Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model.

Franziska Meinck,Lucie Cluver,Fm Orkin

doi:10.1002/jia2.25262

Abstract

IntroductionAdolescent girls are at high risk of HIV infection in sub‐Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision.MethodsSelf‐report questionnaires using validated scales were completed by adolescent girls aged 12 to 17 at baseline in two provinces in South Africa in 2011, with a 99% one‐year follow‐up in 2012 (n = 1498). Sampling included every household in randomly selected census enumeration areas of four deprived health districts. Confirmatory factor analysis was employed to identify measurement models and a structural equation model was developed to test pathways of risk and protection.ResultsInternalizing and externalizing mental health distress fully mediated the positive relationship between ACEs at baseline and HIV risk behaviour at follow‐up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow‐up via higher externalizing problems. Free schooling provision at baseline and follow‐up eliminated the pathway from internalizing to externalizing mental health distress by moderating the pathway between ACEs and internalizing mental health distress. It also weakened the pathway from externalizing mental health distress to HIV risk behaviour at follow‐up through a direct negative effect on externalizing mental health distress.ConclusionsReducing ACEs and adolescent mental health distress is essential for reducing HIV risk behaviour among girls in South Africa. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls.

Highlights

Adolescent girls are at high risk of Human immunodeficiency virus (HIV) infection in sub-Saharan Africa
At baseline adolescent girls had a mean age of 14.3 years. 34.3% had a family member ill with AIDS
This study suggests that free education is an important tool to promote mental health among adolescent girls in South Africa, and thereby mitigate pathways to HIV risk behaviour

Summary

Introduction

Adolescent girls are at high risk of HIV infection in sub-Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision. Results: Internalizing and externalizing mental health distress fully mediated the positive relationship between ACEs at baseline and HIV risk behaviour at follow-up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow-up via higher externalizing problems. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls. In sub-Saharan Africa, factors associated with increased HIV risk behaviour include ACEs such as being AIDS-affected, poverty, abuse and psychological distress [5,6]. Actual pathways between ACEs and HIV risk behaviours are not well understood

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