Image Credit: NASA,ESA and the Hubble SM4 ERO Team Michelle Cluver [email protected].
Cluver, L, Orkin, M, Boyes, M, Kganakga , M, Gardner, F, Makhazi , D, Sherr, L
description
Transcript of Cluver, L, Orkin, M, Boyes, M, Kganakga , M, Gardner, F, Makhazi , D, Sherr, L
Transactional sex in South African children predicted by familial HIV/AIDS,
abuse and hunger
Cluver, L, Orkin, M, Boyes, M, Kganakga, M, Gardner, F, Makhazi, D, Sherr, L
FOR SALE
Transactional sex in South African children predicted by familial HIV/AIDS,
abuse and hunger
A SERIAL KILLER.
Cluver, L, Orkin, M, Boyes, M, Kganakga, M, Gardner, F, Makhazi, D, Sherr, L
FOR SALE
Collaborative OVC research programme
Universities: Oxford, Wits, UCT,
UKZN
NACCA, NGOs e.g. USAID, UNICEF,
REPSSI, Save the Children
Collaborative research: Science to inform Policy
Linked longitudinal studies, 2005-2012: n=7873 children
Orphan resilience study (2005-2009)• 2005: N=1021 (aged 10-18), 71.5% follow-up• 3 provinces South Africa
National Young Carers study (2009-2012)• Main study: N=6002 (age: 10-18), pilot: 850 children, • 6 randomly-selected sites >30% prevalence, 3 provinces• Urban/rural, 1 year follow-up• Stratified random sampling of census enumeration or tribal areas• 2500 matched child-caregiver pairs
Measures and analysis• Standardised scales, national surveys (census, DHS etc.)• Verbal autopsy method (sensitivity 83%, specificity 75%)• Comparing AIDS-orphaned/other orphaned/non-orphaned/parental AIDS-
illnesss/other-illness/non-illness.• Multivariate logistic regression, log-linear models, structural equation
models, all controlling for socio-demographics
THE SCENE OF THE CRIME…
FOR SALE
Healthy caregiver AIDS-orphaned or AIDS-sick caregiverAIDS dual-affected0tan28a566028
0tan1a56601
0tan3a56603
0tan5a56605
0tan7a56607
0tan9a56609
0tan11a566011 % children reporting sexual risk
Transactional sexSex drunk or on drugsPregnant (girls)
Parental HIV/AIDS predicts child sexual risks
Healthy caregiver AIDS-orphaned or AIDS-sick caregiverAIDS dual-affected0tan28a566028
0tan1a56601
0tan3a56603
0tan5a56605
0tan7a56607
0tan9a56609
0tan11a566011 % children reporting sexual risk
Transactional sex
Sex for: Food Shelter School fees Money Transport
Parental HIV/AIDS predicts child sexual risks
Parental HIV/AIDS predicts transactional sex
healthy caregiver AIDS-orphaned/ AIDS-ill carer
Dual AIDS-affected0tan28a566028
0tan1a56601
0tan3a56603
0tan5a56605
0tan7a56607
0tan9a56609
0tan11a566011
0tan2a56602
0tan5a56605
0tan10a566010
% children aged 14-17 reporting transactional sex
girls
boys
IDENTIFYING LIKELY SUSPECTS.
FOR SALE
healthy c
aregiv
er
other-orphan
other-sick
caregiv
er
AIDS-orphan
AIDS-sick
caregiv
er
AIDS-dual
affecte
d0tan28a566028
0tan4a56604
0tan9a56609
0tan14a566014
0tan19a566019
0tan24a566024
0tan29a566029
0tan4a56604
0tan9a56609
0tan12a5660120tan15a566015
0tan13a566013
0tan21a566021
0tan1a56601
0tan5a56605
% children with insufficient food >2 days in past week
Parental HIV/AIDS predicts food insecurity
Parental HIV/AIDS predicts child stigmatization
healthy c
aregiv
er
other orphan
other-sick
caregiv
er
AIDS-orphan
AIDS-sick
caregiv
er
AIDS dual-
affecte
d0tan9a56609
0tan14a566014
0tan19a566019
0tan24a566024
0tan29a566029
0tan4a56604
0tan9a56609
0tan14a566014
0tan19a566019
0tan24a566024
0tan29a566029
0tan20a566020
0tan27a566027
0tan21a566021
0tan11a566011 0tan10a566010
0tan26a566026
% children reporting stigmatization
Healthy carer AIDS-orphaned AIDS-sick carer0tan28a566028
0tan4a56604
0tan9a56609
0tan14a566014
0tan19a566019
0tan24a566024% children reporting child abuse
Physical abuseEmotional abuseDomestic violenceSexual abuse
Parental HIV/AIDS predicts child maltreatment
Parental HIV/AIDS predicts child psychological disorder
healthy c
aregiv
er
other orphan
other-sick
caregiv
er
AIDS-orphan
AIDS-sick
caregiv
er
AIDS dual-
affecte
d0tan9a56609
0tan14a566014
0tan19a566019
0tan24a566024
0tan29a566029
0tan4a56604
0tan9a56609
0tan14a566014
0tan19a566019
0tan24a566024
0tan21a566021
0tan1a56601
0tan21a566021
0tan8a56608 0tan9a56609
0tan18a566018
% children with 1+ psychological disorder (clinical-level depression, anxiety, post-traumatic stress)
UNCOVERING COLLUSION...
