ORCID Profile
0000-0002-0418-835X
Current Organisations
University of Oxford
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University of Cape Town
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Publisher: South African Medical Association NPC
Date: 11-10-2013
DOI: 10.7196/SAMJ.7045
Abstract: Identifying children at the highest risk of negative health effects is a prerequisite to effective public health policies in Southern Africa. A central ongoing debate is whether poverty, orphanhood or parental AIDS most reliably indicates child health risks. Attempts to address this key question have been constrained by a lack of data allowing distinction of AIDS-specific parental death or morbidity from other causes of orphanhood and chronic illness. To examine whether household poverty, orphanhood and parental illness (by AIDS or other causes) independently or interactively predict child health, developmental and HIV-infection risks. We interviewed 6 002 children aged 10 - 17 years in 2009 - 2011, using stratified random s ling in six urban and rural sites across three South African provinces. Outcomes were child mental health risks, educational risks and HIV-infection risks. Regression models that controlled for socio-demographic co-factors tested potential impacts and interactions of poverty, AIDS-specific and other orphanhood and parental illness status. Household poverty independently predicted child mental health and educational risks, AIDS orphanhood independently predicted mental health risks and parental AIDS illness independently predicted mental health, educational and HIV-infection risks. Interaction effects of poverty with AIDS orphanhood and parental AIDS illness were found across all outcomes. No effects, or interactions with poverty, were shown by AIDS-unrelated orphanhood or parental illness. The identification of children at highest risk requires recognition and measurement of both poverty and parental AIDS. This study shows negative impacts of poverty and AIDS-specific vulnerabilities distinct from orphanhood and adult illness more generally. Additionally, effects of interaction between family AIDS and poverty suggest that, where these co-exist, children are at highest risk of all.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2011
Publisher: Wiley
Date: 30-08-2011
DOI: 10.1111/J.1469-7610.2011.02459.X
Abstract: By 2008, 12 million children in sub-Saharan Africa were orphaned by AIDS. Cross-sectional studies show psychological problems for AIDS-orphaned children, but until now no longitudinal study has explored enduring psychological effects of AIDS-orphanhood in the developing world. A 4-year longitudinal follow-up of AIDS-orphaned children with control groups of other-orphans and non-orphans. 1021 children (M = 13.4 years, 50% female, 98% isiXhosa-speaking) were interviewed in 2005 and followed up in 2009 with 71% retention (49% female, M = 16.9 years), in poor urban South African settlements. Children were interviewed using sociodemographic questionnaires and well-validated standardised scales for assessing depression, anxiety, and post-traumatic stress. Data were analysed using mixed-design ANOVA and backward-stepping regression. AIDS-orphaned children showed higher depression, anxiety, and post-traumatic stress disorder (PTSD) scores in both 2005 and 2009 when compared with other-orphans and non-orphans. Backward-stepping regression, controlling for baseline mental health, and sociodemographic cofactors such as age, gender, and type of bereavement, revealed that being AIDS-orphaned in 2005 was associated with depression, anxiety, and PTSD scores in 2009. This was not the case for other-orphaned or non-orphaned children. Age interacted with orphan status, such that there was a steep rise in psychological distress in the AIDS-orphaned group, but no rise with age amongst other-orphans and non-orphans. Negative mental health outcomes amongst AIDS-orphaned children are maintained and worsen over a 4-year period. It is important that psychosocial support programmes are sustained, and focus on youth as well as young children.
