Gentz Shelene G, Calonge-Romano Isabel, Martínez-Arias Rosario, Zeng Chengbo, Ruiz-Casares Mónica
a Human Sciences Department , University of Namibia , Windhoek , Namibia.
b Facultad de Psicología , Universidad Complutense de Madrid , Madrid , Spain.
AIDS Care. 2018 Jun;30(sup2):83-91. doi: 10.1080/09540121.2018.1469727. Epub 2018 May 30.
The mental health needs of children and adolescents living with HIV (ALHIV) in Namibia are poorly understood, despite the dramatic improvement in their survival. ALHIV in resource poor contexts face particular risk factors, such as poverty, orphanhood, and poor social support. This study examines the mental health of ALHIV in Namibia, and the factors that contribute to mental health problems. A case-control design assessed emotional and behavioural symptoms of distress, risk and protective factors among adolescents aged 12-18 years. Case participants were 99 HIV-positive adolescents. Case controls were 159 adolescents from the same community who were not known to be HIV seropositive at the time of the study. Control group participants were selected from schools using a stratified random sampling. A larger proportion of HIV-positive adolescents were orphaned (62.6% vs. 20.8%, p < .001); the groups showed no differences in poverty factors. HIV-positive adolescents scored lower than the control group on total perceived social support (p < .05) and caregiver support (p < .05), but no differences in perceived friend support and support from a self-selected person were present. HIV-positive adolescents reported significantly more total emotional and behavioural difficulties (p = .027) and conduct problems (p = .025), even after controlling for socio-demographic factors. However, after controlling for the effects of orphanhood, group differences in mental health outcomes were no longer significant. Furthermore, mediation analysis suggested that social support completely mediated the relationship between HIV status and mental health (standardised pathway coefficients = .05, p = .021). Policies and programmes that aim to strengthen social support and take orphanhood status into consideration may improve the mental health of adolescents living with HIV.
尽管纳米比亚感染艾滋病毒的儿童和青少年（ALHIV）的存活率有了显著提高，但人们对他们的心理健康需求仍知之甚少。生活在资源匮乏环境中的ALHIV面临着特殊的风险因素，如贫困、成为孤儿以及社会支持不足。本研究调查了纳米比亚ALHIV的心理健康状况以及导致心理健康问题的因素。采用病例对照设计评估了12至18岁青少年的情绪和行为困扰症状、风险因素和保护因素。病例参与者为99名艾滋病毒呈阳性的青少年。病例对照为来自同一社区的159名青少年，在研究时他们的艾滋病毒血清学检测结果为阴性。对照组参与者是通过分层随机抽样从学校中选取的。艾滋病毒呈阳性的青少年中孤儿的比例更高（62.6%对20.8%，p <.001）；两组在贫困因素方面没有差异。艾滋病毒呈阳性的青少年在总体感知社会支持（p <.05）和照顾者支持（p <.05）方面的得分低于对照组，但在感知到的朋友支持和来自自选人员的支持方面没有差异。即使在控制了社会人口学因素之后，艾滋病毒呈阳性的青少年报告的情绪和行为问题总数（p =.027）和品行问题（p =.025）仍显著更多。然而，在控制了孤儿身份的影响后，心理健康结果的组间差异不再显著。此外，中介分析表明社会支持完全中介了艾滋病毒感染状况与心理健康之间的关系（标准化路径系数 =.05，p =.021）。旨在加强社会支持并考虑孤儿身份的政策和项目可能会改善感染艾滋病毒青少年的心理健康。
