With millions of youth orphaned by AIDS in Sub-Saharan Africa undergoing high levels of stress-related problems—such as interpersonal and problem-solving skills deficits, unhealthy thoughts, and maladaptive behaviors—addressing trauma and stress is a pressing need. Addressing these stressors is especially important in preventing the spread of HIV by reducing stress-induced risky sexual behaviors among orphaned and vulnerable children. Other studies have shown that cognitive behavior therapy interventions, when adapted for local environments, have been effective in addressing such stress-related problems.

This study will focus on comparing the effectiveness of psychosocial counseling (PC) and trauma-focused cognitive behavioral therapy (TF-CBT). The study will primarily compare the effectiveness of psychosocial counseling and trauma-focused cognitive behavioral therapy in addressing the stress-related problems among orphaned and vulnerable children. In addition, the study will examine the effectiveness of these two major types of treatment in reducing sexual risk behaviors while accounting for factors that mediate and moderate HIV risk behaviors. Finally, this study will compare the cost-effectiveness of the two treatment methods.

This study, which is being conducted in Zambia, utilizes a randomized controlled trial of psychosocial counseling and trauma-focused cognitive behavioral therapy, which has been utilized in other previous and ongoing studies. The major outcomes that this study will analyze include HIV risk behaviors, emotional and behavioral health, social support, overall well-being and mental health development of orphaned and vulnerable children. Researchers will recruit adolescents aged 13-17 who report risky sexual behavior, including recent sex without a condom. Adolescent participants and their caregivers will be assessed utilizing a computerized interviewing program that will enhance privacy and honesty of responses.

Policy Implications:

  • This study will provide necessary scientific evidence on the feasibility, effectiveness, and cost effectiveness of interventions for orphaned and vulnerable children affected by HIV/AIDS.
  • Results from this study will help inform efficient program design, policy, and effectiveness of interventions for preventing HIV among orphaned and vulnerable children living in low-resource settings.

Principal Investigators: Laura Murray (Johns Hopkins University) and Paul Bolton (Harvard University)

Investigators: Kathryn Whetten (Duke University), Judith Cohen (University of Pittsburg), Shannon Dorsey (University of Washington)