FOR SALE
healthy carer AIDS-affected, abused
AIDS-affected, hungry
hungry, abused AIDS-affected, abused, hungry
0tan28a566028
0tan4a56604
0tan9a56609
0tan14a566014
0tan19a566019
0tan24a566024
0tan29a566029
0tan1a56601
0tan5a566050tan6a56606
0tan9a56609
0tan19a566019
% children 14-17 reporting transactional sex
boysgirls
Cumulative impacts of parental HIV/AIDS, abuse and hunger on child transactional sex
0 risks 1 risk 2 risks 3 risks 4 risks 5 risks0tan28a566028
0tan4a56604
0tan9a56609
0tan14a566014
0tan19a566019
0tan24a566024
0tan29a566029
0tan28a566028
0tan2a56602
0tan3a56603
0tan7a56607
0tan11a566011
0tan25a566025
% children (14-17) reporting transactional sex
boysgirls
Risks: Stigma Extreme poverty Abuse Psychological distress Family AIDS
Increased risk factors, increased child risk of transactional sex
Healthy family AIDS-sick parent Abused & hungry AIDS-sick parent, abused, hungry
0%
10%
20%
30%
40%
50%
60%
1%
7%
13%
57%
% girls aged 15-24 reporting transactional sex
Cumulative impacts 15-25 year oldsCluver, L, Orkin, M, Boyes et al, (2011) ‘Transactional Sex amongst AIDS-orphaned & AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty’. JAIDS
AIDS-orphan
SEXUAL HEALTH RISKS
Abuse
AIDS-sick
parent
Psych. distress
Stigma
Poverty
Education risks
.08
.13
.22
.06.10
.15
.15
.32
.43
.72
.15
.18
.14
.24.12
Pathways of risk for AIDS-affected children (structural equation modeling)
mean χ2(679) Bollen-Stine mean χ2/df
RMSEA SRMR CFI TLI
640.06 p=.001 1.57 .032 .044 .939 .930
AIDS-orphan
SEXUAL HEALTH RISKS
Abuse
AIDS-sick
parent
Psych. distress
Stigma
Poverty
Education risks
.08
.13
.22
.06.10
.15
.15
.32
.43
.72
.15
.18
.14
.24.12
Pathways of risk for AIDS-affected children
mean χ2(679) Bollen-Stine mean χ2/df
RMSEA SRMR CFI TLI
640.06 p=.001 1.57 .032 .044 .939 .930
AIDS-orphan
SEXUAL HEALTH RISKS
Abuse
AIDS-sick
parent
Psych. distress
Stigma
Poverty
Education risks
.08
.13
.22
.06.10
.15
.15
.32
.43
.72
.15
.18
.14
.24.12
Pathways of risk for AIDS-affected children
mean χ2(679) Bollen-Stine mean χ2/df
RMSEA SRMR CFI TLI
640.06 p=.001 1.57 .032 .044 .939 .930
AIDS-orphan
SEXUAL HEALTH RISKS
Abuse
AIDS-sick
parent
Psych. distress
Stigma
Poverty
Education risks
.08
.13
.22
.06.10
.15
.15
.32
.43
.72
.15
.18
.14
.24.12
Pathways of risk for AIDS-affected children
mean χ2(679) Bollen-Stine mean χ2/df
RMSEA SRMR CFI TLI
640.06 p=.001 1.57 .032 .044 .939 .930
AIDS-orphan
SEXUAL HEALTH RISKS
Abuse
AIDS-sick
parent
Psych. distress
Stigma
Poverty
Education risks
.08
.13
.22
.06.10
.15
.15
.32
.43
.72
.15
.18
.14
.24.12
Pathways of risk for AIDS-affected children
mean χ2(679) Bollen-Stine mean χ2/df
RMSEA SRMR CFI TLI
640.06 p=.001 1.57 .032 .044 .939 .930
AIDS-orphan
SEXUAL HEALTH RISKS
Abuse
AIDS-sick
parent
Psych. distress
Stigma
Poverty
Education risks
.08
.13
.22
.06.10
.15
.15
.32
.43
.72
.15
.18
.14
.24.12
Pathways of risk for AIDS-affected children
mean χ2(679) Bollen-Stine mean χ2/df
RMSEA SRMR CFI TLI
640.06 p=.001 1.57 .032 .044 .939 .930
AIDS-orphan
SEXUAL HEALTH RISKS
Abuse
AIDS-sick
parent
Psych. distress
Stigma
Poverty
Education risks
.08
.13
.22
.06.10
.15
.15
.32
.43
.72
.15
.18
.14
.24.12
Pathways of risk for AIDS-affected children
mean χ2(679) Bollen-Stine mean χ2/df
RMSEA SRMR CFI TLI
640.06 p=.001 1.57 .032 .044 .939 .930
Implications for intervention
• Children in AIDS-affected families at higher risk for sexual exploitation and HIV-infection.
