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IntroductionAcross the globe, children born with perinatal HIV infection (PHIV) are reaching adolescence and young adulthood in large numbers. The majority of research has focused on biomedical outcomes yet there is increasing awareness that long‐term survivors with PHIV are at high risk for mental health problems, given genetic, biomedical, familial and environmental risk. This article presents a review of the literature on the mental health functioning of perinatally HIV‐infected (PHIV+) adolescents, corresponding risk and protective factors, treatment modalities and critical needs for future interventions and research.MethodsAn extensive review of online databases was conducted. Articles including: (1) PHIV+ youth; (2) age 10 and older; (3) mental health outcomes; and (4) mental health treatment were reviewed. Of 93 articles identified, 38 met inclusion criteria, the vast majority from the United States and Europe.ResultsThese studies suggest that PHIV+ youth experience emotional and behavioural problems, including psychiatric disorders, at higher than expected rates, often exceeding those of the general population and other high‐risk groups. Yet, the specific role of HIV per se remains unclear, as uninfected youth with HIV exposure or those living in HIV‐affected households displayed similar prevalence rates in some studies, higher rates in others and lower rates in still others. Although studies are limited with mixed findings, this review indicates that child‐health status, cognitive function, parental health and mental health, stressful life events and neighbourhood disorder have been associated with worse mental health outcomes, while parent–child involvement and communication, and peer, parent and teacher social support have been associated with better function. Few evidence‐based interventions exist; CHAMP+, a mental health programme for PHIV+ youth, shows promise across cultures.ConclusionsThis review highlights research limitations that preclude both conclusions and full understanding of aetiology. Conversely, these limitations present opportunities for future research. Many PHIV+ youth experience adequate mental health despite vulnerabilities. However, the focus of research to date highlights the identification of risks rather than positive attributes, which could inform preventive interventions. Development and evaluation of mental health interventions and preventions are urgently needed to optimize mental health, particularly for PHIV+ youth growing up in low‐and‐middle income countries.

AbstractIntroductionAdolescents and young adults (AYA) remain vulnerable to HIV‐infection and significant co‐morbid mental health challenges that are barriers to treatment and prevention efforts. Globally millions of AYA are living with HIV (AYALH) and/or have been affected by HIV in their families (AYAAH), with studies highlighting the need for mental health programmes. With no current guidelines for delivering mental health interventions for AYALH or AYAAH, a scoping review was undertaken to explore current evidence‐based mental health interventions for AYALH and AYAAH to inform future work.MethodsThe review, targeting work between 2014 and 2020, initially included studies of evidence‐based mental health interventions for AYALH and AYAAH, ages 10 to 24 years, that used traditional mental health treatments. Given the few studies identified, we expanded our search to include psychosocial interventions that had mental health study outcomes.Results and discussionWe identified 13 studies, seven focused on AYALH, five on AYAAH, and one on both. Most studies took place in sub‐Saharan Africa. Depression was targeted in eight studies with the remainder focused on a range of emotional and behavioural symptoms. Few studies used evidence‐based approaches such as Cognitive Behaviour Therapy; psychosocial approaches included mental health treatments, group‐based and family strengthening interventions, economic empowerment combined with family strengthening, group‐based mindfulness and community interventions. Eleven studies were randomized control trials with four pilot studies. There was variation in sample size, treatment delivery mode (individual focus, group‐based, family focus), and measures of effectiveness across studies. Most used trained lay counsellors as facilitators, with few using trained mental health professionals. Eleven studies reported positive intervention effects on mental health.ConclusionsDespite the need for mental health interventions for AYALH and AYAAH, we know surprisingly little about mental health treatment for this vulnerable population. There are some promising approaches, but more work is needed to identify evidence‐based approaches and corresponding mechanisms of change. Given limited resources, integrating mental health treatment into healthcare settings and using digital health approaches may support more standardized and scalable treatments. Greater emphasis on implementation science frameworks is needed to create sustainable mental health treatment for AYALH and AYAAH globally.

