Relationships among HIV/AIDS Orphanhood, Stigma, and Symptoms of Anxiety and Depression in South African Youth

"Cross-sectional research has demonstrated that HIV/AIDS orphanhood is associated with anxiety and depression and that HIV/AIDS-related stigma is a risk factor for these outcomes."

The aim of this South African longitudinal study was to examine relationships among HIV/AIDS orphanhood, HIV/AIDS-related stigma, and symptoms of anxiety and depression. From the abstract: "This study used a longitudinal data set to determine whether relationships between HIV/AIDS orphanhood and anxiety/depression scores (measured at 4-year follow-up) operate indirectly via perceived stigma. Youths from poor communities around Cape Town were interviewed in 2005 (n = 1,025) and followed up in 2009 (n = 723). At baseline, HIV/AIDS-orphaned youth reported significantly higher stigma and depression scores than youth not orphaned by HIV/AIDS."

Using a path analysis framework, 1,025 youth between 10 and 19 years of age from [economically] poor peri-urban communities around Cape Town, South Africa, were interviewed as a baseline in a study examining psychological distress in HIV/AIDS-orphaned children in 2005. In 2009, youth were followed up to assess the long-term impacts of HIV/AIDS orphanhood on child mental health.

In 2005, a brief four-item stigma-related scale was devised, including being teased, being treated badly, and being gossiped about because someone in the family was sick or had died. "Additionally, youth reported on the extent to which these events caused distress (0 = not at all, 2 = very much). Responses to the four items were summed to give a total stigma score...." An extended version of the scale was used at follow-up. Anxiety was measured using the Revised Children’s Manifest Anxiety Scale; depression was measured with the Child Depression Inventory-Short Form. "Owing to low literacy rates, questionnaires were administered verbally by five interviewers. Interviewers were all local community health or social workers.... Although follow-up of 71% was relatively high after 4 years for this highly mobile and at-risk population, results must be interpreted in light of the fact that some of the most vulnerable children were among those unable to be traced. Analyses in the current study were limited to the 723 youth who were assessed at both time points."

Both HIV-affected orphans and unaffected youth were measured: "HIV/AIDS-orphaned children reported significantly higher levels of stigma and obtained significantly higher depression scores at both time points." Differences in anxiety scores were not significant at baseline, but were significant at follow-up. Figures 1 and 2 show hypothesized and final models of the path analysis. "HIV/AIDS-orphaned youth reported significantly higher stigma and depression scores when measured at baseline and significantly higher stigma, depression, and anxiety scores at follow-up assessment. Additionally, significant effects of HIV/AIDS orphanhood on mental health outcomes were obtained in path analyses; however, results clearly reveal that being HIV/AIDS orphaned is not directly associated with anxiety or depression scores measured at baseline or follow-up. Rather, the impact of HIV/AIDS orphanhood on baseline anxiety and depression operates indirectly through the stigma that youth experienced at baseline....Importantly, the current findings offer the first evidence (to our knowledge) that the stigma experienced by HIV/AIDS-orphaned youth is maintained over long periods and mediates relationships between HIV/AIDS orphanhood and internalising symptoms cross-sectionally and longitudinally. Moreover, the models linking HIV/AIDS orphanhood to longitudinal mental health outcomes were strikingly similar for anxiety and depression scores - demonstrating that the mediating effect of stigma is consistent across two major mental health domains."

The researchers recommend examining causes of HIV/AIDS-related stigma (and stigma by association) within communities to inform stigma reduction interventions and the rigorous evaluation of resulting programmes. In addition, they recommend identifying factors associated with the promotion of youth resilience in the context of exposure to HIV/AIDS-related stigma.