Publisher: SAGE Publications
Date: 29-07-2017
Abstract: Sexual abuse has severe negative impacts on children’s lives, but little is known about risk factors for sexual abuse victimization in sub-Saharan Africa. This study examined prospective predictors of contact sexual abuse in a random community-based s le of children aged 10 to 17 years ( N = 3,515, 56.6% female) in South Africa. Self-report questionnaires using validated scales were completed at baseline and at 1-year follow-up (96.8% retention rate). Cross-sectional and longitudinal associations between hypothesized factors and sexual abuse were examined. For girls, previous sexual abuse (odds ratio [OR] = 3.44, 95% confidence interval [CI] = [2.03, 5.60]), baseline school dropout (OR = 2.76, 95% CI = [1.00, 6.19]), and physical assault in the community (OR = 2.17, 95% CI = [1.29, 3.48]) predicted sexual abuse at follow-up. Peer social support (OR = 0.84, 95% CI = [0.74, 0.98]) acted as a protective factor. Previous contact sexual abuse was the strongest predictor of subsequent sexual abuse victimization. In addition, peer support moderated the relationship between baseline assault and subsequent sexual abuse. For boys, no longitudinal predictors for sexual abuse victimization were identified. These results indicate that the most vulnerable girls—those not in school and with a history of victimization—are at higher risk for sexual abuse victimization. High levels of peer support reduced the risk of sexual abuse victimization and acted as a moderator for those who had experienced physical assault within the community. Interventions to reduce school drop-out rates and revictimization may help prevent contact sexual abuse of girls in South Africa.
Publisher: Informa UK Limited
Date: 06-12-2015
Publisher: Informa UK Limited
Date: 12-08-2022
DOI: 10.1080/13548506.2022.2108083
Abstract: Adolescence is a crucial phase in life, when foundations are established for future health . Therefore, supporting adolescents is necessary to meet the sustainable development goals by 2030. Evidence on the intergenerational transmission of poverty, education and violence suggests that to improve adolescents' well-being, the broader context in which they grow up needs to be understood when developing programmes and approaches to improve their lives. Our study explored intergenerational factors and early childhood influences on adolescent education, employment and parenthood, using the fourth wave of the MAISHA longitudinal study. This study took place in 2016-2021 among 986 adult women in Mwanza, Tanzania, including questions answered by the women on their adolescent's (aged 13-18) education, employment and parenthood, as well as their participation in early childhood programmes, education attainment and other socio-economic variables. Among the 577 mothers in our analysis who had adolescents living in their households, 32% reported that their adolescents did not attend secondary school, 11% were employed, 4% were pregnant or parents. For adolescents in secondary school, 15% ever failed a grade and 10% missed school more than 2 weeks in the last term. Grandparents' not having secondary education was significantly associated with adolescents not attending secondary education and being employed. Living in a female-headed household and mother's experience of intimate partner violence was associated with adolescent early employment. Early childhood influences showed no impact on any outcome in the multivariate analysis. Overall, we report a strong intergenerational impact of education on adolescent outcomes, suggesting the adoption of a strong policy focus on the provision of secondary education for both men and women due to its long-lasting effect. Interventions aimed at improving adolescent outcomes need to be long-term and invest in whole family poverty reduction measures.
Publisher: SAGE Publications
Date: 05-02-2017
Abstract: Violence against children increases in adolescence, but there is a research and practice gap in research-supported child abuse prevention for the adolescent years. A pilot program for low-resource settings was developed in collaboration with nongovernmental organizations, government, and academics in South Africa, using research-supported principles. This study used a pre-post design to test initial effects of a 10-session parenting program with 60 participants (30 caregiver–adolescent dyads) in high-poverty rural South Africa. Areas requiring further testing and adaptation were also identified. Pre-post findings show medium to large program effects in reducing child abuse and adolescent problem behavior, as well as large effects in improvements of positive parenting, and perceived parent and adolescent social support. There is potential to reduce child abuse, improve parenting, and reduce adolescent problem behavior in rural South Africa through parenting programs. Further development, testing and longer term follow-up are required to ascertain potential for scale-up.
