The protective role of social support for the health of caregivers of children in HIV-endemic South Africa

Includes bibliographical references.In HIV-endemic areas of Southern Africa, the increasing number of orphans and vulnerable children in need of care have been taken in mainly by the extended family. Primary caregivers of children in poor HIV-endemic communities represent a high risk population for mental and physical health conditions, as a result of health risks associated with caregiving in difficult social and financial conditions. Evidence also suggests that caregivers living with HIV, and its related stressors, may be particularly at risk for poor health. In contexts of limited institutional support and formal health services, "informal" support from family, friends and the broader community may constitute a valuable resource for coping and health. Research with diverse adult populations - including HIV-affected individuals and caregivers of children - has shown more social support to be directly associated with better health outcomes (main effects) and/or to buffer against negative effects of stress or specific stressors on health (stress-buffering effects). However, the protective effects of social support on health have remained vastly under-explored in the Southern Africa region. Moreover, in Southern Africa and beyond, key gaps remain in our understanding of the mediating mechanisms and pathways explaining the support-health relationship

Prospective associations between bullying victimisation, internalised stigma, and mental health in South African adolescents living with HIV

Adolescents living with HIV may be at elevated risk of psychological problems, which are correlated with negative health outcomes. In cross-sectional research with HIV-affected adolescents, bullying victimisation and internalised HIV stigma have been associated with poorer psychological health. We extended these findings and tested longitudinal associations between bullying victimisation, internalised stigma, and mental health among adolescents living with HIV. We also tested whether relationships between bullying victimisation and psychological symptoms were mediated by internalised stigma

Factors that protect children from community violence: applying the INSPIRE Model to a sample of South African Children

Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous multisectoral strategies show higher potential to counter interpersonal violence than single interventions, the World Health Organization with partners created INSPIRE. INSPIRE takes an integrated approach coordinated across formal and informal settings of civil and private society. Responding to research paucity on methods that counter community violence in LMIC settings, this study employed a cross-sectional correlational design consisting of a sample of 2,477 children aged 10 to 17 years from the Young Carers 2009–2010 study conducted in a low-income, HIV-endemic province of South Africa highly affected by community violence. Multiple logistic regressions assessed individual and dose associations between four INSPIRE-based violence prevention strategies—positive parenting, basic necessities, formal social support, and school structural support—and direct and indirect community violence outcomes. Three strategies had significant associations with community violence outcomes: necessities (direct p < .001; adjusted odds ratio [AOR] = .57; indirect p < .01; AOR = .62), formal support (direct p < .05; AOR = .83; indirect p < .05; AOR = .73), and school support (direct p < .001; AOR = .53; indirect p < .001; AOR = .49). Combined interventions in direct and indirect community violence analyses demonstrated that children reporting a higher number of strategies were less likely to have experienced community violence. This outcome extends the results of longitudinal studies in South Africa highlighting social protection with care as a means to overcome structural deprivation strains, thereby reducing the likelihood of children’s exposure to community violence. Moreover, these findings uphold the INSPIRE model as an effective cross-sectoral approach to prevent and reduce the community violence that children experience

Pathways and processes linking social support to health: Development of an exploratory model with South African caregivers

Despite ample evidence of the protective role of social support for mental and physical health, key gaps remain in our understanding of the pathways and mediating processes explaining these relationships in specific vulnerable populations. The author applies a theoretical framework developed by House et al. to qualitative data, collected with 24 caregivers of children living in HIV-endemic South African communities, to explore potential effects and processes linking social support to health. The data used for this analysis were part of a sequential mixed-methods research study with caregivers of children; previous survey findings (n = 2,477) showed significant associations between more social support and better mental health and self-reported physical health. Results point to multiple pathways and biopsychosocial mediating processes possibly explaining the support–health relationship. The author develops an exploratory model to illustrate these findings, based on the House et al. framework, and discusses implications for research, interventions, and theory

Is social support related to better mental health, treatment continuation and success rates among individuals undergoing in-vitro fertilization? Systematic review and metaanalysis protocol

Infertility and its treatment via in-vitro fertilization (IVF) represent a global health area of increasing importance. However, the physical and psychological burden of IVF can negatively impact psychological wellbeing, as well as treatment retention and success. Social support has been found to have positive health effects among populations facing healthrelated stressors worldwide, and its potential protective role for IVF patients merits further attention. We present a protocol for a systematic review of peer-reviewed published studies quantitatively investigating associations between social support and i) mental health; ii) the decision to (dis)continue with IVF treatment cycles and; iii) IVF success (pregnancy and birth rates); among individuals who are undertaking or have undertaken IVF cycles. Studies will be included if they work with human subjects, provide correlation coefficients between measures of social support and at least one of the outcomes of interest, and are in the English language. Social support may derive from both naturally occurring networks and more formalized sources or interventions. The protocol for this systematic review was developed according to the PRISMA-P guidelines. Ten health-, psychology- and sociologyrelated databases will be searched using composite search terms that include keywords for 'IVF' and 'social support'. To assess methodological quality, the authors will use a modified version of the Newcastle-Ottawa Scale. Should three or more moderate or good quality studies be identified for any one outcome of interest, correlation meta-analyses, using the Hedges-Olkin method, will be conducted to pool effect sizes and heterogeneity will be assessed. Should the number, quality and characteristics of eligible studies not allow for reliable quantitative synthesis, the authors will limit the analysis to qualitative synthesis, with a focus on implications of findings for future research and programming

