AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #151 - Predictors of resilience amongst AIDS-orphaned children in South Africa: testing Richter, Foster & Sherr’s ecological model with longitudinal data
Authors: Presenting Author: Dr Lucie Cluver - Oxford University
Additional Authors: Dr. Stephan Collishaw, Prof. Frances Gardner, Prof. Larry Aber,
Aim: AIDS-orphaned children have elevated risk of psychological disorder and other associated difficulties. It is therefore valuable to determine predictors of resilience – defined as ‘positive adaptation despite exposure to clearly defined and severe risk’, although to date no known quantitative studies have specifically examined this. Richter, Foster and Sherr in their book ‘Where the Heart is’ (2006) outlined an ecological model of promoting resilience amongst orphaned and vulnerable children, identifying caregiver, family, community and service-level supports. This study aimed to empirically test this model in explaining routes to resilience amongst AIDS-orphaned children over a four year period.
Method / Issue: A prospective longitudinal study design in in high-deprivation, urban areas of South Africa. 1025 youth (50% female, 10-19 years) were interviewed in 2005 and re-interviewed in 2009 (71% retention). Socio-demographics were measured, and standardized psychological scales assessed depression, anxiety, post-traumatic stress, suicidality, delinquency and conduct disorder. Comparison groups were AIDS-orphaned, other-orphaned, and non-orphaned youth, and mental health resilience was operationalized as having no internalizing or externalizing disorder, and no suicidality over four years. Data were analyzed using bivariate and multivariate logistic regression.
Results / Comments: Strong support was shown for Richter, Foster and Sherr’s ecological model. AIDS-orphaned youth showed lower rates of resilience (24%) than other-orphaned (36%) and non-orphaned (41%, p <.001). Mental health resilience was correlated with resilience to sexual and educational risks over four years. Bivariate analyses showed predictors of resilience in all spheres identified in the ecological model: the caregiver sphere (i.e. positive parenting p <.02, joint activities p <.02), family sphere (i.e. lack of domestic conflict p <. 007), community sphere (i.e. sense of community belonging p <.03, not being bullied, p <.001 or stigmatized, p <.001) and at the provision level (i.e. food insecurity, p <. 001). Multivariate analyses showed parenting, poverty and stigma factors to be strongest predictors of resilience.
Discussion: Resilience is a central concept in the development of interventions to improve psychosocial outcomes for AIDS-affected children. Richter, Foster and Sherr’s ecological model, adapted from Bronfenbrenner (1979) suggests that improvements in the quality and stability of care by families can compensate for negative impacts of risk exposure. Importantly, families need access to community and economic support in order to promote resilience amongst the children they care for.
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