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Although declining in all other age groups, AIDS-related deaths among adolescents are increasing. In the context of HIV, mental health problems are associated with negative health outcomes, including non-adherence to life-saving ART. For effective programming it is essential to identify factors associated with psychological outcomes in this population. Adopting a socioecological perspective, we aimed to identify correlates of internalising and externalising symptoms in a large, representative sample of South African adolescents living with HIV. HIV-positive adolescents (n = 1060), who received care in public health facilities in South Africa's Eastern Cape, completed measures of internalising and externalising symptoms. Hypothesised correlates included HIV and health-related factors (physical health, mode of infection, medication sideeffects, disclosure, stigma), health-service related factors (negative interactions with clinic staff, clinic support group), interpersonal factors (abuse, bullying victimisation, social support), parenting-related factors (orphanhood, positive parenting, parental monitoring, parent communication), as well as individual and demographic-related factors (self-efficacy, age, gender, urban/rural location, poverty). Correlates operating across a variety of contexts were identified. Bullying victimisation, self-efficacy, and positive parenting may be particularly salient intervention targets as they were associated with better outcomes on most or all mental health measures, can be addressed without directly targeting adolescents living with HIV (reducing the chances of accidental exposure and stigma), and are associated with better adolescent mental health in South Africa more generally. [ABSTRACT FROM AUTHOR]

This study examined prospective associations between poverty, gender, and school dropout in a large community sample of South African adolescents (baseline:n = 3515, follow-up:n = 3401, 57% female, age range at baseline: 10–17 years, mean age at baseline = 13.45). School dropout was defined as being enrolled in school at baseline assessment but no longer enrolled in school at follow-up assessment. Poverty was measured at baseline assessment using an index of access to the eight highest socially perceived necessities for South African children and adolescents. Demographic characteristics including child gender and age, province, and urban versus rural location were recorded at baseline assessment and controlled for in the analysis. As predicted, higher poverty scores (AOR = 2.01,p < .001) were associated with increased odds of school dropout 1 year later. Gender was not a significant predictor of school dropout (AOR = 1.56,p = .07) but did interact with poverty (AOR = 0.66,p = .04) in predicting school dropout. However, our initial hypothesis that the impact of poverty on school dropout would be stronger for girls than boys was not supported. Instead, results indicated that while girls were at elevated risk of school dropout at low and mean levels of poverty, at high levels of poverty this gender difference was no longer evident. Findings suggest that vulnerable boys should not be neglected in policies to improve retention in education in contexts of extreme poverty. [ABSTRACT FROM PUBLISHER]

A recent systematic review of studies in the developing world has critically examined linkages from familial HIV/AIDS and associated factors such as poverty and child mental health to negative child educational outcomes. In line with several recommendations in the review, the current study modelled relationships between familial HIV/AIDS, poverty, child internalising problems, gender and four educational outcomes: non-enrolment at school, non-attendance, deficits in grade progression and concentration problems. Path analyses reveal no direct associations between familial HIV/AIDS and any of the educational outcomes. Instead, HIV/AIDS-orphanhood or caregiver HIV/AIDS-sickness impacted indirectly on educational outcomes via the poverty and internalising problems that they occasioned. This has implications for evidence-based policy inferences. For instance, by addressing such intervening variables generally, rather than by seeking to target families affected by HIV/AIDS, interventions could avoid exacerbating stigmatisation, while having a more direct and stronger impact on children's educational outcomes. This analytic approach also suggests that future research should seek to identify causal paths, and may include other intervening variables related to poverty (such as child housework and caring responsibilities) or to child mental health (such as stigma and abuse), that are linked to both familial HIV/AIDS and educational outcomes. [ABSTRACT FROM PUBLISHER]

Background: Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa. Methods: Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n = 3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person's disability as hypothesised mediators. Results: For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed. Conclusions: These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for abuse victimisation unless they are subject to higher levels of household disability. Interventions aiming to reduce poverty and increase family support may help prevent child abuse in families experiencing illness in South Africa. [ABSTRACT FROM AUTHOR]

Background: Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa. Methods: Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n = 3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person's disability as hypothesised mediators. Results: For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed. Conclusions: These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for abuse victimisation unless they are subject to higher levels of household disability. Interventions aiming to reduce poverty and increase family support may help prevent child abuse in families experiencing illness in South Africa. [ABSTRACT FROM AUTHOR]

Little is known about risk and protective factors for emotional and physical child abuse in South Africa. Existing research has focused largely on sexual abuse and relied on recollections of childhood abuse from university and high-school students or data from criminal reports. The objective of this study was to establish risk and protective factors for severe physical and emotional abuse amongst a large cross-sectional community sample of South African youth. Confidential self-report questionnaires were completed by children aged 13-19 (n = 603, 47.9% female) with local interviewers in deprived areas of South Africa. Standardised measures of abuse, hypothesised risk factors and socio-demographic variables were used. Factors associated with severe physical and emotional child abuse were experience of family conflict ( p = 0.003), unequal food distribution ( p < 0.014), inconsistent discipline ( p = 0.012), number of caregiver changes ( p = 0.022), living with a step-parent ( p = 0.034), caregiver disability ( p = 0.004), food insecurity ( p = 0.006), bullying ( p < 0.001), acquired immunodeficiency syndrome (AIDS)-related stigma ( p < 0.001), sexual abuse ( p = 0.003), school non-attendance ( p = 0.006) and non-achievement ( p = 0.015). These identified risk and protective factors at community, school, caregiver and household levels have the potential to affect the risk of abuse for children in South Africa, and may be valuable fields for future intervention efforts. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Messages Risk and protective factors for physical and emotional child abuse have not been thoroughly studied in South Africa., Risk and protective factors for child abuse in South Africa include poverty, AIDS-related stigma, bullying, school non-attendance and achievement, sexual abuse, caregiver disability, inconsistent discipline, family conflict and living with a step-parent., Future research should focus on longitudinal data to establish causality and to examine the relationship between child abuse and caregiver AIDS sickness. [ABSTRACT FROM AUTHOR]

Families affected by HIV/AIDS in the developing world experience higher risks of psychosocial problems than nonaffected families. Positive parenting behavior may buffer against the negative impact of child AIDS-orphanhood and caregiver AIDS-sickness on child well-being. Although there is substantial literature regarding the predictors of parenting behavior in Western populations, there is insufficient evidence on HIV/AIDS as a risk factor for poor parenting in low- and middle-income countries. This paper examines the relationship between HIV/AIDS and positive parenting by comparing HIV/AIDS-affected and nonaffected caregiver-child dyads (n=2477) from a cross-sectional survey in KwaZulu-Natal, South Africa (27.7% AIDS-ill caregivers; 7.4% child AIDS-orphanhood). Multiple mediation analyses tested an ecological model with poverty, caregiver depression, perceived social support, and child behavior problems as potential mediators of the association of HIV/AIDS with positive parenting. Results indicate that familial HIV/AIDS's association to reduced positive parenting was consistent with mediation by poverty, caregiver depression, and child behavior problems. Parenting interventions that situate positive parenting within a wider ecological framework by improving child behavior problems and caregiver depression may buffer against risks for poor child mental and physical health outcomes in families affected by HIV/AIDS and poverty. [ABSTRACT FROM PUBLISHER]