Conducting health survey research in a deep rural South African community: challenges and adaptive strategies

BACKGROUND:In many parts of the developing world, rural health requires focused policy attention, informed by reliable, representative health data. Yet there is surprisingly little published material to guide health researchers who face the unique set of hurdles associated with conducting field research in remote rural areas. METHODS: In this paper we provide a detailed description of the key challenges encountered during health survey field research carried out in 2010 in a deep rural site in KwaZulu-Natal, South Africa. The aim of the field research was to collect data on the health of children aged 10 to 17 years old, and their primary adult caregivers, as part of a larger national health survey; the research was a collaboration between several South African and foreign universities, South African national government departments, and various NGO partners. In presenting each of the four fieldwork challenges encountered on this site, we describe the initial planning decisions made, the difficulties faced when implementing these in the field, and the adaptive strategies we used to respond to these challenges. We reflect on learnings of potential relevance for the research community. RESULTS: Our four key fieldwork challenges were scarce research capacity, staff relocation tensions, logistical constraints, and difficulties related to community buy-in. Addressing each of these obstacles required timely assessment of the situation and adaptation of field plans, in collaboration with our local NGO partner. Adaptive strategies included a greater use of local knowledge; the adoption of tribal authority boundaries as the smallest geopolitical units for sampling; a creative developmental approach to capacity building; and planned, on-going engagement with multiple community representatives. CONCLUSIONS: We argue that in order to maintain high scientific standards of research and manage to 'get the job done' on the ground, it is necessary to respond to fieldwork challenges that arise as a cohesive team, with timely, locally-relevant, and often creative, solutions. Budgeting sufficient time and project resources for capacity building and community buy-in processes is also essential when working in remote communities unaccustomed to research. Documenting and sharing field experiences can provide valuable information for other researchers planning to conduct fieldwork in similar contexts

How Do Gender Norms Affect Our Risk of HIV?

Youth carry a diverse set of beliefs on HIV risk and responsibility. Prevention and education about sexual health must address gender stereotypes and inequities that are related to HIV.York’s Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

Impact of HIV / AIDS on poverty, inequality and economic growth

IDRC GGP working paper seriesThis working paper includes a literature review prepared by Marisa Casale and a study of research gaps and priorities by Marisa Casale and Alan Whiteside, prepared to inform an IDRC consultation on HIV/AIDS, Economic Growth and Poverty held in October 2005 in Ottawa. Although there is now more available evidence than ever on the social and economic impact of the AIDS pandemic, many unexplored or under-explored areas still remain. This is highlighted in the 2004 UNAIDS Report on the Global AIDS Pandemic, which points out that more than 40% of countries with a generalized epidemic have yet to evaluate its impact. This paper, first reviews the literature on the socio-economic consequences of the HIV/AIDS pandemic, looking specifically at the interaction of HIV/AIDS with poverty and inequality at a household or micro level, and with economic growth at a macro level, highlighting findings from the most important studies, as well as recent original research. Its second part identifies important gaps in existing research and suggests how future research agendas may be developed. It argues that future work should be focused on areas where research is most lacking and most urgently needed to inform policy, with an emphasis on building on existing work and using multidisciplinary and innovative tools.In particular, the need for broader and deeper micro and sectoral level work, and the interlinkages between micro and macro impacts as well as the specific impacts on government expenditures is highlighted

Decade of research into the acceptability of interventions aimed at improving adolescent and youth health and social outcomes in Africa: a systematic review and evidence map

Objective Interventions aimed at improving adolescent health and social outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability. Acceptability research with adolescents in low-and- middle- income countries (LMICs) is still limited and no known reviews systhesise the evidence from Africa. This paper maps and qualitatively synthesises the scope, characteristics and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability. Design We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10–24) in Africa, published between January 2010 and June 2020

Intimate partner violence and HIV sexual risk behaviour among women who inject drugs in Indonesia: a respondent‑driven sampling study Claudia Stoicescu,

Women who inject drugs are disproportionately affected by HIV and intimate partner violence (IPV); however, the link between IPV and HIV remains under-researched among substance-using women in low- and middle-income countries. This study examined associations and additive effects of different forms of IPV victimization (psychological, physical and/or injurious, and sexual) on HIV sexual risk behavior among women who inject drugs in Indonesia. Respondent-driven sampling (RDS) was used to recruit 731 women from Greater Jakarta and Bandung, West Java. RDS-II weighted prevalence of any past-year IPV was 68.9% (95% CI 65.0, 72.6) in Jakarta and 55.9% (95% CI 48.0, 63.5) in Bandung. In separate logistic regressions controlling for socio-demographic covariates, all three forms of IPV showed statistically significant associations with sexual risk behavior. After adjusting for all IPV types, psychological (OR 1.87; 95% CI 1.17, 2.99; p = 0.009) and sexual (OR 1.98; 95% CI 1.22, 3.21; p = 0.006) IPV independently predicted women’s sexual risk behavior. Marginal effects models suggested that co-occurrence of multiple forms of IPV had greater adverse consequences: sexual risk behavior was reported by 64.1% of women who did not experience any IPV, but increased to 89.9% among women exposed to all three types. Comprehensive harm reduction services that integrate IPV monitoring and prevention are urgently needed to reduce both HIV and IPV