摘要：Objectives. This study evaluated an intervention designed to improve behavioral and mental health outcomes among adolescents and their parents with AIDS. Methods. Parents with AIDS (n = 307) and their adolescent children (n = 412) were randomly assigned to an intensive intervention or a standard care control condition. Ninety-five percent of subjects were reassessed at least once annually over 2 years. Results. Adolescents in the intensive intervention condition reported significantly lower levels of emotional distress, of multiple problem behaviors, of conduct problems, and of family-related stressors and higher levels of self-esteem than adolescents in the standard care condition. Parents with AIDS in the intervention condition also reported significantly lower levels of emotional distress and multiple problem behaviors. Coping style, levels of disclosure regarding serostatus, and formation of legal custody plans were similar across intervention conditions. Conclusions. Interventions can reduce the long-term impact of parents' HIV status on themselves and their children. In the United States, increasing numbers of parents have AIDS, 1 , 2 and these individuals will either live with a chronic, life-threatening illness or they will die. Parents with AIDS must cope with physical health symptoms, complex medication regimens, 3 stigma, 4 and fear of AIDS-related death, as well as caring for their family. 5 , 6 Parents' ability to care for their family and their illness are likely to influence their children. 7 , 8 After living with an ill parent, about 80 000 children in the United States have been orphaned by AIDS 1 (internationally, 13 million) 9 ; this reflects mortality rates similar to those associated with cancer or automobile accidents. 10 Parental death reduces children's selfesteem and increases depression, anxiety, conduct disturbance, academic difficulty, somatic complaints, and suicidal acts over the long term. 11 To help adolescents and their parents cope with parental AIDS, we evaluated the efficacy of an intervention designed to improve behavioral, social, and mental health outcomes. As with other successful HIV intervention programs, 12 social learning theory 13 directed the intervention design. Social learning theory provides a framework for how individuals change their behavior (i.e., in small steps as behaviors are rewarded over time and goals are articulated and defined), as well as specifying a set of factors that must be changed (skills, expectations of competence and efficacy, ability to express and control one's feelings). 14 On the basis of these principles, a 24-session intervention was designed to be delivered over 12 Saturdays in small groups. 6 , 15 The purpose of the intervention was to help parents with AIDS and their adolescents cope with illness-related tasks. Sessions were organized into 2 modules, with each module aimed at helping parents and youths cope with different illness-related challenges. When parents are first diagnosed with AIDS (often at the same time they learn their HIV serostatus), 16 they must decide whether and how to tell their children about their health status. Most parents disclose their HIV illness to their adolescents. 17 These adolescents must then cope with HIV-related stigmatization, 4 their grief concerning their parent's life-threatening illness, and their anxiety about their own welfare. Module 1 (8 sessions over 4 Saturdays) of the intervention addressed parents' issues of disclosure, emotional reactions to AIDS, and coping with stigma. In 1994 (when data collection was initiated), individuals with AIDS lived about 14 months (New York City Human Resources Agency, Division of AIDS Services, unpublished data, 1993). Making custody-related plans was a challenge that parents faced about 6 months after being diagnosed with AIDS. Research has shown that children of parents with AIDS are at higher risk for long-term negative outcomes if their parents do not make custody plans. 18 Children bereaved by sudden, unexpected parental loss demonstrate more negative outcomes than children who have been prepared, 19 , 20 and the legal complications are greater. 18 In addition, seriously ill parents have difficulty maintaining positive daily routines, such as having family dinners. Module 2 addressed making custody plans, expressing love and affection, and maintaining positive family routines with a very ill parent. This report summarizes the efficacy of the intervention in terms of reducing behavioral, social, and mental health symptoms over 2 years among adolescents and their parents with AIDS.