Publisher: Wiley
Date: 2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2007
DOI: 10.1097/01.QAI.0000243126.75153.3C
Abstract: This study estimated the prevalence and sociodemographic characteristics of young people in South Africa who have experienced parental death and examined associations between parental death and young people's HIV status and sexual behaviors. Data were from a cross-sectional nationally representative household survey of 11,904 15- to 24-year-old South Africans. Surveys included items on sexual behavior and family composition, and oral fluid s les were collected to test for HIV status. The prevalence of parental death was 27.3% overall: 22.4% reported a father deceased, 7.9% reported a mother deceased, and 3.0% reported both parents deceased. Parental death was disproportionately associated with black ethnicity, impoverished household living conditions, lack of an adult guardian in the home, and not completing compulsory education levels. Controlling for sociodemographic factors, parental death among female participants was significantly associated with HIV-positive status (odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.08 to 1.44), ever having had oral sex (OR = 1.23, 95% CI: 1.02 to 1.49), ever having had vaginal sex (OR = 1.38, 95% CI: 1.19 to 1.60), and having more than 1 sex partner during the past year (OR = 1.33, 95% CI: 1.07 to 1.64). Among male participants, parental death was significantly associated with ever having had vaginal sex (OR = 1.19, 95% CI: 1.04 to 1.36) and having unprotected sex at the last sexual episode (OR = 1.23, 95% CI: 1.07 to 1.42). More than one quarter of young South Africans have experienced parental death. Death of a parent is associated with young female South Africans' HIV status and sexual behaviors among young female and male South Africans. HIV prevention interventions are necessary to address the specific needs of young South Africans who have experienced parental death.
Publisher: Informa UK Limited
Date: 09-07-2013
DOI: 10.1080/09540121.2012.699668
Abstract: 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 s le 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.
Publisher: Public Library of Science (PLoS)
Date: 03-10-2012
Publisher: Wiley
Date: 24-06-2015
DOI: 10.1111/SODE.12127
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JADOHEALTH.2022.04.010
Abstract: Ethiopia has registered remarkable achievements in reaching global development goals, including reducing child marriage. Policymakers are keen to understand which investments have contributed to this. We evaluated the association between Ethiopia's Health Extension Program (HEP) and 12 adolescent health and wellbeing outcomes. We used Young Lives Ethiopia cohort data between 2002 and 2013. We evaluated associations between household support from HEP at age 15 and 12 adolescent outcomes spread across health, gender-based violence, education, and employment at age 19 using the inverse probability of treatment weighting propensity score approach, stratifying by sex. Adjusted probability differences (APDs) and adjusted mean differences (AMDs) were used to contrast exposure to HEP versus no exposure. Of 775 adolescents with complete follow-up, 46% were female. Sixty-six percent of adolescents reported support from HEP, with higher rates of support in poorer, less educated, and rural households, particularly in Tigray Province. In boys, HEP was positively associated with education enrolment (APD: +20 percentage points [ppts], 95% confidence interval [CI]: +9 ppts, +31 ppts) and literacy (AMD: +6 ppts, 95% CI: +0.2, +11), and negatively associated with >4 hours in income-generating activities per day (APD: -19 ppts, 95% CI: -30 ppts, -9 ppts). In girls, HEP was positively associated with no child marriage (APD: +16 ppts, 95% CI: +4 ppts, +27 ppts), no adolescent pregnancy (APD: +17 ppts, 95% CI: +6 ppts, +28 ppts), education enrolment (APD: +27 ppts, 95% CI: +15 ppts, +39 ppts), literacy (AMD: +5 ppts, 95% CI: +0.2, +11), and numeracy (AMD: +8 ppts, 95% CI: +3 +13). Policies promoting HEP are likely to have supported improvements in multiple areas of adolescents' lives in Ethiopia.
