Global Buddies

Global Buddies is a collaborative program created jointly by the Global Center for Children and Families and Utu Social Ventures, which incubates social programs for the purpose of promoting well-being among children and families worldwide. In 2006-07, we carried out the program’s pilot trip to Cape Town, South Africa, where five American families with children ages 7 – 11 spent a week engaging in cultural exchange and volunteer service in Cape Town’s Mfuleni township—a sprawling shantytown home to approximately 60,000 of the region’s black and colored residents. A second trip to South Africa is planned for Spring 2008.

Global Buddies inspires families and children to see themselves as global citizens and take action on worldwide issues confronting the environment and humanity. We do this by offering innovative family travel opportunities that create a platform for social change on the individual, family, community and global levels.

The program has three goals:

• Help families around the world make meaningful connections with each other, through which they understand their shared humanity and the interconnected world in which they live.
• Bring families together for ongoing global collaboration, joint service projects, and innovative models for action.
• Help families become agents for change who recognize their power to contribute to the world.

Global Buddies creates a platform for people to connect with each other, develop shared projects, and work together over time in ways that make a difference in all of their lives. The program gives children direct experiences with children from places and cultures very different from their own, in order to plant in their consciousness at a young age a sense of themselves as global citizens in an interconnected world. While Global Buddies is a travel program, it is just as much a platform to solve social and environmental problems through unleashing the power of families and children to create change in the world.

The vision of Global Buddies is to build a worldwide community of children and families dedicated to creating a healthy environment and a world in which all people have the opportunity to thrive. We nurture a spirit of equal exchange among families around the world, in which all possess a sense of personal responsibility to help solve global problems, a wide-ranging imagination regarding how to go about this, and a consciousness of the power they possess to improve their own lives, their communities, and the world they share with each other and future generations.

F2F (Family-to-Family) Intervention

HIV has a negative intergenerational impact on families, particularly children with HIV+ parents (Rotheram-Borus et al., 1997). In order to improve the social, behavioral and mental health outcomes for children affected by HIV, we have designed the Family-to-Family (F2F) intervention that includes the critical, universal, program components identified by the NIMH Intervention Workgroup (in revision). All efficacious intervention programs: frame the problem by providing information and shaping beliefs; enhance skills; establish supportive relationships; and remove environmental barriers to behavior change (e.g, HIV testing, ARV). We aim to evaluate a generic intervention approach that is culturally-tailored to families affected by HIV in a specific country, Thailand. The intervention builds on previous efficacious HIV family interventions, adapted to be sustainable in a developing country context. The F2F intervention for HIV+ parents and their family caregivers will assist families to cope with HIV-related stressors (disclosure, stigma, transmission, & custody), build skills for improving their own and their children’s adjustment, and establish supportive community relationships with other families affected by HIV. Families in Thailand need such an intervention: 1 in 4 elderly adults in Thailand will raise an AIDS orphan, even with a relatively low national seroprevalence rate (1.2%).

The study will proceed in two phases. In Phase 1, we will pilot and finalize the intervention, assessments, and procedures with 40 families, 10 of whom are “positive models.” In Phase 2, families with HIV+ parents (400 HIV+ parents, 600 family caregivers) from 4 district hospitals in Chang Rai & Nakhon Ratchasima Provinces will be recruited to an intervention to benefit their 960 school-aged children aged 6-17 years. At their clinical care site, we will randomly assign families to either: 1) F2F, a psychoeducational intervention for HIV+ parents and family caregivers delivered in drop-in groups by healthcare providers (not including their children); or 2) a Standard Care intervention. The impact of the F2F intervention will be monitored over 24 months (baseline, 3, 6, 12, 18, & 24 months). The primary outcomes are school-age children’s social, behavioral, and mental health status. HIV+ parent’s and family caregivers’ health, mental health, parenting skills, and family bonds are intermediate outcomes.

NIMH Collaborative HIV/STD Prevention Trial – UCLA-China Site

This collaborative project between U.S. investigators at UCLA and Chinese investigators through the Chinese Academy of Preventive Medicine (CAPM), is part of the NIMH Collaborative HIV/STD Prevention Trial which adopts a two-arm, randomized community-level design to test the Popular Opinion Leader (POL) HIV prevention intervention model at five international sites (China, India, Peru, Russia, and Uganda). CCH is the lead on the China site.

China, representing 1/4th of the world’s population, has a rapidly emerging HIV epidemic with about 1.2 million individuals already infected, more than the total of all the Asian nations combined. Similar to Africa & India, the country’s 200-250 million labor migrants are a key to the epidemic’s future, however, HIV infection is predominantly occurring in rural settings (75% of population) and migrants transmit the virus heterosexually when moving to the cities annually.

The goals of this project are: 1) to adapt a comprehensive community-level preventive intervention – The Popular Opinion Leader – to populations in China based on data from ethnographic studies and compare the results with the other four international sites which follow the same research procedure; 2) to test the efficacy of this community-level preventive intervention in China as well as the four international sites utilizing both behavioral and biological outcomes; and, 3) to develop a manual that will permit different health care agencies and service providers to conduct rapid ethnographic studies, translate this community-level intervention to different settings and populations, and assess intervention efficacy.

