HIV+ and HIV– youth living in group homes in South Africa need more psychosocial support

Abstract

Orphans and vulnerable youth who live in group homes are at risk of poor mental health and sexual and drug-using behaviors that increase the risk of HIV transmission. This study explores factors related to this risk among youth living in group homes (“children’s homes”) for orphans and vulnerable children in South Africa, a country afflicted by high levels of parental loss due to HIV. The study explores 1) knowledge and attitudes about HIV, 2) social support, 3) communication with group home caregivers, and 4) the relevance of an existing evidence-based HIV prevention and mental health promotion program to situations where sexual and drug risk behaviors can occur. In-depth qualitative individual interviews were conducted with 20 youth (age 10 to 16 years) residing in two children’s homes in Durban, South Africa. Content analysis focused on critical themes related to coping and prevention of risk activities. Respondents exhibited inconsistent and incomplete knowledge of HIV transmission and prevention. They displayed positive attitudes toward people living with HIV, but reported experiencing or witnessing HIV-related stigma. Participants witnessed substance use and romantic/sexual relationships among their peers; few admitted to their own involvement. While relationships with childcare workers were central to their lives, youth reported communication barriers related to substance use, sex, HIV, and personal history (including parental loss, abuse, and other trauma). In conclusion, these qualitative data suggest that evidence-based HIV prevention programs that bring caregivers and youth together to improve communication, HIV knowledge, social support, youth self-esteem, and health care, reduce sexual and drug risk behaviors, and strengthen skills related to negotiating situations of sexual and substance use possibility could benefit youth and childcare workers in children’s homes.

‘They became my second family’: Children's relational lives and relationship‐based practice in residential care in the Philippines

“…This is understandable, given the broad parental responsibilities and roles, such as caring and teaching that caregivers can offer in these settings (Yendork & Somhlaba, 2015). Research also identifies major issues for children living in residential care when caregivers and staff do not provide these roles, leading to issues around children's safety, development and well-being (Carpenter, 2015;Nestadt et al, 2013). In most cases, children and young people have challenging histories and constrained relationships with biological family members, often limited, irregular and outside of the control of children themselves (Khoo et al, 2015).…”

Care-leaving in South Africa: an international and social justice perspective

“…The level of vulnerability of children in South Africa generally is vast, and the range of challenges and risks to all children and young people overwhelming. In addition to the problems already discussed in this article, such as poverty, HIV, orphanhood, child headed households, malnutrition and abuse, children and young people are also at risk of ill health, are exposed to inadequate health care and education services, and are vulnerable to trafficking in persons, exploitation by relatives and sexual exploitation at home and in the wider community, to name but a few of many vulnerabilities (Cluver, Meinck, & Omar, 2014;Hall, 2014aHall, , 2014bJewkes et al, 2006;Lutya, 2009Lutya, , 2010Matthews & Benvenuti, 2014;Nannan, Hall, & Sambu, 2014;Nduna & Jewkes, 2010Nestadt et al, 2013;.…”

A qualitative exploration of psychosocial challenges of perinatally HIV-infected adolescents and families in Bangkok, Thailand

“…Psychosocial challenges faced by Thai PHIV+ youth and their families also identified in other countries included struggles with adherence, disclosure, and communication about HIV, sexual behavior and other sensitive topics (McKay et al, 2007; Mellins et al, 2014; Nestadt et al, 2013; Petersen et al, 2010). However, key cultural nuances that affect how these struggles manifest and impact respondents’ lives also emerged, including well-documented hierarchical expectations that children obey their parents without question or criticism (Cameron, Tapanya, & Gillen, 2006; Limanonda, 1995).…”

“…Two Thai staff members, a social worker and a researcher moderated two hour long groups in Thai in private rooms. Facilitators used semi-structured interview guides based on those used by CHAMP+ researchers previously (Nestadt et al, 2013; Petersen et al, 2010). They were linguistically and culturally adapted to explore key themes including living with HIV, coping, mental health, risk behaviors, parent-child communication, stress, loss, religion and culture, peer relationships, and HIV knowledge, medication adherence, disclosure, and stigma.…”