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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. South Africa 310,000 AIDS deaths

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Caroline Kuo, Lucie Cluver, Marisa Casale, Tyler Lane, Lebo Sello AIDS 2012, Washington DC

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  1. 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

  2. HIV and AIDS in South Africa South Africa 310,000 AIDS deaths 17.2% of global total 5.6 million living with HIV 16.8% of global total 1.9 million children orphaned by AIDS 13.0% of global total Source: http://www.unaids.org/globalreport/HIV_prevalence_map.htm http://www.unaids.org/globalreport http://www.unaids.org/en/regionscountries/countries/southafrica/

  3. 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

  4. Young Carers KwaZulu Natal Study Objectives Child and caregiver outcomes i.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

  5. 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

  6. Collaborative research

  7. Who are Participants? All photos used with consent

  8. Who are participants?

  9. Children and/or caregivers affected by HIV and AIDS

  10. Caregiver health

  11. Caregiver mental health • Depression: 35.6% clinically significant symptoms for depression • Anxiety: 49.5% clinically significant symptoms for anxiety • Depression and/or Anxiety: 56.8%

  12. Caregivers of children orphanedby AIDS have worse mental health Chi square level of significance at p<0.01*, p<0.001***

  13. Among caregivers of children orphaned by AIDS, HIV/AIDS-ill caregivers have worse mental health Chi square level of significance at p<0.001***

  14. Familial HIV or AIDS increases risk for caregiver’s poor mental health Chi square level of significance at p<0.001***

  15. Relationship between Familial HIV/AIDS and caregiver mental health remains Statistically significant associations are shown in bold

  16. Stigma a risk factor for mental health of HIV/AIDS-ill caregivers of orphaned children Statistically significant associations are shown in bold

  17. Food security a protective factor for mental health of HIV/AIDS-ill caregivers Statistically significant associations are shown in bold

  18. Conclusions • Caregivers of children orphaned by AIDS at high risk for psychological distress • This risk increases if these caregivers are living with HIV or AIDS • Risk and protective factors for psychological distress among HIV/AIDS-ill caregivers • Stigma a risk factor • Food 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)

  19. Acknowledgments Additional generous support from: NIMH T32 (PI: Brown) Alcohol Research Center on HIV CFAR Tufts/Brown/Lifespan

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