Publisher: BMJ
Date: 09-03-2016
Publisher: Wiley
Date: 09-10-2013
DOI: 10.1002/CAR.2283
Publisher: Cold Spring Harbor Laboratory
Date: 26-10-2021
DOI: 10.1101/2021.10.22.21264347
Abstract: We examined associations between accelerators (interventions impacting two or more SDG targets) and well-being indicators among adolescents in Zambia. We randomly s led 1,800 households receiving social cash transfers (SCT) in four districts, surveyed adults 16 years and older. Using multivariable logistic regressions, stratified by household heads disability status, we examined associations between accelerators (SCT, life-long learning (LLL), mobile phone access (MPA)) and seven well-being indicators among adolescents 16 to 24 years old. We predicted adolescents’ probabilities of reporting indicators using marginal effects models. We included 1,725 adolescents, 881(51.1%) girls. MPA was associated with no poverty (adjusted Odds Ratio [aOR] 2.08, p .001), informal cash transfers (aOR 1.82 p=0.004), seeking mental support (aOR 1.61, p=0.020) SCT with no health access restrictions related to disability (aOR 2.56, p=0.004), lesser odds seeking mental support (aOR 0.53, p=0.029) LLL with informal cash transfers (aOR 3.49, p .001), lower school enrolment (aOR 0.70, p=0.004). Adolescents living with disabled household heads reported worse poverty, good health, less suicidal ideation. Accelerators - SCT, LLL, MPA - were associated with well-being indicators. Adolescents living with disabled household heads benefited less. This paper shows that adopting accelerators can help achieve SDGs-aligned well-being indicators for adolescents living in poverty. However, accelerators may not offset disability-related inequalities. Adolescents living with disabled household heads may require more attention to achieve the SDGs. 1.2. no poverty 1.3.1 social cash transfers, Informal cash transfers 3. good Health 3.4. no suicidal ideation 3.4. seeking mental support 4.1. school enrolment 10. no health access restrictions related to disability.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14089
Abstract: Background Adolescent pregnancy has been linked to adverse outcomes. Most studies proposing risk pathways for adolescent pregnancy in South Africa are qualitative, hypothesising links among age-disparate relationships, reduced condom use and higher pregnancy rates. No known South African studies have quantitatively explored pathways to adolescent pregnancy. Objectives: This study aimed to: (i) identify the factors associated with adolescent pregnancy and (ii) explore a pathway of risk by assessing whether condom use mediated the relationship between age-disparate sexual relationships and adolescent pregnancy. Methods: A cross-sectional survey of 447 sexually active girls aged 10–19 years was undertaken in six health districts of South Africa. Multivariate logistic regressions controlled for confounders. Mediation tests used bootstrapping. Results: Consistent condom use (β = –2.148, odds ratio (OR) = 8.566, P ≤ 0.001) and school enrolment (β = –1.600, OR = 0.202, P ≤ 0.001) were associated with lower pregnancy rates. Age-disparate sex (β = 1.093, OR = 2.982, P ≤ 0.001) and long-term school absences (β = 1.402, OR = 4.061, P ≤ 0.001) were associated with higher pregnancy rates. The indirect effect of age-disparate sex on adolescent pregnancy through condom use was significant, irrespective of age, age at sexual initiation, poverty and residential environment (B = 0.4466, s.d. = 0.1303, confidence interval: 0.2323–0.7428). Conclusion: This survey supports hypotheses that inability to negotiate condom use in age-disparate sexual relationships may drive adolescent pregnancy. Interventions addressing these relationships, facilitating condom use and increasing access to sexual health services among adolescents might avert unwanted pregnancies.
Publisher: Springer Science and Business Media LLC
Date: 08-09-2017
Publisher: Public Library of Science (PLoS)
Date: 17-10-2016
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.SOCSCIMED.2013.03.028
Abstract: Increasing evidence demonstrates negative psychological, health, and developmental outcomes for children associated with parental HIV/AIDS illness and death. However, little is known about how parental AIDS leads to negative child outcomes. This study used a structural equation modelling approach to develop an empirically-based theoretical model of interactive relationships between parental or primary caregiver AIDS-illness, AIDS-orphanhood and predicted intervening factors associated with children's psychological distress, educational access and sexual health. Cross-sectional data were collected in 2009-2011, from 6002 children aged 10-17 years in three provinces of South Africa using stratified random s ling. Comparison groups included children orphaned by AIDS, orphaned by other causes and non-orphans, and children whose parents or primary caregivers were unwell with AIDS, unwell with other causes or healthy. Participants reported on psychological symptoms, educational access, and sexual health risks, as well as hypothesized sociodemographic and intervening factors. In order to build an interactive theoretical model of multiple child outcomes, multivariate regression and structural equation models were developed for each in idual outcome, and then combined into an overall model. Neither AIDS-orphanhood nor parental AIDS-illness were directly associated with psychological distress, educational access, or sexual health. Instead, significant indirect effects of AIDS-orphanhood and parental AIDS-illness were obtained on all measured outcomes. Child psychological, educational and sexual health risks share a common set of intervening variables including parental disability, poverty, community violence, stigma, and child abuse that together comprise chain effects. In all models, parental AIDS-illness had stronger effects and more risk pathways than AIDS-orphanhood, especially via poverty and parental disability. AIDS-orphanhood and parental AIDS-illness impact child outcomes through multiple, interlinked pathways. The interactive model developed in this study suggests key areas of focus for interventions with AIDS-affected children.
