The Relationships between Stress, Coping Resources, and Psychosocial Functioning Among Perinatally HIV-Infected Adolescents in South Africa

Background: Adolescents living with a perinatal HIV infection (APHs) and their families experience multiple HIV-related stressors that may result in psychological problems and distress. However, despite the high rate of APHs in sub-Saharan Africa, few studies have examined the relationships between HIV-related stressors and psychological functioning in this population. Additionally, there is limited knowledge of psychosocial resources such as adolescent coping abilities and the extent to which these resources may mitigate the adverse effects of HIV-related stressors. To address these gaps, the following research questions were addressed: 1) Are there significant associations between HIV-related stressors (i.e., APH and caregiver HIV-related stigma) and the burden of a child’s illness on the family and psychological distress (i.e., depressive symptoms, anxiety, and self-esteem) among APHs? And 2) Does the adolescent’s ability to cope with adversity significantly moderate the relationship between HIV-related stigma and psychological functioning?

Methods: This cross-sectional study used baseline data from the VUKA Family Program, an RCT conducted with a convenience sample of 315 perinatally HIV-infected adolescents (ages 9-15; 52% female) and their caregivers in KwaZulu Natal, South Africa, between 2011 and 2016. Independent variables included: 1) HIV-related stressors, 2) burden of child’s illness on the family, 3) adolescent’s ability to cope with adversity. Dependent variables were: 1) anxiety, 2) depression, and 3) self-esteem. Data analyses included univariate statistics and a series of multiple regression analyses. All regression models included the following control variables: APH age, APH age at HIV diagnosis, and the number of adults sharing the household.

Results: Analyses indicated that 49% of APHs endorsed ≥5 anxiety symptoms on a 13-point scale. Additionally, most APHs (96 %) endorsed symptoms that were ≥ 5, indicating “elevated depressive symptoms”. Most APHs (92%) scored high on self-esteem (M=86.3; (SD=10.1). Multiple regression analyses indicated that APHs who reported higher levels of HIV-related stigma (b=-.75, p<.001) and APHs whose caregivers reported a greater burden of child illness on family (b=-.17, p=.02) were significantly associated with lower levels of self-esteem. APHs who report higher levels of HIV-related stigma (b=.29, p<.000) were significantly associated with higher anxiety levels. Likewise, caregivers who reported higher levels of HIV-related stigma (b=.11, p<.01) were significantly associated with higher anxiety levels in APHs. Furthermore, APHs who reported higher levels of HIV-related stigma were significantly associated with higher levels of depressive symptoms (b=.11, p<.000). However, the burden of child illness on the family was not significantly associated with anxiety or depressive symptoms. Last, results indicated that the adolescent’s ability to cope with adversity significantly moderated the relationship between HIV-related stigma (experienced by both adolescents and caregivers) on depressive symptoms among APHs (b = −.05; p = .004; b = .04; p =.01, respectively).

Conclusions: Findings suggest the need for interventions that increase access to psychosocial resources to reduce the burden of the child’s illness on the family while enhancing APHs’ ability to cope with HIV-related adversities. Future research may be warranted to identify additional psychosocial resources that enhance the ability to cope with HIV-related stress among APHs.