title: 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.
authors.affiliation: a SA Medical Research Council , Health Systems Research Unit , Durban , South Africa.|b School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Arvin
authors.initials: A
authors.lastname: Bhana
authors.affiliation: c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA.
authors.forename: Claude A
authors.initials: CA
authors.lastname: Mellins
authors.affiliation: d School of Social Work , The University of North Carolina at Chapel Hill , NC , USA.
authors.forename: Latoya
authors.initials: L
authors.lastname: Small
authors.affiliation: c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA.
authors.forename: Danielle F
authors.initials: DF
authors.lastname: Nestadt
authors.affiliation: c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA.
authors.forename: Cheng-Shiun
authors.initials: CS
authors.lastname: Leu
authors.affiliation: b School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Inge
authors.initials: I
authors.lastname: Petersen
authors.affiliation: b School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Sphindile
authors.initials: S
authors.lastname: Machanyangwa
authors.affiliation: e Silver School of Social Work , New York University , New York , NY , USA.
authors.forename: Mary
authors.initials: M
authors.lastname: McKay
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000342:Affective Symptoms / Q000175:diagnosis / Q000503:physiopathology; D001007:Anxiety / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D002648:Child; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008603:Mental Health; D010287:Parent-Child Relations; D011247:Pregnancy; D000066553:Problem Behavior; D055500:Resilience, Psychological; D012649:Self Concept; D057545:Social Stigma; D012944:Social Support; D013019:South Africa
keywords: HIV+ adolescents; Resilience; mental health; social action theory