Publisher: Springer Science and Business Media LLC
Date: 05-07-2015
DOI: 10.1007/S10964-014-0146-3
Abstract: 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 s ling 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.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2018
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.JADOHEALTH.2015.03.001
Abstract: This is the first known prospective study of child suicidal behavior in sub-Saharan Africa. Aims were to determine whether (1) cumulative exposure to adverse childhood experiences (ACEs) predicts later suicidality and (2) heightened risks are mediated by mental health disorder and drug/alcohol misuse. Longitudinal repeated interviews were conducted 1 year apart (97% retention) with 3,515 adolescents aged 10-18 years in South Africa (56% female 5 ACEs (cumulative odds ratio [OR], 2.46 confidence interval [CI], 1.00-6.05) for suicide planning, from 2.4% to 12.5% (cumulative OR, 4.40 CI, 2.08-9.29) and for suicide ideation, from 4.2% to 15.6% (cumulative OR, 2.99 CI, 1.68-5.53). Preventing and mitigating childhood adversities have the potential to reduce suicidality. Among adolescents already exposed to adversities, effective mental health services may buffer against future suicidality.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2014
Publisher: Springer Science and Business Media LLC
Date: 24-04-2013
Publisher: Springer Science and Business Media LLC
Date: 05-08-2014
Publisher: Springer Science and Business Media LLC
Date: 05-2015
Publisher: Informa UK Limited
Date: 12-08-2013
Publisher: Informa UK Limited
Date: 22-08-2014
DOI: 10.1080/09540121.2013.824533
Abstract: 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.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Springer Science and Business Media LLC
Date: 03-06-2014
DOI: 10.1007/S10802-014-9888-3
Abstract: Bullying victimisation has been prospectively linked with mental health problems among children and adolescents in longitudinal studies in the developed world. However, research from the developing world, where adolescents face multiple risks to social and emotional development, has been limited by cross-sectional designs. This is the first longitudinal study of the psychological impacts of bullying victimisation in South Africa. The primary aim was to examine prospective relationships between bullying victimisation and internalising and externalising symptoms in South African youth. Secondary aims were to examine gender and age-related differences in experiences of bullying victimisation. Children and adolescents (10-17 years, 57 % female, n = 3,515) from high HIV-prevalent (>30 %) communities in South Africa were interviewed and followed-up 1 year later (97 % retention). Census enumeration areas were randomly selected from urban and rural sites in two provinces and door-to-door s ling included all households with a resident child/adolescent. Exposure to multiple experiences of bullying victimisation at baseline predicted internalising symptoms and conduct problems 1 year later. Additionally, baseline mental health scores predicted later bullying victimisation, demonstrating bi-directionality of relationships between bullying victimisation and mental health outcomes in this s le. Expected gender differences in physical, verbal, and relational bullying victimisation were evident and predicted declines in bullying victimisation over time were observed. In the developed world, school-based anti-bullying programmes have been shown to be effective in reducing bullying and victimisation. Anti-bullying programmes should be implemented and rigorously evaluated in South Africa, as this may promote improved mental health among South African children and adolescents.
