AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #137 - Abuse and familial AIDS predict 15-fold risk of transactional sex amongst girls in South Africa: Prospective longitudinal study
Authors: Presenting Author: Dr Lucie Cluver - Oxford University
Additional Authors: Prof. Mark Orkin, Prof. Frances Gardner, Ms. Franziska Meinck, Dr. Malega Kganakga,
Aim: Little is known about impacts of familial HIV/AIDS on abuse and sexual health outcomes amongst youth in sub-Saharan Africa. Aims of the study were i) to determine whether AIDS-orphanhood and caregiver AIDS-sickness predicted child physical, emotional and sexual abuse or transactional sex and ii) to determine whether exposure to both familial AIDS and abuse had a cumulative impact on likelihood of transactional sex.
Method / Issue: A prospective 4-year longitudinal study (n=1025, 73% retention; 2005-2009) of AIDS-orphaned, other-orphaned and non-orphaned children, and of children with AIDS-sick, other-sick and healthy caregivers in poor, urban areas of South Africa. Standardised measures of abuse, sexual risk behaviour and sociodemographic variables were used, and data were analysed with multivariate linear and logistic regression.
Results / Comments: AIDS-orphanhood and parental AIDS-sickness both predicted emotional abuse (p <.001 B.18; p <.001 B.15 respectively), physical abuse (p <.04 B.08; p <02 B.11 respectively), and for females, transactional sexual exploitation (p <.007 B.17; p <.013, B.16), independently of sociodemographic cofactors, and measured at both 2005 and 2009. Orphanhood and parental sickness by non-AIDS causes, and having healthy, surviving parents did not predict any abuse or transactional sexual exploitation outcomes. AIDS-affected children showed no other sexual risk behaviours, suggesting the possibility of different mechanisms to transactional sex amongst this group. A cumulative effect of familial AIDS and AIDS-bereavement was shown, whereby children affected simultaneously by both AIDS-orphanhood and caregiver sickness showed threefold likelihood of emotional abuse (23% compared to 7%; chi-sq 17.5 p <.001), threefold likelihood of physical abuse (12.3% compared to 4.6%; chi-sq 6.1 p <.05) and fivefold likelihood of transactional sexual exploitation (15.4% compared to 2.9%; chi-sq 18.8 p <.001), compared to children in healthy families. In light of heightened risk for abuse amongst AIDS-affected families, we examined potential effects of exposure to both familial AIDS and abuse on risk of transactional sex. Cumulative and long-term effects were shown: Exposure to both abuse and caregiver AIDS-sickness raised prevalence of transactional sex amongst girls fifteen-fold: from 3% to 46%. Prospective analyses showed that these same risk factors at 2005 also predicted transactional sex at 2009, suggesting long-term cumulative effects of abuse and familial AIDS on sexual risk amongst youth.
Discussion: This study identifies AIDS-affected adolescents as highly vulnerable to abuse and exploitation. Familial AIDS and abuse have a strong cumulative effect on risk of transactional sex, particularly amongst girls. International research has demonstrated that both child abuse and transactional sex are risk factors for later HIV-infection, and these findings thus suggest a potential mechanism of intergenerational vulnerability to HIV. These findings have implications for policy and programming in child protection and HIV services.
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