South African AIDS orphans and carers have greater depression, poorer health, need financial help

AIDS orphans in South Africa suffer significantly higher levels of psychological distress than other orphans, and caregivers of AIDS orphans report significantly poorer health than caregivers of other children, according to two studies presented at the Third South African AIDS Conference in Durban, June 5^th-8^th.

South Africa has approximately 1.2 million children who have lost one or both parents to AIDS, and it is estimated that by 2020 one in five children could be orphans if parental deaths continue at the same rate as seen over the past ten years.

A study conducted by Oxford University and Cape Town Child Welfare found high levels of psychological distress in AIDS orphans. The research team, led by Lucie Culver, interviewed 1025 children aged 10-19 in poor neighbourhoods of Cape Town using a standardised questionnaire.

Children orphaned by AIDS were compared with children orphaned by other causes, and non-orphaned children. The researchers collected information on sociodemographic factors and selected poverty indicators, household employment, food security, social security and school access.

They found that children orphaned by AIDS had significantly poorer psychological health than other children in the study, and suffered levels of post-traumatic stress equivalent to those of children experiencing sexual abuse, said Lucie Culver of Oxford University’s Department of Social Policy and Social Work.

AIDS orphans were less likely to have psychological ill health if they lived in a household with access to social security grants, food security and at least one member in employment, suggesting that efforts to alleviate poverty could mitigate the psychological problems manifesting as depression and delinquency in AIDS orphans.

“If AIDS orphans are given enough food, enabled to go to school, and given a social grant, it reduces depression and behavioural problems,” said Lucie Culver, who won a conference award for the study.

A study by the Boston University School of Public Health Centre for International Health and Development found that the caregivers of AIDS orphans were significantly more likely to report ill health and to describe their health as poor, suggesting the high burden being placed on households that are caring for orphaned children.

The research group found that the carers of orphans were older (50 years vs 45 years), less likely to be married or cohabiting, more likely to have cared for a sick adult child in the previous year, and likely to be caring for a larger number of children than the caregivers of non-orphans.

The researchers concluded that caregivers of orphans, already under strain, are more vulnerable than others in society. Orphan caregivers were less likely to be able to lay their hands on a loan to buy enough food for a week through their social networks, suggesting the fragile nature of many of the households now taking the strain of the AIDS crisis in South Africa.

A study in rural Zimbabwe showed that young people aged 16-21 had a significant burden of mental health problems, with AIDS orphans most severely affected. Fifty-one per cent of 1495 young people recruited as part of a larger study were found to have substantial mental ill health as measured by a locally validated mental health scale, and 10% said that they had thought about committing suicide in the previous week.

Mental health symptoms were associated with being stigmatised by others (72% vs 34%), having to work more than others (37% vs 17%), and being given less food 17% vs 6%) (all p=0.0001).

Maternal orphanhood was significantly associated with mental ill health. Cases had lower self-esteem as judged by responses to five questions and were more likely to be sexually active (66% cv 34%). Cases were also more likely to report forced sex or rape (7% vs 3%). Alcohol and drug use was higher among cases ( 60% cv 40%).