Prevalence of mental health problems and protective factors in children and adolescents affected and unaffected by HIV/AIDS in rural Rwanda

Background: Children infected with and affected by HIV are at increased risk of mental health problems, which has implications for risk behavior, educational attainment and provision of healthcare services. Methods: A case-control design was used to assess the prevalence of mental health problems among N= 680 children aged 10-17 who are (a) HIV-infected; (b) HIV-affected but not infected (i.e. children who have an HIV-positive caregiver); and (c) non-HIV-affected, in southern Kayonza and Kirehe districts in Rwanda. Children and their caregivers were assessed for child mental health, functioning, and resilience factors. Sampling followed a 3-part procedure: electronic medical records identified all HIV-infected children 10-17, community health workers assembled stratified lists of all HIV-affected and non-affected children in the same villages, and one participant was randomly sampled from each of these two lists, matched at the village level, to compare with each HIV-infected child. Results: HIV-affected children had significantly worse mental health outcomes than HIV-unaffected children whereas HIV+ children did not. Compared with HIV non-affected children, HIV-affected children reported significantly higher levels of depression- mean symptom score 32.4 (95% CI 30.0-34.8) vs 26.8 (95% CI 24.5-29.2), p < .001, and impaired functioning- mean score 16.6 (95% CI 15.1-18.1) vs 13.4 (95% CI 11.9-14.8), p = .002; however, HIV-positive children did not report significantly higher levels compared with HIV non-affected children. Conclusions: HIV-affected children, in addition to HIV+ children, are at increased risk for mental health problems and require increased attention in programming and policy in low resource settings.