Original article
Effects of Stigma on the Mental Health of Adolescents Orphaned by AIDS

https://doi.org/10.1016/j.jadohealth.2007.09.022Get rights and content

Abstract

Purpose

By 2010, an estimated 18.4 million children in Sub-Saharan Africa will be orphaned by AIDS. Research in South Africa shows that AIDS orphanhood is independently associated with heightened levels of psychological problems. This study is the first to explore the mediating effects of stigma and other factors operating on a community level, on associations between AIDS orphanhood and mental health. We assessed the associations of four risk factors that can potentially be addressed at a community level (bullying, stigma, community violence, and lack of positive activities) with psychological problems and orphanhood status.

Method

One thousand twenty-five participants aged 10–19 were recruited from deprived urban settlements in South Africa. The sample included adolescents orphaned by AIDS (n = 425), adolescents orphaned by non-AIDS causes (n = 241), and nonorphaned adolescents (n = 278). Participants were interviewed using standardized psychological measures of depression, anxiety, posttraumatic stress, peer problems, delinquency, and conduct problems. Information on risk factors and demographic characteristics were also assessed.

Results

AIDS-orphaned adolescents reported higher levels of stigma and fewer positive activities than other groups. There were no reported differences on bullying or community violence. All community-level risk factors were associated with poorer psychological outcomes. Multivariate analyses controlling for age and gender showed that experience of stigma significantly mediated associations between AIDS orphanhood and poor psychological outcomes.

Conclusions

Reduction of AIDS-related stigma could potentially reduce adverse psychological outcomes among AIDS-orphaned adolescents.

Section snippets

Participants

The sample comprised 1025 children and adolescents: 425 were orphaned by AIDS, 241 orphaned by other causes, and 278 who were not orphaned. Eighty-one were excluded from analyses because of uncertainty regarding cause of parental death. The study used the UN definition of orphanhood as loss of one or both parents [4], and followed the World Health Organization definition of adolescence as 10 to 19 years [11]. To increase generalizability, we purposively sampled populations unlikely to be

Associations between orphanhood and community risk factors

Descriptive properties of the four measured community risk factors are described in Table 1. Overall levels of bullying and experience of community traumas were high, but showed no group differences. Significant group differences on stigma and positive activities were observed. One-way ANOVAs showed that AIDS orphans reported significantly more stigma than other orphans (p < .001), and that other orphans reported more stigma than nonorphans (p < .001). AIDS orphans were more likely to report

Discussion

This study highlights the emergence of a group at high risk of adverse psychological outcomes. AIDS-orphaned adolescents have been shown to be at particular risk for mental health problems of depression, peer problems, posttraumatic stress disorder, and behavior problems. Levels of anxiety showed no differences, perhaps reflecting the exceptionally high levels of community violence affecting most children in the study areas, irrespective of orphan group [23]. AIDS-orphaned children are also at

Conclusions

It is crucial that policies are developed to address psychological distress experienced by AIDS-orphaned adolescents. Although some factors addressable at a community level, such as reducing bullying and exposure to community trauma, and increasing positive activities, have potential to improve mental health more generally, AIDS-related stigma was shown to be particularly relevant to AIDS orphans, and to have strong predictive effects on psychopathology. It is essential that interventions are

Acknowledgments

This study was undertaken in collaboration between Oxford University and Cape Town Child Welfare Society. The study was made possible by support from the UK Economic and Social Research Council. The authors wish to thank the children who participated in the study, and their families, the participating schools and organizations, and interviewers. Also thanks to Brendan Maughan-Brown and Harriet Deacon. L. Cluver conceived of the study and conducted fieldwork and analyses. F. Gardner assisted

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