Relationships Between Familial HIV/AIDS and Symptoms of Anxiety and Depression: The Mediating Effect of Bullying Victimization in a Prospective Sample of South African Children and Adolescents

South African children and adolescents living in HIV/AIDS-affected families are at elevated risk of both symptoms of anxiety and depressive symptoms. Poverty and HIV/AIDS-related stigma are additional risk factors for these negative mental health outcomes. Community level factors, such as poverty and stigma, are difficult to change in the short term and identifying additional potentially malleable mechanisms linking familial HIV/AIDS with mental health is important from an intervention perspective. HIV/AIDS-affected children are also at increased risk of bullying victimization. This longitudinal study aimed to determine whether prospective relationships between familial HIV/AIDS and both anxiety symptoms and depressive symptoms operate indirectly via bullying victimization. Adolescents (M = 13.45 years, 56.67 % female, n = 3,515) from high HIV-prevalent (>30 %) communities in South Africa were interviewed and followed-up one year later (n = 3,401, 96.70 % retention). Census enumeration areas were randomly selected from urban and rural sites in two provinces, and door-to-door sampling included all households with a resident child/adolescent. Familial HIV/AIDS at baseline assessment was not directly associated with mental health outcomes 1 year later. However, significant indirect effects operating via bullying victimization were obtained for both anxiety and depression scores. Importantly, these effects were independent of poverty, HIV/AIDS-related stigma, and baseline mental health, which highlight bullying victimization as a potential target for future intervention efforts. The implementation and rigorous evaluation of bullying prevention programs in South African communities may improve mental health outcomes for HIV/AIDS-affected children and adolescents and this should be a focus of future research and intervention

Covid-19: accelerating recovery

Covid-19 infections and related illness and death are rightly at the forefront of our minds. It is critical that we consider how to reduce infections, treat those who are ill and protect health systems. We must, however, also consider how the pandemic is affecting the families of those infected, and how interventions to prevent the spread of the virus come with large negative economic and social consequences. We must begin to identify the ways in which we can soften these blows and recover from the negative consequences over the medium and long-term. We highlight here the importance of moving away the tendency to search for interventions to improve one outcome at a time. It will be essential, particularly in highly resource constrained settings, to look for accelerators, interventions which improve multiple outcomes simultaneously. We discuss how this will be especially important for groups who are at particular risk at this time, including of long-term negative outcomes. These include very young children, adolescents and those who have limited capacity to benefit from narrow interventions given critical needs in multiple domains. Searching for accelerators requires that we take a step back and look to identify common causes of negative outcomes and consider how we might address them. For many countries, recovery from this epidemic will be highly constrained by the limited availability of financial resources. Wise investments will be especially important at this time

Psychometric Properties of the Child PTSD Checklist in a Community Sample of South African Children and Adolescents

Objective: The current study assessed the basic psychometric properties of the Child PTSD Checklist and examined the structure of symptoms of posttraumatic stress disorder (PTSD) in a large sample of South African youth. Methodology: The checklist was completed by 1025 (540 male; 485 female) South African youth (aged between 10 and 19 years). The factor structure of the scale was assessed with a combination of confirmatory and exploratory techniques. Internal consistencies for the full scale and all subscales were evaluated with Cronbach’s alpha and McDonald’s omega. Validity was assessed by comparing PTSD scores obtained by children who had and had not experienced a traumatic event, and by examining associations between total PTSD scores and known correlates of PTSD. Results: Scores on the Child PTSD Checklist clearly discriminated between youth who had experienced a traumatic event and those who had not. Internal consistencies for the full scale (and all subscales) were acceptable to good and hypothesized correlations between PTSD, depression, anxiety, somatic symptoms, and age were observed. Two of the reported fit statistics for the tripartite DSM-IV-TR model of PTSD did not meet traditional criteria and further exploratory analyses revealed a four-factor structure (broadly consistent with Simms and colleagues’ Dysphoria Model of PTSD symptoms) which provided a better fit to the observed data. Conclusion: Given the continued use of the Child PTSD Checklist in South Africa, findings offer an important first step in establishing the reliability and validity of the checklist for use with South African youth. However, further evaluation of the checklist in South African samples is clearly required before conclusions regarding its use as diagnostic tool in this context can be made

Validation of a brief stigma-by-association scale for use with HIV/AIDS-affected youth in South Africa