• Preventing transactional sex for AIDS-affected children needs social protection not behavioral interventions
• Interactive model of risk shows modifiable pathways from familial AIDS to child sex risk.
• Reducing extreme poverty, abuse, stigma and psychological distress could interrupt these risk pathways
• Social protection programs must be HIV-sensitive: both to children in AIDS-affected families, and to HIV risk outcomes.
• Cluver, L (2011)‘Children of the AIDS pandemic’. Nature, 474 27-29.• Boyes, M. E. & Cluver, L. (2012). Performance of the Revised
Children's Manifest Anxiety Scale in a sample of children and adolescents from poor urban communities in Cape Town. European Journal of Psychological Assessment
• Boyes, M, Mason, S, & Cluver, L (2012). Validation of a brief stigma-by-association scale for use with HIV/AIDS-affected youth in South Africa. AIDS Care.
• Cluver, L, Orkin, M, Boyes, M & Gardner, F (2012) Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychiatry and Psychology.
• Cluver, L, Orkin, M, Boyes, M, Gardner, F, & Meinck, (2011) ‘Transactional Sex amongst AIDS-orphaned and AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty’. JAIDS
• Cluver, L, Orkin, M, Boyes, M & Gardner, F (2011) Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychiatry and Psychology.
• Cluver, L, Operario, D, Lane, T, Kganakga, M (2011). Educational shortfalls among ‘Young Carers’ in the South African AIDS Epidemic. Journal of Adolescent Research.
• Kuo, C, Operario, D & Cluver. L (in press) Depression amongst carers of AIDS-orphaned and other children in Umlazi Township, South Africa. Global Public Health.
• Cluver, L, Bowes, L & Gardner, F (2010) Risk and protective factors for bullying victimisation amongst AIDS-affected and vulnerable children in South Africa. Child Abuse and Neglect
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• Cluver, L, Finch, D & Seedat, S (2009) Predictors of post-traumatic stress symptomology amongst AIDS-orphaned children. Journal of Traumatic Stress, 22 (2) 106-113
• Cluver, L, Gardner, F & Operario, D (2009). Effects of poverty on the psychological health of AIDS-orphaned children. AIDS Care 21 (6) 732-741
• Operario, D, Underhill, K, Chuong, C, Cluver, L. (2011) HIV infection and sexual risk behaviour among youth who have experienced orphanhood: systematic review and meta-analysis. Journal of the International AIDS Society, 14, 25.
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• Operario, D, Pettifor, A, Cluver, L, MacPhail, C and Rees, H (2007), Prevalence of Parental Death among young people in South Africa and Risk for HIV Infection: Results from a National Representative Sample. Journal of Acquired Immune Deficiency Syndromes (JAIDS) 44, 93-98.
• Cluver, L, Orkin, M., Boyes, M. E., Madisha, L., and Baban, R. (in press). Child development in sub-Saharan Africa: Identifying challenges and planning solutions. In M. Tomlinson, C. Hanlon, L. Swartz, P. Cooper, and A. Sameroff (Eds). Infant and child development in Africa: Perspectives from the continent. City
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The Nuffield Foundation
Thank you. www.youngcarers.org.za
National Department of Social Development
The National Research Foundation
HEARD, University of KwaZulu-Natal
The John Fell Fund
The Claude Leon Foundation
The Economic & Social Research Council