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Cluver, L, Orkin, M, Boyes, M, Kganakga , M, Gardner, F, Makhazi , D, Sherr, L

FOR SALE. Transactional sex in South African children predicted by familial HIV/AIDS, abuse and hunger. Cluver, L, Orkin, M, Boyes, M, Kganakga , M, Gardner, F, Makhazi , D, Sherr, L. FOR SALE. Transactional sex in South African children predicted by familial HIV/AIDS,

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Cluver, L, Orkin, M, Boyes, M, Kganakga , M, Gardner, F, Makhazi , D, Sherr, L

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  1. FOR SALE Transactional sex in South African children predicted by familial HIV/AIDS, abuse and hunger Cluver, L, Orkin, M, Boyes, M, Kganakga, M, Gardner, F, Makhazi, D, Sherr, L

  2. FOR SALE Transactional sex in South African children predicted by familial HIV/AIDS, abuse and hunger A SERIAL KILLER. Cluver, L, Orkin, M, Boyes, M, Kganakga, M, Gardner, F, Makhazi, D, Sherr, L

  3. Collaborative research: Science to inform Policy

  4. Linked longitudinal studies, 2005-2012: n=7873 children • Orphan resilience study (2005-2009) • 2005: N=1021 (aged 10-18), 71.5% follow-up • 3 provinces South Africa National Young Carers study (2009-2012) • Main study: N=6002 (age: 10-18), pilot: 850 children, • 6 randomly-selected sites >30% prevalence, 3 provinces • Urban/rural, 1 year follow-up • Stratified random sampling of census enumeration or tribal areas • 2500 matched child-caregiver pairs Measures and analysis • Standardised scales, national surveys (census, DHS etc.) • Verbal autopsy method (sensitivity 83%, specificity 75%) • Comparing AIDS-orphaned/other orphaned/non-orphaned/parental AIDS-illnesss/other-illness/non-illness. • Multivariate logistic regression, log-linear models, structural equation models, all controlling for socio-demographics

  5. FOR SALE THE SCENE OF THE CRIME…

  6. Parental HIV/AIDS predicts child sexual risks

  7. Parental HIV/AIDS predicts child sexual risks

  8. Parental HIV/AIDS predicts transactional sex

  9. FOR SALE IDENTIFYING LIKELY SUSPECTS.

  10. Parental HIV/AIDS predicts food insecurity

  11. Parental HIV/AIDS predicts child stigmatization

  12. Parental HIV/AIDS predicts child maltreatment

  13. Parental HIV/AIDS predicts child psychological disorder

  14. FOR SALE UNCOVERING COLLUSION...

  15. Cumulative impacts of parental HIV/AIDS, abuse and hunger on child transactional sex

  16. Increased risk factors, increased child risk of transactional sex

  17. Cumulative impacts 15-25 year olds Cluver, L, Orkin, M, Boyes et al, (2011) ‘Transactional Sex amongst AIDS-orphaned &AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty’. JAIDS

  18. Pathways of risk for AIDS-affected children (structural equation modeling) AIDS-orphan Education risks .13 .06 Poverty .18 .10 Stigma .32 Psych. distress .12 .24 .43 .08 .22 .14 .72 Abuse .15 .15 .15 AIDS-sick parent SEXUAL HEALTH RISKS

  19. Pathways of risk for AIDS-affected children AIDS-orphan Education risks .13 .06 Poverty .18 .10 Stigma .32 Psych. distress .12 .24 .43 .08 .22 .14 .72 Abuse .15 .15 .15 AIDS-sick parent SEXUAL HEALTH RISKS

  20. Pathways of risk for AIDS-affected children AIDS-orphan Education risks .13 .06 Poverty .18 .10 Stigma .32 Psych. distress .12 .24 .43 .08 .22 .14 .72 Abuse .15 .15 .15 AIDS-sick parent SEXUAL HEALTH RISKS

  21. Pathways of risk for AIDS-affected children AIDS-orphan Education risks .13 .06 Poverty .18 .10 Stigma .32 Psych. distress .12 .24 .43 .08 .22 .14 .72 Abuse .15 .15 .15 AIDS-sick parent SEXUAL HEALTH RISKS

  22. Pathways of risk for AIDS-affected children AIDS-orphan Education risks .13 .06 Poverty .18 .10 Stigma .32 Psych. distress .12 .24 .43 .08 .22 .14 .72 Abuse .15 .15 .15 AIDS-sick parent SEXUAL HEALTH RISKS

  23. Pathways of risk for AIDS-affected children AIDS-orphan Education risks .13 .06 Poverty .18 .10 Stigma .32 Psych. distress .12 .24 .43 .08 .22 .14 .72 Abuse .15 .15 .15 AIDS-sick parent SEXUAL HEALTH RISKS

  24. Pathways of risk for AIDS-affected children AIDS-orphan Education risks .13 .06 Poverty .18 .10 Stigma .32 Psych. distress .12 .24 .43 .08 .22 .14 .72 Abuse .15 .15 .15 AIDS-sick parent SEXUAL HEALTH RISKS

  25. Implications for intervention • Children in AIDS-affected families at higher risk for sexual exploitation and HIV-infection. • Preventing transactional sex for AIDS-affected children needs social protection not behavioral interventions • Interactive model of risk shows modifiable pathways from familial AIDS to child sex risk. • Reducing extreme poverty, abuse, stigma and psychological distress could interrupt these risk pathways • Social protection programs must be HIV-sensitive: both to children in AIDS-affected families, and to HIV risk outcomes.

