The importance of quality of care: effects of perinatal HIV infection and early institutional rearing on preschoolers' attachment and indiscriminate friendliness.

BACKGROUND The rearing environment of human immunodeficiency virus (HIV)-infected children is often compromised, putting these children at additional risks. Positive caregiving may ameliorate the impact of adverse circumstances and promote attachment security. The goal of the present study was to examine the attachment relationships of HIV-infected children in biological families and institutions; to examine the effects of HIV infection and institutional rearing on attachment security and indiscriminate friendliness; and to assess the role of caregiving in the face of HIV-related adversities. METHODS We studied 64 Ukrainian uninfected and HIV-infected children reared in families and institutions (mean age 50.9 months). Physical and cognitive development of children as well as attachment-related domains and indiscriminate friendliness were assessed. RESULTS Institutional care but not the presence of HIV was associated with lower levels of attachment security and higher levels of indiscriminate friendliness. On average, the level of indiscriminate friendliness among institution-reared children was more than twice as high as among family-reared children. Only 24% of institution-reared children had clearly developed attachment patterns, as opposed to 97% among family-reared children. Controlling for physical and cognitive development, type of care (institution or family), and HIV status, positive caregiving was associated with higher levels of attachment security. Indiscriminate friendliness was associated with lower levels of attachment security among family-reared children, but with higher levels of positive caregiving among institution-reared children. CONCLUSIONS Etiology and function of indiscriminate friendliness may differ for family-reared versus institution-reared children. The findings of this study suggest the necessity of early interventions improving the quality of care for HIV-infected children.