Resilience in young people orphaned by AIDS
By 2011, 17 million children were orphaned by HIV/AIDS, with 1.4 million in South Africa alone. This project is the developing world’s first longitudinal study of the impacts of familial HIV/AIDS and AIDS-orphanhood on children. It followed 1025 children over four years in high-deprivation urban South Africa (71% retention rate). It compared AIDS-orphaned, other-orphaned and non-orphaned children, and those whose primary caregivers have AIDS, other chronic illnesses or were healthy.
The project aimed to identify causal factors associated with children’s mental health, sexual health, education and delinquency. The project was conducted in collaboration with the South African government, NGOs and a ‘Teen Advisory Group’ of AIDS-affected children, with the explicit aim of providing rigorous evidence for policy and programming.
Severe and long-lasting mental health impacts of both AIDS-orphanhood and caregiver AIDS-sickness, including depression, anxiety and post-traumatic stress.
Negative educational impacts of familial HIV are mediated by poverty and internalising mental health problems.
Higher levels of child maltreatment (physical, sexual, emotional abuse and domestic violence) amongst AIDS-affected families. These heightened levels of abuse, combined with poverty and familial HIV, predicted marked increases in youth exposure to transactional sexual exploitation. For girls this was particularly severe: The combination of familial AIDS, food insecurity and abuse raise transactional sex risk (for girls over 15) from 1% to 57% (amongst girls).
Mental health resilience carries implications for other areas of adaptive functioning in young peoples’ lives: resilient youth showed better engagement with schooling, and lower levels of pregnancy, sexual risk, drug use and gang involvement.
Key longitudinal predictors of resilience included child physical health, caregiving quality, food security, and absence of community violence, bullying or stigma. The study shows that mental health problems are not inevitable for these young people who have experienced high levels of stress and adversity. Many of the protective factors identified are potentially modifiable and offer targets for interventions aimed at improving the mental wellbeing and life chances of AIDS-orphaned and AIDS-affected children.
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