Publisher: SAGE Publications
Date: 02-09-2012
Abstract: “I go to the hospital with my mother when she is sick. I can’t go to school and leave her in so much pain. I won’t concentrate.” Millions of adolescents live with AIDS-affected parents or primary caregivers. Little is known about educational impacts of living in an AIDS-affected home, or of acting as a “young carer” in the context of AIDS. This study combined qualitative and quantitative methods to determine educational impacts of household AIDS-sickness and other-sickness. Six hundred and fifty-nine adolescents (aged 10-20) were interviewed in high-poverty areas of urban and rural South Africa. Qualitative findings identified three major themes of missing school, being hungry at school, and concentration problems due to worry about the sick person. In quantitative analyses, living in an AIDS-affected home predicted all these three outcomes ( p .001) compared to homes affected by other sickness and to healthy homes, and independent of sociodemographic cofactors. This study demonstrates that familial AIDS-sickness is associated with negative educational impacts for adolescents. It is important that policies are developed to support young people in these circumstances to continue with their education.
Publisher: Oxford University Press
Date: 10-02-2012
Publisher: Informa UK Limited
Date: 21-04-2015
DOI: 10.1080/17437199.2014.996243
Abstract: This systematic review aims to synthesise evidence on predictors of internalised HIV stigma amongst people living with HIV in sub-Saharan Africa. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Studies were identified through electronic databases, grey literature, reference harvesting and contacts with key researchers. Quality of findings was assessed through an adapted version of the Cambridge Quality Checklists. A total of 590 potentially relevant titles were identified. Seventeen peer-reviewed articles and one draft book chapter were included. Studies investigated socio-demographic, HIV-related, intra-personal and interpersonal correlates of internalised stigma. Eleven articles used cross-sectional data, six articles used prospective cohort data and one used both prospective cohort and cross-sectional data to assess correlates of internalised stigma. Poor HIV-related health weakly predicted increases in internalised HIV stigma in three longitudinal studies. Lower depression scores and improvements in overall mental health predicted reductions in internalised HIV stigma in two longitudinal studies, with moderate and weak effects, respectively. No other consistent predictors were found. Studies utilising analysis of change and accounting for confounding factors are necessary to guide policy and programming but are scarce. High-risk populations, other stigma markers that might layer upon internalised stigma, and structural drivers of internalised stigma need to be examined.
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.CHIABU.2018.05.022
Abstract: Child abuse prevention research has been h ered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric properties of this substantially modified tool in a South African s le. First, cross-cultural and sensitivity adaptation of the original ICAST tools resulted in two preliminary measures (ICAST-Trial adolescents: 27 items, ICAST-Trial caregivers: 19 items). Second, ICAST-Trial data from a cluster randomized trial of a parenting intervention for families with adolescents (N = 1104, 552 caregiver-adolescent dyads) was analyzed. Confirmatory factor analysis established the hypothesized 6-factor (adolescents) and 4-factor (caregivers) structure. Removal of two items for adolescents and five for caregivers resulted in adequate model fit. Concurrent criterion validity analysis confirmed hypothesized relationships between child abuse and adolescent and caregiver mental health, adolescent behavior, discipline techniques and caregiver childhood abuse history. The resulting ICAST-Trial measures have 25 (adolescent) and 14 (caregiver) items respectively and measure physical, emotional and contact sexual abuse, neglect (both versions), and witnessing intimate partner violence and sexual harassment (adolescent version). The study established that both tools are sensitive to measuring change over time in response to a parenting intervention. The ICAST-Trial should have utility for evaluating the effectiveness of child abuse prevention efforts in similar socioeconomic contexts. Further research is needed to replicate these findings and examine cultural appropriateness, barriers for disclosure, and willingness to engage in child abuse research.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.JAD.2018.10.102
Abstract: Adolescents living with HIV represent a high-risk population for suicidal ideation and attempts, especially in low-income settings. Yet little is known about risk and protective factors for suicide in this population. A moderated mediation model was employed to test for potential (a) effects of stigma on suicidal ideation and attempts, both direct and mediated through depression and (b) direct and stress-buffering effects of social support resources on depression and suicidal ideation and attempts, among 1053 HIV-positive 10-19-year-old adolescents from a resource-scarce health district in South Africa. The survey data was collected using full community s ling of 53 clinics and tracing to over 180 communities. Effects of two support resources were tested: perceived support availability from the adolescents' social network and structured clinic support groups. Stigma was measured using the ALHIV-SS scale, depression through the CDI short form and social support through items from the MOS-SS. Stigma was a risk factor for depression (B = 0.295 p < 001) and for suicidal thoughts and behaviour (B = 0.185 p < .001). Only perceived support availability was directly associated with less depression (B = -0.182, p < .001). However, both perceived support availability and support group participation contributed to the overall stress-buffering effects moderating the direct and indirect relationships between stigma and suicidal thoughts and behaviour. The data used in this study was self-reported and cross-sectional. Findings suggest that strengthening multiple social support resources for HIV-positive adolescents, through early clinic and community-based interventions, may protect them from experiencing poor mental health and suicidal tendencies.
