Abstract
Fostering children is common in sub-Saharan Africa, but few studies examine these children’s mental health needs. This study investigated the impact of living in a foster family on the mental health of HIV-positive, HIV-affected and HIV-unaffected children (n = 681 aged 10–17) in rural Rwanda. Regression analyses assessed the impact of living in a foster family on mental health, parenting, and daily hardships; multiple mediation analyses assessed whether family factors mediated the association between foster status and mental health. HIV-positive children were eight times more likely to live in foster families than HIV-unaffected children. Being HIV-affected was predictive of depression and irritability symptoms after controlling for family factors. Controlling for HIV-status, foster children had more symptoms of depression, anxiety, and irritability than non-fostered children. Positive parenting fully mediated the association between foster status and mental health. Mental health and parenting interventions for foster children and HIV-affected children may improve child outcomes.
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Acknowledgments
This work was made possible by the collaboration and dedication of the Rwandan Ministry of Health and Partners In Health/Inshuti Mu Buzima. We are endlessly grateful to the local research team who carried out these interviews and to the study participants and their families who shared their experiences with us. We also wish to express our deep gratitude to the Honorable Minister of Health, Dr. Agnes Binagwaho and Dr. Yvonne Kayiteshonga, Mental Health Division Manager at the Rwandan Biomedical Center. This study was funded by the Harvard University Center for AIDS Research (CFAR) Grant numbers P30 AI060354, 1K01MH07724601 A2, R34MH084679 03S1, and 5T32MH093310 from the National Institute of Mental Health, the François-Xavier Bagnoud Center for Health and Human Rights, the Peter C. Alderman Foundation, the Harvard Center for the Developing Child, the Harvard School of Public Health Career Incubator Fund, and the Julie Henry Family Development Fund. The funders had no role in study design, data collection, analysis or interpretation, manuscript writing, or the decision to publish.
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Theresa S. Betancourt has received funding from Harvard University Center for AIDS Research (Grant number P30 AI060354) and the National Institutes of Mental Health (Grant numbers 1K01MH07724601 A2, R34MH084679 03S1), and Lauren C. Ng’s time was supported by NIMH Grant #5T32MH093310).
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Estella Nduwimana and Sylvere Mukunzi have contributed equally to this work.
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Nduwimana, E., Mukunzi, S., Ng, L.C. et al. Mental Health of Children Living in Foster Families in Rural Rwanda: The Role of HIV and the Family Environment. AIDS Behav 21, 1518–1529 (2017). https://doi.org/10.1007/s10461-016-1482-y
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DOI: https://doi.org/10.1007/s10461-016-1482-y