Dr. Vivian Lamphear

DR. LAMPHEAR'S WORK TO SAVE AFRICA'S CHILDREN

The Psychosocial Needs of AIDS Orphans:
An International collaborative study between Save Africa's Children, World Youth Missions and Russell T. Jones, Ph.D. Virginia Tech University
by
Vivian S. Lamphear, Ph.D.

Assessment of Psychosocial Needs of AIDS Orphans

According to "Children on the Brink 2004", by the year 2015 an estimated 20% of Sub-Saharan African children 18 or younger will have lost one or both parents to HIV/AIDS. Wars, famines, natural disasters, mass migration, and diseases have long impeded the health and wellbeing of children in low-resource countries. Yet, the devastating impact of parental HIV/AIDS on children is unparallel. Arguably the most physically and mentally at-risk population of children in the world, AIDS orphans are assaulted by manifold origins of stress and psychological trauma.

These children face multiple losses when parents, siblings, relatives and neighbors become infected and die. Siblings are often split up as parents are unable to continue to care for them or die. Multiple changes of residence, care-givers who are strangers and to whom the child has no attachment put these children at high risk for psychopathology. Family income often plummets as parents are unable to work and medical bills pile up. School fees are no longer feasibly paid and children lose their school friends and the benefits of education.

Many children become heads of household, have to work outside the home at young ages, receive poorer nutrition and supervision at home, engage in sexual activity earlier, are abducted into child trade, have become street children and sex for income. They endure stigmatization and are often ostracized and ridiculed even among relatives. As feelings of hopelessness and despair grow, many turn to drugs and sex, further increasing their risk for HIV infection. Studies concur that children orphaned by AIDS manifest high risk behaviors in reaction to the trauma and aftermath of parental loss due to AIDS. These behaviors include, drug use, sex for money and early sexual behavior.

What little research has been done in the U.S. shows that AIDS orphans suffer a variety of psychological reactions to parental illness and death. They experience higher rates of post-traumatic stress disorder, grief, depression, anxiety, social withdrawal and impaired cognitive functioning than non-orphans (Forehand et al, l998; Hough et al, 2003). They tend to show internalizing (depression, anxiety and withdrawal) rather than externalizing symptoms (aggression and antisocial behavior (Makare et al, 2002). Other research has shown that AIDS orphaned children's adjustment may be worsened by poor parental coping, stigma and social ostracism (Klunkin & Harrigan, 2002).

Although scarce, research in developing countries shows similar psychosocial problems in children from families affected by HIV/AIDS. For example, Congolese children of infected parents show high rates of depression, anxiety, hyperactivity, and antisocial behavior (Makaya et al, 2002. Ten to 14 year-old Tanzanian children orphaned by AIDS had higher rates of suicidal ideation and internalizing disorders compared to demographically matched non-orphans (Makare et al, 2002).

In sub-Saharan Africa, Sengendo & Nambi (1997) found that child trauma was associated with witnessing declines in parental health. These authors found that AIDS orphans self-report more depression than children orphaned due to other reasons or children in intact families. Other research done in sub-Saharan Africa has found that AIDS orphans experience more interruptions and loss of their education (Ankrah, 1993; Foster et al., 1997) than children orphaned for other reasons and non orphans...

Parentally bereaved children report significantly more PTSD (posttraumatic stress disorder) symptoms than the disaster and non trauma control groups (Stoppelbein and Greening, 2000). Among the bereaved children, girls, younger children and children living with a surviving parent who scored high on a measure of PTSD reported more symptoms including anxiety and depression. Another study showed that depressive symptoms were the best predictors of PTSD following and years after the traumatic event. This demonstrates the importance of identifying such risk factors as depression as an important mediator of chronicity in PTSD.

Need for Intervention and Prevention Programs with AIDS Orphans

Whether due to cultural norms, stressed care-givers or limited resources, little or no support is offered to help AIDS orphans make sense of the overwhelming stress and trauma they experience (Foster et al, 2001). To date, very little research has been conducted in high prevalence, low-resource countries to develop, implement, and evaluate interventions and preventions which minimize the devastating psychosocial outcomes of parental AIDS on children.
Rotheram-Borus et al, 2001 demonstrated that psychological interventions can reduce the long-term impact of parents' HIV/AIDS status on themselves and their children. Adolescents receiving intervention reported significantly lower levels of emotional distress, problem behaviors and higher levels of self-esteem than controls.
Witnessing a parent's lengthy agony and ultimate death from AIDS and the immense trauma and stress that follows, puts children and adolescents at risk for developing Posttraumatic Stress Disorder (PTSD) and related psychological problems. A diagnosis of PTSD means that an individual experienced an event that involved a threat to one's own or another's life or physical or emotional integrity and that this person responded with intense fear, helplessness, or horror. While some may recover from the experienced trauma, many untreated victims show emotional scars through out their lifetime.

The Purpose of this Study

To date, no studies exist which assess the presence or treatment of PTSD in AIDS orphans in Africa or the effectiveness of group interventions to reduce these symptoms. Group interventions are essential given the scarcity of mental health personnel and financial resources to assist these children. The present study extends work of Aduriz et al, 2004 who demonstrated the effectiveness of a group intervention for child trauma victims in the low resource country of Argentina.

The current study has two purposes: (a) to examine the psychosocial adjustment in AIDS orphans in Uganda and (b) to evaluate the effectiveness of a brief group intervention for AIDS orphans experiencing post traumatic stress symptoms (EMDR or EFT). This pilot study is designed as part of a larger prospective research effort by the present authors to evaluate risk and resilience factors that predict children's response to the devastating impact of the AIDS epidemic. This knowledge is essential for early intervention efforts to reduce the overwhelming distress these victims face. The information derived from this study will also greatly facilitate prevention of chronic psychopathology and high risk AIDS behavior in AIDS orphans (Pfefferbaum, 1997; Verngerg & Vogel, 1993).

To find out more information about this project, or make a tax deductible donation, please write:
Save Africa's Children-Child Trauma Project
West Angeles COGIC
3045 S. Crenshaw Ave
Los Angeles, CA 90016

Mothers Helping Mothers

On my recent humanitarian trips to Haiti and Africa, I've been deeply touched by mothers who selflessly take in children orphaned by the current AIDS pandemic. Many rise to the need by starting orphanages with what little resources they have. Some work two jobs just to meet the needs of the orphanages they have formed. To support these “mothers helping mothers”, I am donating a portion of the proceeds from my seminars, books, tapes and other products to their selfless efforts.

You can help support these volunteer humanitarian efforts by *purchasing my products.

1.	Anger Control Parenting Book	$20
2.	Anger Control Parenting Class Video	$15
3.	Anger Control Parenting Relaxation Tape/CD	$15
4.	Anger Control Parenting Seminar Handouts	$10
5.	Gentle Eating Weight Loss Book. (Co-authored with New Life's Stephen Arterburn)	$20
6.	Gentle Eating Weight Loss Workbook (Co-authored with New Life's Stephen Arterburn)	$20
7.	Assertion Video and Handouts	$15
8.	Guided Imagery Relaxation Tape/CD	$15

*Cost of donated products (tax included). To purchase these products please email Dr.Lamphear at drlamphear@charter.net. Thank you in advance for your support.