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Pathways from parental AIDS to child psychological, educational and sexual risk: Developing an empirically-based interactive theoretical model

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  • Cluver, Lucie
  • Orkin, Mark
  • Boyes, Mark E.
  • Sherr, Lorraine
  • Makasi, Daphne
  • Nikelo, Joy

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 sampling. 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 individual 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.

Suggested Citation

  • Cluver, Lucie & Orkin, Mark & Boyes, Mark E. & Sherr, Lorraine & Makasi, Daphne & Nikelo, Joy, 2013. "Pathways from parental AIDS to child psychological, educational and sexual risk: Developing an empirically-based interactive theoretical model," Social Science & Medicine, Elsevier, vol. 87(C), pages 185-193.
    • Handle: RePEc:eee:socmed:v:87:y:2013:i:c:p:185-193
    DOI: 10.1016/j.socscimed.2013.03.028
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    2. Wang, Bo & Li, Xiaoming & Barnett, Douglas & Zhao, Guoxiang & Zhao, Junfeng & Stanton, Bonita, 2012. "Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: A structural equation modeling analysis," Social Science & Medicine, Elsevier, vol. 74(9), pages 1435-1443.
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    2. Perry, Elizabeth W. & Culbreth, Rachel & Swahn, Monica & Kasirye, Rogers & Self-Brown, Shannon, 2020. "Psychological distress among orphaned youth and youth reporting sexual exploitation in Kampala, Uganda," Children and Youth Services Review, Elsevier, vol. 119(C).
    3. Gavan, Luana & Hartog, Kim & Koppenol-Gonzalez, Gabriela V. & Gronholm, Petra C. & Feddes, Allard R. & Kohrt, Brandon A. & Jordans, Mark J.D. & Peters, Ruth M.H., 2022. "Assessing stigma in low- and middle-income countries: A systematic review of scales used with children and adolescents," Social Science & Medicine, Elsevier, vol. 307(C).
    4. Skeen, Sarah & Tomlinson, Mark & Macedo, Ana & Miltz, Ada & Croome, Natasha & Sherr, Lorraine, 2014. "Child development in HIV-positive and HIV-affected children in South Africa and Malawi—What role for community organisations?," Children and Youth Services Review, Elsevier, vol. 45(C), pages 90-97.
    5. Janina Isabel Steinert & Lucie Dale Cluver & G. J. Melendez-Torres & Sebastian Vollmer, 2018. "One Size Fits All? The Validity of a Composite Poverty Index Across Urban and Rural Households in South Africa," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 136(1), pages 51-72, February.
    6. Marija Pantelic & Mark Boyes & Lucie Cluver & Mildred Thabeng, 2018. "‘They Say HIV is a Punishment from God or from Ancestors’: Cross-Cultural Adaptation and Psychometric Assessment of an HIV Stigma Scale for South African Adolescents Living with HIV (ALHIV-SS)," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 11(1), pages 207-223, February.
    7. Li, Xiaoming & Harrison, Sayward E. & Fairchild, Amanda J. & Chi, Peilian & Zhao, Junfeng & Zhao, Guoxiang, 2017. "A randomized controlled trial of a resilience-based intervention on psychosocial well-being of children affected by HIV/AIDS: Effects at 6- and 12-month follow-up," Social Science & Medicine, Elsevier, vol. 190(C), pages 256-264.
    8. Foster, Holly & Brooks-Gunn, Jeanne, 2015. "Children's exposure to community and war violence and mental health in four African countries," Social Science & Medicine, Elsevier, vol. 146(C), pages 292-299.
    9. Michael L. Goodman & Beatrice J. Selwyn & Robert O. Morgan & Linda E. Lloyd & Moses Mwongera & Stanley Gitari & Philip H. Keiser, 2016. "Improved food quality, quantity and security among Kenyan orphans and vulnerable children: associations with participation in a multisectoral community-based program, age, gender, and sexual risk," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 8(2), pages 427-442, April.

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