title: Exposure to violence and psychological well-being over time in children affected by HIV/AIDS in South Africa and Malawi.
abstract: 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.
authors.affiliation: a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa.|b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Skeen
authors.affiliation: c Department of Infection and Population Health , University College London , London , UK.
authors.forename: A
authors.initials: A
authors.lastname: Macedo
authors.affiliation: a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Tomlinson
authors.affiliation: c Department of Infection and Population Health , University College London , London , UK.
authors.forename: I S
authors.initials: IS
authors.lastname: Hensels
authors.affiliation: c Department of Infection and Population Health , University College London , London , UK.
authors.forename: L
authors.initials: L
authors.lastname: Sherr
mesh_terms: D002648:Child; D002675:Child, Preschool; D055812:Community-Based Participatory Research; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology; D000069581:Exposure to Violence / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008603:Mental Health; D012307:Risk Factors; D012309:Risk-Taking; D013019:South Africa / Q000453:epidemiology; D014754:Violence
keywords: HIV; Violence; children; mental health