According to a 2002 New York City Department of Health and Mental Hygiene report, teen pregnancy in the city was 10 percent for females age 15. In the current study of daughters of parents with HIV, the pregnancy rate ranged from 38 percent to 67 percent, depending on participation in a coping skills intervention.
The study in the latest American Journal of Health Behavior also found that interventions to improve coping skills reduced the likelihood of early childbearing, as did lower levels of emotional distress, academic counseling and a positive perception of family finances.
"Supportive interventions for families living with HIV are critical," said study co-author Mary Jane Rotheram-Borus, Ph.D., of Semel Institute and the Department of Psychiatry at UCLA. "A family approach is really important for all parents coping with terminal or chronic illnesses." She said grandchildren of those with HIV were better adjusted and had better home environments when counseling was given.
The researchers studied 181 adolescent daughters of people with HIV. Participants, with an average age of 15, received either family-based counseling aimed to reduce mental health symptoms, substance abuse, sexual risk and problem behaviors or routine family case management services with access to health and mental health care, counseling and support services. Girls in both groups were followed for up to seven years.
The researchers interviewed participants periodically, asking about childbearing, family finances, drug abuse or risky sexual behaviors and testing their mental health status and self-esteem. Participants were also asked if they participated in the coping skills intervention and religious services, counseling with a psychiatrist, psychologist or social worker.
Over the course of the study, 101 of the young women had one or more children. In the intervention group, 28 (38 percent) of the adolescents had one or more children compared with 73 (67 percent) of adolescents in the nonintervention group who had one or more children.
The average age of conception for the intervention group was 18 years compared with 17 years for the nonintervention group. Risk for childbearing in the intervention group was lower for those who received academic counseling and in both groups was higher for those who had physical symptoms of emotional or psychiatric disturbances, and who perceived their family's financial status as poor or very poor.
According to the authors, 585,000 to 750,000 children in the United States have a parent with HIV and almost half of these children are adolescents. Characteristics of adolescents of parents with HIV are very similar to those of young people in general who become teenaged parents, namely those of low-income background from large urban area who are ethnic minorities.
"Families in a given neighborhood with higher HIV risk may also be families with higher early-pregnancy risk, because of characteristics associated with both kinds of risk," said Stephen Crystal, Ph.D., of Rutgers University. "In general...effective intervention is not easy and is costly. Many of the critical influences on the outcomes of concern -- access to quality education, health care, peer influences, exposure to substance abuse, and other community based exposure factors -- are difficult to address with programmatic interventions."
"Clinicians working with HIV-affected families should provide psychoeducational and referral information to parents regarding the risks of early childbearing as well as the benefits of both mental health and academic referrals for affected adolescents," according to the authors, who hope results of the current study can be extrapolated to other populations, both in the United States and internationally.
"We are currently replicating this NYC study in LA. We also have studies in China, Thailand, South Africa and Zimbabwe," Rotheram-Borus said.
May S, et al. Childbearing among daughters of parents with HIV. Am J Health Behav 30(1)