed their serostatus.…”

Revelação do diagnóstico de HIV dos pais

“…This research identified the following scientific evidence of factors that influence the decision to disclose parents' HIV diagnosis to children: cognitive ability and maturity of the child; strengthening of family ties; informing children about the disease; parents' illness or death; the possibility of discovery by third parties; stigma and prejudice; negative reactions by children; the way of speaking about the disease to the child; and fear of losing parental power [22][23][24][25][26][27][28][29][30][31][32][33][34][35] (Table 1, appendix).…”

“…The most common adverse reactions of children after the disclosure of paternal diagnosis was fear regarding their parents' state of health and life, and fear of being stigmatized by friends 30 . After disclosure, children can become frightened and shocked 31 .…”

Cumulative Effects of HIV Illness and Caring for Children Orphaned by AIDS on Anxiety Symptoms Among Adults Caring for Children in HIV-Endemic South Africa

“…91,92 Given the important role of stigma in mediating the relationship between HIV and anxiety, interventions supporting disclosure may also be needed for the target population but remains a major challenge for parents and other caregivers in South Africa 93,94 and elsewhere. 95 Disclosure interventions have been tested in South Africa 96 and elsewhere 97 that could be tested for use among caregivers. Caregivers affected with both conditions are most vulnerable; it follows that development of psychological interventions to support these caregivers may need to incorporate a family-level approach.…”