  26. Cluver, L, Gardner, F & Operario, D (2008) Effects of stigma on the mental health of adolescents orphaned by AIDS. Journal of Adolescent Health 42 (4) 410-418 • Cluver, L, Gardner, F & Operario, D (2007). Psychological distress amongst AIDS-orphaned children in urban South Africa Journal of Child Psychiatry & Psychology & Allied Disciplines 48(8) 755-763 • Cluver, L & Operario (2008) Review: Intergenerational linkages of AIDS: Vulnerability of orphaned children for HIV infection. Institute of Development Studies Bulletin, 39(5) 28-35 • Cluver, L & Gardner, F (2007) The Mental Health of Children orphaned by AIDS: A review of International and South African Research. Journal of Child and Adolescent Mental Health 19(1) 1-17 • Cluver, L. & Gardner, F. (2007) Risk and protective factors for well-being of children orphaned by AIDS in Cape Town, South Africa: a qualitative study of children’s views AIDS Care 19(3) 318-325. • Cluver, L. & Gardner, F. (2006) Psychological well-being of children orphaned by AIDS in Cape Town, South Africa Annals of General Psychiatry. 5, 8. BioMed Press. • Cluver, L, Gardner, F & Operario, D (2009). Effects of caregiving on psychological distress amongst AIDS-orphaned children in South Africa. Vulnerable Children and Youth Studies • Richter, L, Stein, A and Cluver, L (2009) Infants and young children affected by AIDS. HIV/AIDS in South Africa 25 years on: Psychosocial perspectives. EdsRohleder, P, Swartz, L, Kalichman, S, Simbayi, L. Springer Press. • Operario, D, Cluver, L, Pettifor, A, MacPhail, C and Rees, H (2008) Orphanhood and Completion of Compulsory School Education Among Young People in South Africa. Journal of Research on Adolescence 18(1), 173-186 • Operario, D, Pettifor, A, Cluver, L, MacPhail, C and Rees, H (2007),Prevalence of Parental Death among young people in South Africa and Risk for HIV Infection: Results from a National Representative Sample. Journal of Acquired Immune Deficiency Syndromes (JAIDS) 44, 93-98. • Cluver, L, Orkin, M., Boyes, M. E., Madisha, L., and Baban, R. (in press). Child development in sub-Saharan Africa: Identifying challenges and planning solutions. In M. Tomlinson, C. Hanlon, L. Swartz, P. Cooper, and A. Sameroff (Eds). Infant and child development in Africa: Perspectives from the continent. City • Cluver, L, Kganakga, M, Boyes, M (in press) ‘Children affected by HIV/AIDS: Psychsocial Interventions for School-Aged Children’. EdsSherr, L, Heyman, J, Kidman, R. Children Affected by AIDS: Moving from Research to Action. Oxford University Press. • Cluver, L (2011)‘Children of the AIDS pandemic’. Nature, 474 27-29. • Boyes, M. E. & Cluver, L. (2012). Performance of the Revised Children's Manifest Anxiety Scale in a sample of children and adolescents from poor urban communities in Cape Town. European Journal of Psychological Assessment • Boyes, M, Mason, S, & Cluver, L (2012). Validation of a brief stigma-by-association scale for use with HIV/AIDS-affected youth in South Africa. AIDS Care. • Cluver, L, Orkin, M, Boyes, M & Gardner, F (2012) Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychiatry and Psychology. • Cluver, L, Orkin, M, Boyes, M, Gardner, F, & Meinck, (2011) ‘Transactional Sex amongst AIDS-orphaned and AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty’. JAIDS • Cluver, L, Orkin, M, Boyes, M & Gardner, F (2011) Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychiatry and Psychology. • Cluver, L, Operario, D, Lane, T, Kganakga, M (2011). Educational shortfalls among ‘Young Carers’ in the South African AIDS Epidemic. Journal of Adolescent Research. • Kuo, C, Operario, D & Cluver. L (in press) Depression amongst carers of AIDS-orphaned and other children in Umlazi Township, South Africa. Global Public Health. • Cluver, L, Bowes, L & Gardner, F (2010) Risk and protective factors for bullying victimisation amongst AIDS-affected and vulnerable children in South Africa. Child Abuse and Neglect • Cluver, L & Orkin, M (2009) Stigma, bullying, poverty and AIDS-orphanhood: Interactions mediating psychological problems for children in South Africa. Social Science and Medicine. • Cluver, L, Finch, D & Seedat, S (2009) Predictors of post-traumatic stress symptomology amongst AIDS-orphaned children. Journal of Traumatic Stress, 22 (2) 106-113 • Cluver, L, Gardner, F & Operario, D (2009). Effects of poverty on the psychological health of AIDS-orphaned children. AIDS Care 21 (6) 732-741 • Operario, D, Underhill, K, Chuong, C, Cluver, L. (2011) HIV infection and sexual risk behaviour among youth who have experienced orphanhood: systematic review and meta-analysis. Journal of the International AIDS Society, 14, 25.

  27. Thank you. www.youngcarers.org.za The Economic & Social Research Council HEARD, University of KwaZulu-Natal National Department of Social Development The Nuffield Foundation The Claude Leon Foundation The John Fell Fund The National Research Foundation

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