title: HIV and child mental health: a case-control study in Rwanda.
abstract: BACKGROUND
  The global HIV/AIDS response has advanced in addressing the health and well-being of HIV-positive children. Although attention has been paid to children orphaned by parental AIDS, children who live with HIV-positive caregivers have received less attention. This study compares mental health problems and risk and protective factors in HIV-positive, HIV-affected (due to caregiver HIV), and HIV-unaffected children in Rwanda.
  
  
  METHODS
  A case-control design assessed mental health, risk, and protective factors among 683 children aged 10 to 17 years at different levels of HIV exposure. A stratified random sampling strategy based on electronic medical records identified all known HIV-positive children in this age range in 2 districts in Rwanda. Lists of all same-age children in villages with an HIV-positive child were then collected and split by HIV status (HIV-positive, HIV-affected, and HIV-unaffected). One child was randomly sampled from the latter 2 groups to compare with each HIV-positive child per village.
  
  
  RESULTS
  HIV-affected and HIV-positive children demonstrated higher levels of depression, anxiety, conduct problems, and functional impairment compared with HIV-unaffected children. HIV-affected children had significantly higher odds of depression (1.68: 95% confidence interval [CI] 1.15-2.44), anxiety (1.77: 95% CI 1.14-2.75), and conduct problems (1.59: 95% CI 1.04-2.45) compared with HIV-unaffected children, and rates of these mental health conditions were similar to HIV-positive children. These results remained significant after controlling for contextual variables, there were no significant differences on mental health outcomes groups, reflecting a potential explanatory role of factors such as daily hardships, caregiver depression, and HIV-related stigma [corrected].
  
  
  CONCLUSIONS
  The mental health of HIV-affected children requires policy and programmatic responses comparable to HIV-positive children.
authors: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts; Theresa_Betancourt@harvard.edu.
authors: Theresa
authors: T
authors: Betancourt
authors: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York;
authors: Pamela
authors: P
authors: Scorza
authors: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda;
authors: Frederick
authors: F
authors: Kanyanganzi
authors: Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;Partners In Health, Boston, Massachusetts;
authors: Mary C Smith
authors: MC
authors: Fawzi
authors: Department of Clinical Psychology, University of Rwanda, Butare, Rwanda;
authors: Vincent
authors: V
authors: Sezibera
authors: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda;
authors: Felix
authors: F
authors: Cyamatare
authors: Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts;
authors: William
authors: W
authors: Beardslee
authors: Partners In Health, Boston, Massachusetts;
authors: Sara
authors: S
authors: Stulac
authors: Department of Mental Health, Rwinkwavu Hospital, Rwinkwavu, Eastern Province, Rwanda;
authors: Justin I
authors: JI
authors: Bizimana
authors: François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts; and.
authors: Anne
authors: A
authors: Stevenson
authors: Rwanda Biomedical Center, Ministry of Health, Mental Health Division, Kigali, Rwanda.
authors: Yvonne
authors: Y
authors: Kayiteshonga
mesh_terms: D000293:Adolescent; D017028:Caregivers; D016022:Case-Control Studies; D002648:Child; D005192:Family Health; D005260:Female; D006679:HIV Seropositivity / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012307:Risk Factors; D012432:Rwanda
keywords: HIV-affected; HIV-infected; HIV/AIDS; Rwanda; child; mental health