Abstract
Community-based responses have a lengthy history. The ravages of HIV on family functioning has included a widespread community response. Although much funding has been invested in front line community-based organisations (CBO), there was no equal investment in evaluations. This study was set up to compare children aged 9–13 years old, randomly sampled from two South African provinces, who had not received CBO support over time (YC) with a group of similarly aged children who were CBO attenders (CCC). YC baseline refusal rate was 2.5% and retention rate was 97%. CCC baseline refusal rate was 0.7% and retention rate was 86.5%. 1848 children were included—446 CBO attenders compared to 1402 9–13 year olds drawn from a random sample of high-HIV prevalence areas. Data were gathered at baseline and 12–15 months follow-up. Standardised measures recorded demographics, violence and abuse, mental health, social and educational factors. Multivariate regression analyses revealed that children attending CBOs had lower odds of experiencing weekly domestic conflict between adults in their home (OR 0.17; 95% CI 0.09, 0.32), domestic violence (OR 0.22; 95% CI 0.08, 0.62), or abuse (OR 0.11; 95% CI 0.05, 0.25) at follow-up compared to participants without CBO contact. CBO attenders had lower odds of suicidal ideation (OR 0.41; 95% CI 0.18, 0.91), fewer depressive symptoms (B = -0.40; 95% CI -0.62, -0.17), less perceived stigma (B = -0.37; 95% CI -0.57, -0.18), fewer peer problems (B = -1.08; 95% CI -1.29, -0.86) and fewer conduct problems (B = -0.77; 95% CI -0.95, -0.60) at follow-up. In addition, CBO contact was associated with more prosocial behaviours at follow-up (B = 1.40; 95% CI 1.13, 1.67). No associations were observed between CBO contact and parental praise or post-traumatic symptoms. These results suggest that CBO exposure is associated with behavioural and mental health benefits for children over time. More severe psychopathology was not affected by attendance and may need more specialised input.
Highlights
in both studies [17]. (In) the era of HIV infection, children are increasingly vulnerable
Four community-based organisations (CBOs) were administered by volunteers only
Cumulative deprivation was a summed score of the following: orphanhood, HIV-positive carer, HIV-positive child, child cares for other children, child cares for sick people, child has seen someone being attacked, and child lives in an overcrowded household
Summary
In the era of HIV infection, children are increasingly vulnerable. The high death rate and burden of the illness in those infected–especially in resource-poor settings–has impacted considerably on family life and functioning [1]. In high endemic countries all village children may be touched in some way by the ravages of HIV. These environmental challenges pose a risk for children and their capacity to reach their full developmental potential. Community-based organisations have been used as a response to various health and social needs over time [5]. The growth of community-based organisations (CBOs) to meet the needs of families in the HIV epidemic has been well-documented [7]. An early review failed to identify a single study that met inclusion criteria for evaluation of such interventions to improve the psychosocial well-being of children [9]
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