title: HIV+ and HIV- youth living in group homes in South Africa need more psychosocial support.
abstract: Orphans and vulnerable youth who live in group homes are at risk of poor mental health and sexual and drug-using behaviors that increase the risk of HIV transmission. This study explores factors related to this risk among youth living in group homes ("children's homes") for orphans and vulnerable children in South Africa, a country afflicted by high levels of parental loss due to HIV. The study explores 1) knowledge and attitudes about HIV, 2) social support, 3) communication with group home caregivers, and 4) the relevance of an existing evidence-based HIV prevention and mental health promotion program to situations where sexual and drug risk behaviors can occur. In-depth qualitative individual interviews were conducted with 20 youth (age 10 to 16 years) residing in two children's homes in Durban, South Africa. Content analysis focused on critical themes related to coping and prevention of risk activities. Respondents exhibited inconsistent and incomplete knowledge of HIV transmission and prevention. They displayed positive attitudes toward people living with HIV, but reported experiencing or witnessing HIV-related stigma. Participants witnessed substance use and romantic/sexual relationships among their peers; few admitted to their own involvement. While relationships with childcare workers were central to their lives, youth reported communication barriers related to substance use, sex, HIV, and personal history (including parental loss, abuse, and other trauma). In conclusion, these qualitative data suggest that evidence-based HIV prevention programs that bring caregivers and youth together to improve communication, HIV knowledge, social support, youth self-esteem, and health care, reduce sexual and drug risk behaviors, and strengthen skills related to negotiating situations of sexual and substance use possibility could benefit youth and childcare workers in children's homes.
authors.affiliation: ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Nestadt
authors.forename: S
authors.initials: S
authors.lastname: Alicea
authors.forename: I
authors.initials: I
authors.lastname: Petersen
authors.forename: S
authors.initials: S
authors.lastname: John
authors.forename: N P
authors.initials: NP
authors.lastname: Myeza
authors.forename: S W
authors.initials: SW
authors.lastname: Nicholas
authors.forename: L G
authors.initials: LG
authors.lastname: Cohen
authors.forename: H
authors.initials: H
authors.lastname: Holst
authors.forename: A
authors.initials: A
authors.lastname: Bhana
authors.forename: M M
authors.initials: MM
authors.lastname: McKay
authors.forename: E J
authors.initials: EJ
authors.lastname: Abrams
authors.forename: C A
authors.initials: CA
authors.lastname: Mellins
keywords: HIV; South Africa; children’s homes; orphans; social support
references.citation: Acta Paediatr. 2002;91(4):459-65
references.pmid: 12061364
references.citation: Dev Psychopathol. 2003 Fall;15(4):853-84
references.pmid: 14984130
references.citation: Ann Gen Psychiatry. 2006 Jul 19;5:8
references.pmid: 16848910
references.citation: J Trauma Stress. 2009 Apr;22(2):106-12
references.pmid: 19319917
references.citation: AIDS Behav. 2006 Nov;10(6):627-35
references.pmid: 16838071
references.citation: J Consult Clin Psychol. 2005 Apr;73(2):221-8
references.pmid: 15796629
references.citation: J Int AIDS Soc. 2010 Jun 23;13 Suppl 2:S8
references.pmid: 20573290
references.citation: J Natl Med Assoc. 2008 Aug;100(8):936-44
references.pmid: 18717144
references.citation: J Acquir Immune Defic Syndr. 2007 Jan 1;44(1):93-8
references.pmid: 17075394
references.citation: Am Psychol. 1991 Sep;46(9):931-46
references.pmid: 1958012
references.citation: Fam Process. 2004 Mar;43(1):79-93
references.pmid: 15359716
references.citation: Soc Work Ment Health. 2007 Jan 1;5(3/4):355-378
references.pmid: 20852676
references.citation: Soc Sci Med. 2005 Aug;61(3):555-64
references.pmid: 15899315