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Pediatrics. 2014 Aug;134(2):e464-72. doi: 10.1542/peds.2013-2734.

HIV and child mental health: a case-control study in Rwanda.

Author information

  • 1Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts;
  • 2Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York;
  • 3Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda;
  • 4Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;Partners In Health, Boston, Massachusetts;
  • 5Department of Clinical Psychology, University of Rwanda, Butare, Rwanda;
  • 6Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts;
  • 7Partners In Health, Boston, Massachusetts;
  • 8Department of Mental Health, Rwinkwavu Hospital, Rwinkwavu, Eastern Province, Rwanda;
  • 9François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts; and.
  • 10Rwanda Biomedical Center, Ministry of Health, Mental Health Division, Kigali, Rwanda.



The global HIV/AIDS response has advanced in addressing the health and well-being of HIV-positive children. Although attention has been paid to children orphaned by parental AIDS, children who live with HIV-positive caregivers have received less attention. This study compares mental health problems and risk and protective factors in HIV-positive, HIV-affected (due to caregiver HIV), and HIV-unaffected children in Rwanda.


A case-control design assessed mental health, risk, and protective factors among 683 children aged 10 to 17 years at different levels of HIV exposure. A stratified random sampling strategy based on electronic medical records identified all known HIV-positive children in this age range in 2 districts in Rwanda. Lists of all same-age children in villages with an HIV-positive child were then collected and split by HIV status (HIV-positive, HIV-affected, and HIV-unaffected). One child was randomly sampled from the latter 2 groups to compare with each HIV-positive child per village.


HIV-affected and HIV-positive children demonstrated higher levels of depression, anxiety, conduct problems, and functional impairment compared with HIV-unaffected children. HIV-affected children had significantly higher odds of depression (1.68: 95% confidence interval [CI] 1.15-2.44), anxiety (1.77: 95% CI 1.14-2.75), and conduct problems (1.59: 95% CI 1.04-2.45) compared with HIV-unaffected children, and rates of these mental health conditions were similar to HIV-positive children. These results remained significant after controlling for contextual variables, there were no significant differences on mental health outcomes groups, reflecting a potential explanatory role of factors such as daily hardships, caregiver depression, and HIV-related stigma [corrected].


The mental health of HIV-affected children requires policy and programmatic responses comparable to HIV-positive children.

Copyright © 2014 by the American Academy of Pediatrics.


HIV-affected; HIV-infected; HIV/AIDS; Rwanda; child; mental health

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