Resilience in perinatal HIV+ adolescents in South Africa

ABSTRACT

Increasing numbers of perinatally HIV (PHIV+)-infected youth are surviving into adulthood with better access to treatment. However, few studies examine positive outcomes in the face of adversity (resilience) for PHIV+ youth. Social Action Theory (SAT) provided the theoretical framework for this study of PHIV + youth in South Africa (SA), allowing examination of contextual, social, and self-regulatory factors that influence behavioral health. Data were from youth and caregiver baseline interviews, simply pooled from a pilot (N=66) and larger (n=111) randomized control trial (RCT) of the VUKA Family program. For this analysis, outcomes included emotional and behavioral functioning (total difficulties), and prosocial behaviors. Potential SAT correlates included socio-demographics; caregiver health and mental health; parent-child relationship factors; stigma, and child coping, support; and self-esteem. Regression analyses adjusted for age, gender, and study revealed significant associations at the contextual, social, and self-regulation level. Lower total child difficulties scores were associated with lower caregiver depression (β = 3.906,p < .001), less caregiver-reported communication about difficult issues (β = 1.882, p = .009) and higher youth self-esteem (β = -0.119, p = .020). Greater prosocial behaviors were associated with greater caregiver-reported communication (β = 0.722, p = .020) and child use of wishful thinking for coping (β = 5.532, p = .009). Less youth depression was associated with higher caregiver education (β =−0.399, p = .010), greater caregiver supervision (β = −1.261, p = .012), more social support seeking (β = −0.453, p = .002), higher youth self-esteem (β = −0.067, p < .001), lower internalized stigma (β = 0.608, p = .040), and child use of resignation for coping (β = 1.152, p = .041). Our data support evidence-based family interventions that also promote youth self-regulation skills to enhance the health and mental health of PHIV+ youth.

KEYWORDS:

• Resilience
• HIV+ adolescents
• social action theory
• mental health

Acknowledgements

The authors want to acknowledge the time and contributions of the children and caregivers who participated in this study and the research staff who worked with them to collect the data. In addition, we wish to thank our collaborators at the Human Sciences Research Council and University of KwaZulu-Natal.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by several grants from the National Institutes of Health, including, “Adapting Champ+ For South Africa: Supporting HIV-Infected Youth and Families” [R21 NR010474; PI: Mellins] and “VUKA Family Program: Supporting Perinatally HIV+ Youth in South Africa” [R01 HD074052; PI: McKay]. The research was also supported by an NIMH center grant to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University [P30-MH43520;PI: Remien].