This study validated a brief stigma-by-association scale for use with South African youth (adapted from the HIV Stigma-by-Association Scale for Adolescents). Participants were 723 youth (364 male, 359 female) from poor urban communities around Cape Town. Youths completed the brief stigma-by-association scale and measures of bullying victimisation and peer-problems, as well as inventories measuring symptoms of depression and anxiety. Exploratory analyses revealed that the scale consists of two subscales: (1) experience of stigma-by-association and (2) consequences of stigma-by-association. This two factor structure was obtained in the full sample and both the HIV/AIDS-affected and unaffected subgroups. The full stigma-by-association scale showed excellent reliability (α = 0.89–0.90) and reliabilities for both subscales were also good (α = 0.78–0.87). As predicted, children living in HIV/AIDS-affected households obtained significantly higher stigma-by-association scores than children in non-affected households [F(1, 693) = 46.53, p<0.001, partial η 2=0.06] and hypothesized correlations between stigma-by-association, bullying, peer problems, depression and anxiety symptoms were observed. It is concluded that the brief stigma-by-association scale is a reliable and valid instrument for use with South African youth; however, further confirmatory research regarding the structure of the scale is required

‘At school I got myself a certificate’: HIV/AIDS Orphanhood and Secondary Education: a Qualitative Study of Risk and Protective Factors

Secondary school is a period during which risk of school dropout is highest. To date, little research has examined reasons for school dropout amongst HIV/AIDS-orphaned children, who are affected economically, psychosocially and educationally. HIV/AIDS orphanhood can perpetuate poverty and increase school dropout in a range of ways, including inability to pay school fees, family disruption and stigma. Related research mostly focuses on school performance and completion and, more recently, on context-specific approaches to measure educational outcomes. The primary aim of this qualitative study was to examine how HIV/AIDS orphanhood influences participation in secondary education in South Africa and to investigate why some HIV/AIDS-orphaned adolescents find it easier to stay in school than others. Specifically, the study aimed to explore, interpret and elicit the perceptions of South African HIV/AIDS-orphaned adolescents (N = 243, aged 13–22, 53 % female, 47 % male) towards potential risk and protective factors influencing their secondary school attendance. Findings suggest complex and interconnecting multiple risk factors such as poverty pre- and post-parental death, crisis-fosterage often accompanied by further traumatic events, changing schools sporadically, recurring household migration and forced employment all of which can create obstacles to secondary education. Protective factors that emerged included extra-curricular activities and teacher/community support. These findings highlight the need for evidence-informed school and community policies, which consider the effects of household poverty, migration and living arrangements, if secondary school participation for HIV/AIDS-orphaned adolescents is to be promoted and sustained

Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap

Adolescent (10–19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic search of electronic databases using pre-defned search terms, supplemented by hand-searching, was undertaken in September 2020. One author and an independent researcher completed a title and abstract screening of results from the search. A full-text search of all seemingly relevant manuscripts (both quantitative and qualitative) was undertaken and data extracted using pre-determined criteria. A narrative synthesis of included studies is provided. Quality and risk of bias within included studies was assessed using the Newcastle-Ottawa scale. A systematic keyword search of databases and follow-up hand searching identifed 2287 unique records. Of these, thirty-eight full-text quantitative records and seven fulltext qualitative records were assessed for eligibility. No qualitative records met the eligibility criteria for inclusion within the review. One quantitative record was identifed for inclusion. This study reported on depressive symptomology amongst 14 pregnant adolescents living with HIV in Kenya, identifying a prevalence of 92.9%. This included study did not meet the high methodological quality of this review. No studies were identifed reporting on risk and protective factors for common mental disorder, and no studies were found identifying any specifc interventions for common mental disorder for this group, either for prevention or for treatment. The limited data identifed within this review provides no good quality evidence relating to the prevalence of common mental disorder among adolescents living with HIV who have experienced pregnancy in sub-Saharan Africa. No data was available relating to risk and protective factors or interventions for psychological distress amongst this group. This systematic review identifes a need for rigorous evidence regarding the mental health of pregnant and parenting adolescents living with HIV, and calls for granular interrogation of existing data to further our understanding of the needs of this group. The absence of research on this topic (both quantitative and qualitative) is a critical evidence gap, limiting evidence-based policy and programming responses, as well as regional development opportunities

Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa

While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children