Caroline Kuo, Lucie Cluver, Marisa Casale, Tyler Lane, Lebo Sello AIDS 2012, Washington DC
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Transcript of Caroline Kuo, Lucie Cluver, Marisa Casale, Tyler Lane, Lebo Sello AIDS 2012, Washington DC
Living with HIV or AIDS increases risk for poor mental health
among adults caring for orphaned children in South Africa
Caroline Kuo, Lucie Cluver, Marisa Casale, Tyler Lane, Lebo Sello
AIDS 2012, Washington DC
HIV and AIDS in South Africa
Source: http://www.unaids.org/globalreport/HIV_prevalence_map.htm http://www.unaids.org/globalreport http://www.unaids.org/en/regionscountries/countries/southafrica/
South Africa
310,000 AIDS deaths17.2% of global total
5.6 million living with HIV16.8% of global total
1.9 million children orphaned by AIDS13.0% of global total
What do we know about caregivers of AIDS-orphaned children?Caregiver type: extended family, primarily women
Child placement: decisions to care influenced by children’s traits (gender, age), economic challenges
Care challenges: poverty, nutrition, children’s educational and other needs
Health: chronic illness, grief, stress, depression, anxiety, PTSD
Sources: Kuo, C. et al., 2009, 2010, 2012; Ice, G. et al., 2012; Govender, K. et al., 2012; Boon et al., 2010
Young Carers KwaZulu Natal Study ObjectivesChild and caregiver outcomesi.e., mental health, chronic illness,
HIV/AIDS-ill, sexual risk behaviour
Relationship between caregiver and child health outcomes
i.e., caregiver and child mental health outcomes; caregiver illness and child outcomes
Role of family factors in child risk behaviours
i.e., parenting behaviours
Methods• Sites: Lamontville and Manguzi
• Sampling: stratified random sampling of census size enumeration areas with door-to-door household sampling using GIS
• Participants: N= 5238 (2600 matched child-caregiver pairs)
Children aged 10-17, Caregivers aged 18+
• Ethical Approval: University of Oxford and KwaZulu Natal, South African Departments of Health and Education
• Measures: CESD, Beck Anxiety Index, Verbal autopsy
Collaborative research
Young Carers Projec
t
Universities: Oxford, Brown, UKZN
National Department of
Education
National Department of
Heath
National Department of
Social Development
National Department of Agriculture, Forestry and
Fisheries
National Action
Committee for Children
Affected by HIV and AIDS
Tholulwazi NGO
Teen Advisory Group & PLWHA
WHO ARE PARTICIPANTS?
All photos used with consent
Who are participants?CAREGIVERS CHILDREN
Age 44 (Range 18-92, SD=13) 13 (Range 10-17, SD=2)
Education 82% did not finish high school
18% high school diploma or higher
Mean education: 6th grade
Gender 88% female11% male
54% female46% male
Ethnicity 99% African/Black 99% African/Black
Language 96% isiZulu 96% isiZulu
Children and/or caregivers affected by HIV and AIDS
53.5%
35.7%
4.8%6.0%
Type of HouseholdHealthy caregiver, no child(ren) orphaned by AIDS
HIV/AIDS ill caregiver, no child(ren) orphaned by AIDS
Healthy caregiver, child(ren) orphaned by AIDS
HIV/AIDS ill caregiver, child(ren) orphaned by AIDS
CAREGIVER HEALTH
Caregiver mental healthDepression: 35.6% clinically significant
symptoms for depression
Anxiety: 49.5% clinically significant symptoms for anxiety
Depression and/or Anxiety: 56.8%
Depression Anxiety.000%
10.000%
20.000%
30.000%
40.000%
50.000%60.000%
70.000%
35.200%
48.700%41.8%*
58.7%***
Household has no children orphaned by AIDSHousehold has child(ren) orphaned by AIDS
Caregivers of children orphaned by AIDS have worse mental health
Chi square level of significance at p<0.01*, p<0.001***
Among caregivers of children orphaned by AIDS, HIV/AIDS-ill caregivers have worse mental health
Depression Anxiety.000%10.000%20.000%30.000%40.000%50.000%60.000%70.000%80.000%90.000%
29.200%
48.400%
65.6%***
78.2%***
Healthy caregiver for household with child(ren) orphaned by AIDSHIV/AIDS-ill caregiver for household has child(ren) orphaned by AIDS
Chi square level of significance at p<0.001***
Familial HIV or AIDS increases risk for caregiver’s poor mental health
Healthy caregiver, no children or-phaned by AIDS
Healthy caregiver, child(ren) or-
phaned by AIDS
HIV/AIDS ill care-giver, no children orphaned by AIDS
HIV/AIDS ill care-giver, child(ren)
orphaned by AIDS
.000%
20.000%
40.000%
60.000%
80.000%
100.000%
35.9%***46.4%***
74.4%***87.1%***
Percentage of caregivers with depression and anxiety
Chi square level of significance at p<0.001***
Relationship between Familial HIV/AIDS and caregiver mental health remains
Relative Risk for Caregiver Depression and/or Anxiety (95%
CI)Household with HIV/AIDS-ill caregiver and child(ren) orphaned by AIDS
4.26 (1.42-12.76)
Household socioeconomic status 0.71 (0.55-0.93)Caregiver age 1.41 (1.09-1.81)Caregiver gender 1.69 (1.17-2.42)Caregiver education 0.51 (0.40-0.66)Child age 1.47 (1.07-2.04)Child gender 1.14 (0.90-1.44)Child education 0.94 (0.87-1.00)
Statistically significant associations are shown in bold
Stigma a risk factor for mental health of HIV/AIDS-ill caregivers of orphaned children
Relative Risk for Caregiver Depression and/or Anxiety (95%
CI)Household with HIV/AIDS-ill caregiver and child(ren) orphaned by AIDS
3.43 (1.13-10.38)
Household socioeconomic status 0.84 (0.64-1.11)Caregiver age 1.40 (1.08-1.81)Caregiver gender 1.69 (1.16-2.44)Caregiver education 0.50 (0.39-0.65)Child age 1.46 (1.05-2.04)Child gender 1.13 (0.89-1.44)Child education 0.94 (0.88-1.01)Caregiver stigma 2.44 (1.86-3.18)
Statistically significant associations are shown in bold
Food security a protective factor for mental health of HIV/AIDS-ill caregivers
Relative Risk for Caregiver Depression and/or Anxiety (95%
CI)Household with HIV/AIDS-ill caregiver and child(ren) orphaned by AIDS
3.41 (1.13-10.36)
Household socioeconomic status 0.85 (0.64-1.12)Caregiver age 1.40 (1.08-1.81)Caregiver gender 1.68 (1.16-2.43)Caregiver education 0.51 (0.40-0.66)Child age 1.44 (1.03-2.00)Child gender 1.13 (0.89-1.44)Child education 0.94 (0.88-1.01)Caregiver stigma 2.35 (1.79-3.08)Household food insecurity 1.46 (1.05-2.03)Statistically significant associations are shown in bold
ConclusionsCaregivers of children orphaned by AIDS at high
risk for psychological distressThis risk increases if these caregivers are living with
HIV or AIDSRisk and protective factors for psychological
distress among HIV/AIDS-ill caregivers Stigma a risk factorFood security a protective factor
Interventions needed to address psychological distress, and may need to be paired with community interventions (to address stigma) and structural interventions (to address food insecurity)
Acknowledgments
Additional generous support from: NIMH T32 (PI: Brown)
Alcohol Research Center on HIV
CFAR Tufts/Brown/Lifespan