Family‐based interventions with children who are affected by HIV and AIDS are not well established. The Collaborative HIV Prevention and Adolescent Mental Health Program (CHAMP) represents one of the few evidence‐based interventions tested in low‐income contexts in the US, Caribbean and South Africa. This paper provides a description of the theoretical and empirical bases of the development and implementation of CHAMP in two of these countries, the US and South Africa. In addition, with the advent of increasing numbers of children infected with HIV surviving into adolescence and young adulthood, a CHAMP+ family‐based intervention, using the founding principles of CHAMP, has been developed to mitigate the risk influences associated with being HIV positive.

IntroductionThe tremendous success of antiretroviral therapy has resulted in a diminishing population of perinatally HIV‐infected children on the one hand and a mounting number of HIV‐exposed uninfected (HEU) children on the other. As the oldest of these HEU children are reaching adolescence, questions have emerged surrounding the implications of HEU status disclosure to these adolescents. This article outlines the arguments for and against disclosure of a child's HEU status.DiscussionDisclosure of a child's HEU status, by definition, requires disclosure of maternal HIV status. It is necessary to weigh the benefits and harms which could occur with disclosure in each of the following domains: psychosocial impact, long‐term physical health of the HEU individual and the public health impact. Does disclosure improve or worsen the psychological health of the HEU individual and extended family unit? Do present data on the long‐term safety of in utero HIV/ARV exposure reveal potential health risks which merit disclosure to the HEU adolescent? What research and public health programmes or systems need to be in place to afford monitoring of HEU individuals and which, if any, of these require disclosure?ConclusionsAt present, it is not clear that there is sufficient evidence on whether long‐term adverse effects are associated with in utero HIV/ARV exposures, making it difficult to mandate universal disclosure. However, as more countries adopt electronic medical record systems, the HEU status of an individual should be an important piece of the health record which follows the infant not only through childhood and adolescence but also adulthood. Clinicians and researchers should continue to approach the dialogue around mother–child disclosure with sensitivity and a cogent consideration of the evolving risks and benefits as new information becomes available while also working to maintain documentation of an individual's perinatal HIV/ARV exposures as a vital part of his/her medical records. As more long‐term adult safety data on in utero HIV/ARV exposures become available these decisions may become clearer, but at this time, they remain complex and multi‐faceted.

Undergraduate binge drinking, a well-documented problem at U.S. institutions of higher education, has been associated with a host of negative behavioral health outcomes. Scholars have extensively examined individual- and institutional-level risk factors for college binge drinking. However, these data have not been effectively translated into binge-drinking interventions. To inform the development of additional evidence-based prevention programs, this article documents the varied social practices that constitute "binge drinking," drawing on primarily ethnographic data. By disaggregating what survey research has largely examined as a unified outcome, we offer a descriptive account of the different reasons for and contexts in which students consume alcohol in amounts that constitute binge drinking. Our discussion points to modifiable social factors in university life as strategy for prevention. The implication of our argument is that acknowledging and responding to the varied motivations underlying students' alcohol use is one strategy to enhance campus binge-drinking prevention.

Using in‐depth interviews with 20 probation youth (60% female; 35% White; 30% Hispanic; mean age: 15 years, range = 13–17), their caregivers (100% female; mean age: 44 years, range = 34–71), and 12 female probation officers (100% White; mean age: 46 years, range = 34–57), we explored how family and probation systems exacerbate or mitigate sexual risk. We conducted thematic analyses of interviews, comparing narratives of families of sexually risky (n = 9) versus nonsexually risky (n = 11) youth. Family functioning differed by youth sexual risk behavior around quality of relationships, communication, and limit setting and monitoring. The involvement of families of sexually risky youth in probation positively influenced family functioning. Data suggest that these families are amenable to intervention and may benefit from family‐based HIV/STI interventions delivered in tandem with probation.