The Mothers’ Programmes (TMP)

South Africa has 5 million persons living with HIV (2.7 million women of childbearing age), the country with the most persons living with HIV (UNAIDS, 2004a). Fortunately, HIV testing and access to antiretroviral drugs (ARV) to prevent mother-to-child transmission (MTCT) of HIV from HIV+ pregnant women and their babies is being scaled up . Yet, 40.7% of pregnant women are HIV seropositive (HIV+) in townships such as those in the KwaZulu-Natal (KZN) Province of South Africa (Department of Public Health, South Africa, 2004). This project is primarily aimed at enhancing the adjustment of children of MLH by improving the health and mental health of MLH which benefits their children, as well as the MLH.

The Mothers’ Programmes (TMP) is a community based non-government organization, operating in South Africa including the Western and Eastern Cape, KZN, Mpumalanga and Northern Cape Provinces and two other African countries, Ethiopia and Botswana. TMP provides wrap-around preventive social support and educational services for MLH at MTCT clinic sites. The proposed project aims to transform the existing TMP into a theoretically-based, sustainable behavioral prevention program (the Mothers-To-Mothers [M2M] intervention) that will improve the adjustment of MLH and their babies. Rather than design an intervention that then must adapt itself to a delivery vehicle, we will take a delivery vehicle (TMP) and enhance its efficacy by creating the M2M intervention. We propose a two phase project over five years. In Phase 1 over the first year, we will finalize all measures, procedures, recruitment of staff, training protocols, and intervention manuals and strategies. In Phase 2, a quasi-experimental design will be implemented with 1632 MLH at 8 clinics (204 mothers/ clinic). Study clinics will be selected that provide environmental access to these services from two strata (large, peri-urban clinics [4 clinics] & small, rural clinics [4 clinics]). All MLH in 8 clinics (n = 1632) will be randomly assigned by clinic within strata to either: 1) standard care (SC), the health care that is delivered by the province; or 2) an enhanced care intervention condition (Mothers-to-Mothers [M2M]). The M2M intervention will be focused on caring for one’s own health, parenting one’s baby, maintaining mental health, and reducing transmission. The intervention’s impact will be assessed over 15 months in a design that is a blend of an efficacy and effectiveness trial.

Adapting Evidence Based Prevention for Adolescents Affected by HIV (TALK)

Objectives: To adapt a successful family based intervention for Mothers with HIV/AIDS (MWH) and their adolescent children to meet the new social and psychological demands of living with HIV in an era of effective combination antiretroviral therapies. Primary intervention outcomes include improving mental health and reducing risk behaviors for both adolescents and parents.

Background: Over 120,000 children in the United Sates live with an HIV positive parent. A successful randomized control trial of a family based intervention has demonstrated emotional, behavioral and social outcomes in adolescents of parents with HIV with longitudinal follow-up over six years. The new intervention focuses on: improving mental health, coping with illness-related stressors, reducing parent and child risk behaviors, and improving family functioning in the face of maternal HIV illness. Based on core principles of cognitive behavior therapy, the intervention focuses on improving parent-child communication, enhancing coping and goal setting, improving social support, increasing developmentally appropriate parenting, and developing a life narrative in the context of HIV illness. Mothers and adolescents (age 12 to 20) attend 12 independent small-group sessions and 4 conjoint sessions, led by a facilitator. Session content focuses on ongoing treatment adherence, establishing life goals and parenting in the context of a chronic illness. Core HIV specific topics endure from the earlier era, such as coping with HIV-related symptoms, decision making about disclosure, maintaining positive mental and physical health, and reducing transmission behaviors.

Results: To date, 216 MWH have been recruited. Latinas comprise 65% of the sample, African-American women 29%. To date, 48 “healthy” neighborhood control mothers have been recruited (38% Latina and 50% African-American). Adolescents of MWH are on average 15.2 years of age and 61% are female. Control adolescents are 15.3 years of age and 58% female. Significantly higher rates of emotional distress are present in MWH relative to controls, including Post Traumatic Stress Disorder (PTSD) (p = .02); depression (p = .001) and anxiety (p = .03). Traumatic exposure is more common among MWH. MWH endorse 5.0 traumatic experiences on average, relative to 2.5 traumas reported by healthy moms. Most MWH (95%) endorsed learning about their HIV diagnosis as a traumatic event. 52% indicated learning about their diagnosis as the trauma which bothers them the most.

Conclusions: Living with parental HIV/AIDS creates greater risk relative to families living in similar impoverished ethnic/racial minority communities. Parental emotional distress, particularly high rates of maternal post traumatic stress, indicate the ongoing need for preventive interventions for families living with parental HIV, despite advances in HIV prognosis and treatment. Intervention models for families living with HIV must address the traumatic impact of HIV diagnosis on MWH.