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.

Main findings
  • 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.

Project details



Dr Lucie CluverProfessor Frances Gardner, Dr Stephan Collishaw, Professor Larry Aber, Dr Mark Boyes

Project Website:

Grant amount and duration:


December 2008 - November 2011



Meinck, F., Cluver, L., Boyes, M. E., & Ndlhovo, L. (in press). Risk and protective factors for physical and emotional abuse victimisation amongst vulnerable children in South Africa. Child Abuse Review

Boyes, M. & Cluver, L. (in press). Performance of the Revised Children’s Manifest Anxiety Scale in sample of children and adolescents from poor urban communities in Cape Town. European Journal of Psychological Assessment. DOI: 10.1027/1015-5759/a000134

Boyes, M., Mason, S., & Cluver, L. (2013). Validation of a brief stigma-by-association scale for use with HIV/AIDS-affected youth in South AfricaAIDS Care, 25, 215-222

Boyes, M., Cluver, L., & Gardner, F. (2012). Psychometric properties of the Child PTSD Checklist in a community sample of South African children and adolescents. PLOS ONE, 7, e46905. DOI: 10.1371/journal.pone.0046905

Cluver, L., Orkin, M., Boyes, M., Gardner, F., & Nikelo, J. (2012). AIDS-orphanhood and caregiver AIDS sickness status: Effects on psychological symptoms in South African youth. Journal of Pediatric Psychology, 37, 857-867

Cluver, L., Orkin, M., Gardner, F., & Boyes, M. E. (2012).Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychology and Psychiatry, 53, 363-370

Cluver, L (2011)‘Children of the AIDS pandemic’. Nature, 474 27-29

Cluver, L., Orkin, M., Boyes, M., Gardner, F., & Meinck, F. (2011) Transactional sex amongst AIDS-orphaned & AIDS-affected adolescents predicted by abuse & extreme poverty.Journal of Acquired Immune Deficiency Syndromes, 58, 336-343.

Cluver, L., Bowes, L., & Gardner, F. (2010) Risk and protective factors for bullying victimisation amongst AIDS-affected and vulnerable children in South Africa. Child Abuse & Neglect, 34, 793-803.

Operario, D, Underhill, K, Chuong, C, Cluver, L. (2011) HIV infection and sexual risk behaviour among youth who have experienced orphanhood: systematic review and meta-analysis. Journal of the International AIDS Society, 14, 25.

Cluver, L& Orkin, M (2009). Stigma, bullying, poverty and AIDS-orphanhood: Interactions mediating psychological problems for children in South Africa. Social Science and Medicine. 69 (8) 1186-1193

Cluver, L, Finch, D & Seedat, S (2009) Predictors of post-traumatic stress symptomology amongst AIDS-orphaned children. Journal of Traumatic Stress, 22 (2) 106-113