Social Support: Who and What Matters Among Children Affected By HIV in South Africa?

Purpose:   Children affected by HIV are known to have significantly higher rates of mental health disorders than unaffected children.  There is a need for research that examines in depth how social support functions as a source of resiliency for adolescents in high HIV prevalence settings such as South Africa.  The purpose of this research was to explore how family, peers, and community social support relate to depression, anxiety, and post-traumatic stress (PTS).   

Methods:  Using the ecological model as a frame, data were drawn from a longitudinal research study, Young Carers, which began in 2009 among 3,516 adolescents (ages 10-19).  Of these original 3,516 adolescents, 1,380 were classified as either orphaned by AIDS and/or living with an AIDS sick family member, the focus of this research.   The children were from high-poverty and high HIV prevalent rural and urban communities in Mpumalanga and Western Cape Provinces, South Africa.  In all, 18 independent variables were analyzed, including a number of controls and the source of social support (e.g. family, peer, and community) and the social support type (e.g. emotional, instrumental, and quality) to determine predictors of depression, anxiety, and PTS symptoms.  Depression, anxiety, and PTS were measured using standardized scales.  The independent variables were entered into multiple regression analyses (forward block method) to estimate the most parsimonious regression models to best predicts depression, anxiety, and PTS symptoms among these 1,380 children.    

Results:  Several social support source and type variables emerged as predictors of children’s well-being.  Family, and in particular siblings, emerged as the most consistent predictive source of social support on mental health.  Overall family social support explained 14% variance in depression, 11% in anxiety, and 11% in PTS.  Additionally, emotional support was the most frequent type of social support that predicted mental health in all regression models.  Unexpectedly, the higher the level of emotional support received from a sibling, the higher their rates of depression, anxiety, and PTS symptoms.  This contrasted with the emotional support findings from caregivers, peers, and community leaders, where higher levels of emotional support resulted in lower levels of depression, anxiety, and PTS symptoms among the children.  Limited findings emerged that detailed some protective types of social support provided from peers (for depression and PTS) and religious leaders (on depression).  Social support from teachers was not significant on any mental health outcome.  Gender was significant in all regressions, indicating the presence of moderation.

 Implications: Findings suggest that social workers and other professionals should consider social support from a number of sources, but in particular look more closely at the peer and sibling group relationships among children affected by HIV and AIDS, which can foster the resilience of this vulnerable group.  Furthermore, social workers, providers, and policy makers are urged to leverage these mechanisms of support to improve the mental health and resiliency of children.