Standing between two worlds in Harlem: A developmental psychopathology
perspective of perinatally acquired human immunodeficiency virus
and adolescence
Ezer Kang
a,b,c,
⁎
, Claude Ann Mellins
a,c
, Warren Yiu Kee Ng
a,b
,
Lisa-Gaye Robinson
b
, Elaine J. Abrams
b,d
a
Columbia-Presbyterian Center of the New York Presbyterian Hospital, Department of Pediatric Psychiatry, USA
b
Harlem Hospital Center, Department of Pediatrics, USA
c
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, USA
d
Columbia University, Mailman School of Public Health, USA
article info abstract
Available online 7 March 2008
Perinatal HIV infection in the US continues to evolve from a fatal pediatric illness to a chronic
medical condition of childhood and adolescence. Although navigating this period is influenced
by multi-leveled deprivations commonly experienced by low-income minority families, HIV
alters the timing and experience of developmental milestones for many adolescents with
perinatal HIV. This selective review of the growing developmental psychopathology literature
and the authors' clinical work at a pediatric HIV program in Harlem, NY provide an overview of
how developmental psychopathology offers an integrative framework that elucidates how
autonomy, peer relationships, and self-concept evolve among 13–21 year old adolescents. This
paper highlights the importance of considering influences of both perinatal HIV and the culture
of poverty on adolescent development, and of adopting multilevel interventions and research
to address how interactions among biologic, environmental, and HIV-related stressors
(serostatus disclosure, medical treatment adherence, illness stigma) influence the
development of adolescents with perinatal HIV.
© 2008 Elsevier Inc. All rights reserved.
Keywords:
Adolescence
Perinatal HIV
Developmental psychopathology
Behavioral and adjustment problems
Minority youth
Autonomy, Peer relationships
Self-concept
“I stand between two worlds. I am at home in neither and I suffer the consequences” (Thomas Mann, 1929, “Tonio Kröger”)
1. Introduction
Since the peak of perinatal HIV infection in 1992 until the precipitous decline in perinatally-acquired cases of AIDS between
1993 and 1997 in the United States (US), the emergence of behavioral and adjustment problems in children living with perinatal
HIV infection has gradually eclipsed medical management issues. For example, decisions about initiating and discontinuing
antiretroviral treatment are determined largely by familial, individual, and psychosocial factors in addition to markers of HIV
progression. However, advances in the medical treatment and prevention of maternal to infant transmission of HIV in the US have
been tempered by several alarming realities. First, children perinatally infected and “affected” by HIV/AIDS in the early 1990s are
disproportionately urban ethnic minorities and the offspring of crack-cocaine abusers who contend with multiple socioeconomic
Journal of Applied Developmental Psychology 29 (2008) 227–237
⁎ Corresponding author. Columbia Presbyterian Hospital, Department of Pediatric Psychiatry, 622 W. 168th St., VC4, New York, New York 10032. USA. Tel.: +1 212
939 4052; fax: +1 212 305 7400.
E-mail address: eek34@columbia.edu (E. Kang).
0193-3973/$ – see front matter © 2008 Elsevier Inc. All rights reserved.
doi:10.1016/j.appdev.2008.02.001
Contents lists available at ScienceDirect
Journal of Applied Developmental Psychology