Posted: Feb 28, 2017
Cumulative risk and AIDS-orphanhood: Interactions of stigma, bullying and poverty on child mental health in South Africa
Research shows that AIDS-orphaned children are more likely to experience clinical-range psychological problems. Little is known about possible interactions between factors mediating these high distress levels. We assessed how food insecurity, bullying, and AIDS-related stigma interacted with each other and with likelihood of experiencing clinical-range disorder. In South Africa, 1025 adolescents completed standardised measures of depression, anxiety and post-traumatic stress. 52 potential mediators were measured, including AIDS-orphanhood status. Logistic regressions and hierarchical log-linear modelling were used to identify interactions among signiﬁcant risk factors. Food insecurity, stigma and bullying all independently increased likelihood of disorder. Poverty and stigma were found to interact strongly, and with both present, likelihood of disorder rose from 19% to 83%. Similarly, bullying interacted with AIDS-orphanhood status, and with both present, likelihood of disorder rose from 12% to 76%. Approaches to alleviating psychological distress amongst AIDS-affected children must address cumulative risk effects.
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Posted: Feb 28, 2017
Effects of Stigma on the Mental Health of Adolescents Orphaned by AIDS
Purpose: By 2010, an estimated 18.4 million children in Sub-Saharan Africa will be orphaned by AIDS. Research in South Africa shows that AIDS orphanhood is independently associated with heightened levels of psychological problems. This study is the ﬁrst to explore the mediating effects of stigma and other factors operating on a community level, on associations between AIDS orphanhood and mental health. We assessed the associations of four risk factors that can potentially be addressed at a community level (bullying, stigma, community violence, and lack of positive activities) with psychological problems and orphanhood status.
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Method: One thousand twenty-ﬁve participants aged 10–19 were recruited from deprived urban settlements in South Africa. The sample included adolescents orphaned by AIDS (n = 425), adolescents orphaned by non-AIDS causes (n = 241), and nonorphaned adolescents (n = 278). Participants were interviewed using standardized psychological measures of depression, anxiety, posttraumatic stress, peer problems, delinquency, and conduct problems. Information on risk factors and demographic characteristics were also assessed.
Results: AIDS-orphaned adolescents reported higher levels of stigma and fewer positive activities than other groups. There were no reported differences on bullying or community violence. All community-level risk factors were associated with poorer psychological outcomes. Multivariate analyses controlling for age and gender showed that experience of stigma signiﬁcantly mediated associations between AIDS orphanhood and poor psychological outcomes.
Conclusions: Reduction of AIDS-related stigma could potentially reduce adverse psychological out-comes among AIDS-orphaned adolescents. © 2008 Society for Adolescent Medicine. All rights reserved.
CLUVER, L. D., GARDNER, F. & OPERARIO, D. 2008. Effects of stigma on the mental health of adolescents orphaned by AIDS. J Adolesc Health, 42, 410-7.
Posted: Feb 28, 2017
HIV/AIDS-RELATED SOCIAL ANXIETIES IN ADOLESCENTS IN THREE AFRICAN COUNTRIES
This study examines the social anxieties associated with HIV prevention in adolescents in three African countries (Nigeria, Kenya. and Zimbabwe). The subjects used in this study were black Africans in form 2 or grade 10 in public high schools (Nigeria, n = 387; Kenya, n = 274; Zimbabwe n = 313). Subjects responded to the 33 item AIDS Social Assertiveness Scale (ASAS). Data indicated similar factor structures for each of the three countries and included five factors. The combined sample factor intercorrelations were modestly but significantly correlated. The mean scores for each factor were compared, and ANOVA of the factors by country, by gender, and by interaction between country and gender were performed. The factor structures were very similar between countries, each including five factors that had similar themes: condom interactions, refusal of risk, confiding in significant others. contact with people with HIV/AIDS, and general assertiveness. These factor structures were also very similar to one found in previous studies of Australian adolescents on the ASAS. The Kenyan means for four of the five factors were significantly lower than those for Nigeria. and were also significantly lower than the Zimbabwean means for two of the five factors. suggesting that Kenyan students are less anxious about social situations related to HIV/ AIDS than others. Significant variance was found for several factors due to gender, country, and the interaction between gender and country. These results have important implications for designing education programs. The similarities of anxieties regarding HIV/AIDS social situations suggest that these clusters of social barriers to reduction of HIV infection risk might form the basis of educational interventions. and that dimensions of HIV social anxieties are similar across countries.
