Risk and protective factors for internalizing and externalizing outcomes among HIV-affected youth in Haiti

Abstract

The present study aims to: (1) estimate the levels of internalizing symptoms and externalizing behaviors among youth affected by HIV in central Haiti; and (2) examine the risk and protective factors associated with these outcomes to identify potential areas of intervention for HIV-affected youth. Baseline data for 492 youth affected by HIV (ages 10–17) and their 330 caregivers were collected for a pilot study of a psychosocial support intervention. Participants were recruited from a list of HIV-positive patients receiving care at Partners In Health/Zanmi Lasante clinic sites. Internalizing and externalizing behaviors were assessed using the Strengths and Difficulties Questionnaire. Demographic, economic, and social indicators were collected using a structured questionnaire administered by trained social workers. Youth affected by HIV in central Haiti displayed high levels of internalizing and, to a lesser degree, externalizing symptoms. Multivariate regression analysis demonstrated risk factors most strongly associated with internalizing symptoms (socioeconomic status, parental depressive symptoms) and externalizing behaviors (household living arrangements, such as living with a stepparent). Social support had a protective effect on externalizing behaviors for both caregiver (β = –0.03, p = 0.01) and self-report (β = –0.05, p < 0.0001). High levels of psychological distress were observed in this population, especially with respect to internalizing outcomes. Interventions should address the economic security, mental health, and access to antiretroviral therapy for families affected by HIV, as well as emphasize the importance of building supportive caregiver–child relationships to decrease the psychological symptoms and impact of other life stressors experienced by youth affected by HIV in Haiti and similar resource-limited settings.

Keywords:

• HIV-affected
• youth
• adolescents
• caregivers
• mental health
• Haiti

Acknowledgments

The authors thank all of the youth and parents/caregivers who participated in the study and the staff at Partners In Health, Zanmi Lasante, and Harvard Medical School who contributed significantly to this study. Special thanks are extended to Marianne Appolon, Navdya Clerveaux, Evens Coqmar, Nancy Dorsinville, Wilder Dubuisson, Naomie Emmanuel, Oupet Evenson, Jinette Fetiere, John Guillaume, Thierry Jean-Paul, Wesler Lambert, Joly Laramie, Fernet Leandre, Lucinda Leung, Patrice Nevil, Ernst Origene, Sherley Piard, Jean Renald Pierre, Marie Lourdes Pierre, and Rivot St. Fleur. We are grateful for the long-term support of Loune Viaud and Dr Paul Farmer. This paper is dedicated to the memory of Thomas J. White, whose generosity has made the work at Zanmi Lasante possible.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute of Mental Health [grant number R21-MH076447].