title: Enhancing the Emotional Wellbeing of Perinatally HIV Infected Youth across Global Contexts.
abstract: Increased access to antiretroviral treatment worldwide makes it more possible for children diagnosed with HIV before their 15thbirthday to age into adolescence and beyond. Many HIV+ youth navigate stressors including poverty and resource scarcity, which may converge to produce emotional distress. For over a decade, CHAMP (Collaborative HIV Prevention and Adolescent Mental Health Project) investigators partnered with youth, caregivers, providers and community stakeholders to address the health, mental health and risk taking behaviors of perinatally HIV-infected youth. This paper explores the mental health needs of aging cohorts of HIV+ youth, across three global contexts, New York (U.S.), Buenos Aires (Argentina), and KwaZulu-Natal (South Africa), to inform the development and implementation of combination HIV care and prevention supports for HIV+ youth.
  
  
  METHODS
  Analysis of data pooled across three countries involving HIV+ early adolescents and their caregivers over time (baseline and three month follow-up) was conducted. Univariate and multivariate analyses were applied to data from standardized measures used across sites to identify mental health needs of youth participants. The impact of the site specific versions of a family-strengthening intervention, CHAMP+U.S., CHAMP+Argentina, CHAMP+SA, was also examined relative to a randomized standard of care (SOC) comparison condition.
  
  
  RESULTS
  Analyses revealed mental health resilience in a large proportion of HIV+ youth, particularly behavioral functioning and overall mental health. Yet, significant numbers of caregivers across country contexts reported impaired child emotional and prosocial wellbeing. Significant site differences emerged at baseline. Involvement in the CHAMP+ Family Program was related to significant improvement in emotional wellbeing and a trend towards enhanced prosocial behavior relative to SOC across global sites.
  
  
  CONCLUSIONS
  Ongoing partnerships with youth, family and provider stakeholders across global sites helped to tailor programs like CHAMP+ to specific contextual needs. This has global intervention research and care implications as cohorts of HIV+ children age into adolescence.
authors.affiliation: New York University, Silver School of Social Work, Junior Research Scientist, McSilver Institute for Poverty Policy & Research.
authors.forename: Latoya
authors.initials: L
authors.lastname: Small
authors.affiliation: McSilver Institute for Poverty Policy & Research.
authors.forename: Micaela
authors.initials: M
authors.lastname: Mercado
authors.affiliation: McSilver Institute for Poverty Policy & Research.
authors.forename: Priya
authors.initials: P
authors.lastname: Gopalan
authors.affiliation: McSilver Institute for Poverty Policy & Research.
authors.forename: Gisselle
authors.initials: G
authors.lastname: Pardo
authors.affiliation: Medical Psychology, Psychiatry and Sociomedical Sciences, Columbia University Medical Center, Co-Director, HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute and Columbia University.
authors.forename: Claude
authors.initials: C
authors.lastname: Ann Mellins
authors.affiliation: Poverty Studies, New York University, Silver School of Social Work, Director, McSilver Institute for Poverty Policy & Research.
authors.forename: Mary McKernan
authors.initials: MM
authors.lastname: McKay