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VENIER, J. L., ROSS, M. W. & AKANDE, A. 1998. HIV/AIDS-related social anxieties in adolescents in three African countries. Soc Sci Med, 46, 313-20.
Posted: Feb 28, 2017
Psychological distress amongst AIDS-orphaned children in urban South Africa
Background: South Africa is predicted to have 2.3 million children orphaned by Acquired Immune Deﬁciency Syndrome (AIDS) by 2020 (Actuarial Society of South Africa, 2005). There is little knowledge about impacts of AIDS-related bereavement on children, to aid planning of services. This study aimed to investigate psychological consequences of AIDS orphanhood in urban township areas of Cape Town, South Africa, compared to control groups of children and adolescents orphaned by other causes, and non-orphans. Method: One thousand and twenty-ﬁve children and adolescents (aged 10–19) were interviewed using socio-demographic questionnaires and standardised scales for assessing depression, anxiety, post-traumatic stress, peer problems, delinquency and conduct problems. Results: Controlling for socio-demographic factors such as age, gender, formal/informal dwelling and age at orphanhood, children orphaned by AIDS were more likely to report symptoms of depression, peer relationship problems, post-traumatic stress, delinquency and conduct problems than both children orphaned by other causes and non-orphaned children. Anxiety showed no differences. AIDS-orphaned children were more likely to report suicidal ideation. Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems. Conclusions: Children orphaned by AIDS may be a particularly vulnerable group in terms of emotional and, to a lesser extent, behavioural problems. Intervention programs are necessary to ameliorate the psychological sequelae of losing a parent to AIDS.
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CLUVER, L., GARDNER, F. & OPERARIO, D. 2007. Psychological distress amongst AIDS-orphaned children in urban South Africa. J Child Psychol Psychiatry, 48, 755-63.
Posted: Jan 27, 2017
Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study
There is a lack of data on the prevalence of emotional abuse in youth. The aim of this study was thus to estimate the prevalence of emotional abuse in intimate partnerships among young women in rural South Africa and to measure the association between lifetime experience of emotional abuse (with and without the combined experience of physical and/or sexual abuse) and adverse health outcomes. Between 2002 and 2003, young women from 70 villages were recruited to participate in the cluster randomized controlled trial of an HIV behavioural intervention, Stepping Stones. Data was obtained through the administration of a questionnaire at baseline. Of the 1293 women who had ever been partnered, 189 (14.6%) had experienced only emotional abuse in their lifetimes. Three hundred and sixty-six women (28.3%) experienced emotional abuse with physical and/or sexual abuse in their lifetimes, and one hundred and forty-four women (11.1%) experienced physical and/or sexual abuse without emotional abuse. Hazardous drinking was associated with the experience of physical and/or sexual abuse, with (OR 6.0, 95% CI 1.0 – 36.6) and without emotional abuse (OR 5.8, 95% CI 1.1 – 29.4). Illicit drug use (OR 5.6, 95% CI 2.4 – 12.6), having depressive symptoms (OR 2.9, 95% CI 1.2 – 4.2), having psychological distress (OR 1.9, 95% CI 1.4 – 2.6), and suicidality (OR 79.0, 95% CI 17.3 – 359.6) was associated with the experience of emotional abuse with physical and/or sexual abuse. Suicidality was also strongly associated with having experienced emotional abuse alone (OR 79.5, 95% CI 16.7 – 377.4). This study showed that emotionally abused young women had a greater risk of suicidality than those experiencing no abuse and that the combined experience of emotional with physical and/or sexual abuse was strongly associated with poor mental health outcomes.
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Jina R, Jewkes R, Hoffman S, Dunkle KL, Nduna M, Shai NJ. Adverse mental health outcomes associated with emotional abuse in young rural South African women: A cross-sectional study. Journal of Interpersonal Violence. 2012 Mar/Apr; 27(5): 862-80.