Many of the risk factors for violence against children are particularly prevalent in families and communities affected by HIV/AIDS. Yet, in sub-Saharan Africa, where HIV rates are high, efforts to prevent or address violence against children and its long-lasting effects are hampered by a lack of evidence. We assessed the relationship between violence exposure and mental health among HIV-affected children attending community-based organisations in South Africa (n = 834) and Malawi (n = 155, total sample n = 989) at baseline and 12–15-month follow-up. Exposure to violence in the home and in the community was high. HIV-negative children who lived with an HIV-positive person experienced most violence overall, followed by HIV-positive children. Children unaffected by HIV experienced least violence (all p < .05). Interpersonal violence in the home predicted child depression (β = 0.17, p < .001), trauma symptoms (β = 0.17, p < .001), lower self-esteem (β = −0.17, p < .001), and internalising and externalising behavioural problems (β = 0.07, p < .05), while exposure to community violence predicted trauma symptoms (β = 0.16, p < .001) and behavioural problems (β = 0.07, p < .05). Harsh physical discipline predicted lower self-esteem (β = −0.18, p < .001) and behavioural problems for children (β = 0.24, p < .001). Exposure to home (OR: 1.89, 95% CI: 1.23–2.85) and community violence predicted risk behaviour (OR: 2.39, 95% CI: 1.57–3.62). Over time, there was a decrease in depressed mood and problem behaviours, and an increase in self-esteem for children experiencing different types of violence at baseline. This may have been due to ongoing participation in the community-based programme. These data highlight the burden of violence in these communities and possibilities for programmes to include violence prevention to improve psychosocial well-being in HIV-affected children.

BackgroundViolence during childhood may affect short and long-term educational factors. There is scant literature on younger children from resource poor settings.MethodsThis study assessed child violence experiences (harsh punishment and exposure to domestic or community violence) and school enrolment, progress and attendance in children attending community-based organisations in South Africa and Malawi (n=989) at baseline and at 15 months' follow-up, examining differential experience of HIV positive, HIV affected and HIV unaffected children.ResultsViolence exposure was high: 45.4% experienced some form of psychological violence, 47.8% physical violence, 46.7% domestic violence and 41.8% community violence. Primary school enrolment was 96%. Violence was not associated with school enrolment at baseline but, controlling for baseline, children exposed to psychological violence for discipline were more than ten times less likely to be enrolled at follow-up (OR 0.09; 95% CI 0.01 to 0.57). Harsh discipline was associated with poor school progress. For children HIV positive a detrimental effect of harsh physical discipline was found on school performance (OR 0.10; 95% CI 0.02 to 0.61).ConclusionViolence experiences were associated with a number of educational outcomes, which may have long-term consequences. Community-based organisations may be well placed to address such violence, with a particular emphasis on the challenges faced by children who are HIV positive.

Purpose Adolescent health is a major concern in LMIC but little is known about its predictors. Family disadvantage and abusive parenting may be important factors associated with adolescent psychological, behavioral and physical health outcomes. This study, based in South Africa, aimed to develop an empirically-based theoretical model of relationships between family factors such as deprivation, illness and parenting and adolescent health outcomes. Methods Cross-sectional data were collected in 2009–2010 from 2477 adolescents (aged 10–17) and their caregivers using stratified random sampling in KwaZulu-Natal, South Africa. Participants reported on socio-demographics, psychological symptoms, parenting and physical health. Multivariate regressions were conducted, confirmatory factor analysis employed to identify measurement models and a structural equation model developed. Results The final model demonstrated that family disadvantage (caregiver AIDS -illness and poverty) was associated with increased abusive parenting. Abusive parenting was in turn associated with higher adolescent health risks. Additionally, family disadvantage was directly associated with caregiver mental health distress which increased adolescent health risks. There was no direct effect of family disadvantage on adolescent health risks but indirect effects through caregiver mental health distress and abusive parenting were found. Conclusions Reducing family disadvantage and abusive parenting is essential in improving adolescent health in South Africa. Combination interventions could include poverty and violence reduction, access to health care, mental health services for caregivers and adolescents, and positive parenting support. Such combination packages can improve caregiver and child outcomes by reducing disadvantage and mitigating negative pathways from disadvantage among highly vulnerable families.

Objective Many studies that document child outcomes in the context of parental HIV – which has been established as a risk factor for child development – focus on older children/adolescents. Studies also concentrate on the status of the primary caregiver, not other household members who might be infected. Design This study examined the effects of caregiver and household HIV on child development (4–13 years) in South Africa and Malawi (2011–2014) Methods Data was gathered from 989 children and their primary caregivers at baseline and repeated at 12–15 month follow-up (86.5% follow-up rate). Only caregivers of a single child and caregiver/child dyads without missing data were included, providing a sample of 808 dyads for analysis. Children were divided into three groups according to caregiver reported HIV burden: having a HIV-positive primary caregiver (19.8%), having HIV in the household (14.2%), or no HIV (66%). Results HIV burden was positively associated with an array of negative child outcomes, often mediated by caregiver depression levels. Family HIV burden at baseline affected child behavioural problems at follow-up indirectly through carer depression (B=0.02; CI=0.003, 0.06). Internalising (B=0.02; CI=0.002, 0.05) and externalising problems at follow-up (B=0.01; CI=0.0002, 0.03) were also indirectly affected by family HIV burden through caregiver depression. Conclusion The data suggest that family HIV can affect child development, emphasising the important role of depression in the pathway to such an effect. Community-based interventions directed at alleviating parental depression in the presence of HIV may help to interrupt the cycle of family HIV and adverse child outcomes.