Grief Interventions for PLAs, Adolescents and Guardians

Project Name: 
Grief Interventions for PLAs, Adolescents and Guardians
Project Type: 
Living with HIV

Grief Interventions for PLAs, Adolescents and Guardians

Project Description:

By the year two thousand, 80,000 children will be orphaned by AIDS in the U.S. and this number will continue to rise. Parental death during one’s childhood has been consistently associated with negative outcomes for children, however, there have been no prospective studies of adolescent bereavement from any type of parental death, including death from AIDS. This continuation study is aimed at delivering and evaluating an intervention to alleviate grief associated with the death of a parent. These results are likely to have implications for millions of AIDS orphans internationally and for the 550,000 US adolescents bereaved annually by parental death.


Over the last two and a half years, 310 parents living with AIDS (PLAs) and their 498 adolescent children, age 12-18 were recruited. They were randomly assigned to receive: (1) a standard care condition in which extensive social welfare services are provided; or (2) an enhanced care condition in which three modules of coping skills intervention (Project TALC: Teens and Adults Learning to Communicate) plus social services are provided. Linked to the phases of parental illness, PLAs, their adolescents, and new custodial guardians are schedule to meet individually and jointly in over 32 sessions. Because the life span of women with AIDS extended from 14.3 months to 27 months over the last two years, about two thirds of the sample of PLAs continue to live longer than anticipated, delaying the delivery of the final intervention module. Over the next 18 months, the investigator anticipates that the PLAs will die, and the final, post-death module of the intervention will be delivered. The present continuation study will allow the investigator to complete the delivery and the evaluation of the intervention, and in addition, pursue the following activities: (1) follow youths of PLAs prospectively and longitudinally for four additional years to evaluate their mental health, behavioral, and social outcomes; (2) complete the delivery and evaluation of the enhanced coping skills intervention, particularly of Module 3 to new custodial guardians and youths; and (3) develop new measures of grief to describe the bereavement process over time.

Parents living with AIDS reported a mean of 3.3 (SD=1.3) areas of conflict with their adolescents and 1.5 (SD=1.7) stressful parenting events over the previous three months. The parents were very ill, with many physical symptoms and diseases. Simultaneously, substance use was common (17% used daily), but not injection drug use (3.3%). Half had a sexual partner (63% protected partners by using condoms consistently). Regression analysis revealed that parent-adolescent conflict was significantly associated with high parental drug use: stressful parent events were significantly related to the lifestyle (high drug use and frequent sex acts) of Latino and African-American parents, but not white parents. In contrast to parents with other illnesses, parent-adolescent conflict and stressful parenting events were not influenced by parents’ health status, but were significantly influenced by substance use and sexual lifestyles. Both mothers (87%) and fathers were significantly more likely to disclose their serostatus to adolescents (73%), compared to younger children (23%). Only 44% disclosed to all their children; 11% disclosed to none. Most PLAs (80%) discussed custody plans; however, only 30% initiated legal plans, typically for younger children. Adolescents informed of their PLA’s serostatus engaged in more sexual risk acts, smoked more cigarettes, reported more severe substance use, and greater emotional distress than did uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or followup.

National Institute of Mental Health, grant 2R01MH49958-06

Targeted Risk Group: 
AIDS-infected parents and their children