Publisher: Springer Science and Business Media LLC
Date: 18-07-2014
Publisher: Mary Ann Liebert Inc
Date: 06-2014
Publisher: Oxford University Press (OUP)
Date: 07-02-2012
Abstract: Research has established that AIDS-orphaned youth are at high risk of internalizing psychological distress. However, little is known about youth living with caregivers who are unwell with AIDS or youth simultaneously affected by AIDS-orphanhood and caregiver AIDS sickness. 1025 South African youth were interviewed in 2005 and followed up in 2009 (71% retention). Participants completed standardized measures of anxiety, depression, and posttraumatic stress. Comparison groups were youth who were AIDS-orphaned, other-orphaned, and nonorphaned, and those whose caregivers were sick with AIDS, sick with another disease, or healthy. Longitudinal analyses showed that both AIDS-orphanhood and caregiver AIDS sickness predicted increased depression, anxiety, and posttraumatic stress symptoms over a 4-year period, independently of sociodemographic cofactors and of each other. Caregiver sickness or death by non-AIDS causes, and having a healthy or living caregiver, did not predict youth symptomatology. Youths simultaneously affected by caregiver AIDS sickness and AIDS-orphanhood showed cumulative negative effects. Findings suggest that policy and interventions, currently focused on orphanhood, should include youth whose caregivers are unwell with AIDS.
Publisher: Elsevier BV
Date: 12-2013
Publisher: Informa UK Limited
Date: 08-05-2013
Publisher: Hogrefe Publishing Group
Date: 05-2013
DOI: 10.1027/1015-5759/A000134
Abstract: The Revised Children’s Manifest Anxiety Scale (RCMAS) is regularly used with South African children, although its performance in this context has yet to be empirically evaluated. This study assessed the basic psychometric properties of the RCMAS using data collected in a large study examining the mental health of children and adolescents living in poor urban communities around Cape Town. Reliability of the full-scale was good, and the predicted relationships between anxiety, depression, PTSD, delinquency, age, sex, and somaticism scores offered evidence of construct validity. However, the reliabilities for the physiological, worry/oversensitivity, and concentration subscales were low, and confirmatory factor analysis revealed the hypothesized three-factor model did not adequately fit the data. Exploratory analyses suggested a four-factor solution consisting of social evaluation, worry, affective responses, and physiological symptoms/sleep disturbance factors. Further confirmatory research examining this four-factor structure is needed. Given the continued use of the RCMAS in South Africa, these findings provide an important first step in establishing its reliability and validity for use with South African youth however, scores obtained on the three subscales should be interpreted with caution and further detailed psychometric evaluation of the RCMAS in South African s les is clearly required.
Publisher: Wiley
Date: 03-2008
Publisher: Public Library of Science (PLoS)
Date: 27-01-2014
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Lucie Cluver.