1. FOR SALE Transactional sex in South African children
predicted by familial HIV/AIDS,
abuse and hunger
Cluver, L, Orkin, M, Boyes, M, Kganakga, M, Gardner, F, Makhazi, D, Sherr, L

2. FOR SALE Transactional sex in South African children
predicted by familial HIV/AIDS,
abuse and hunger
A SERIAL KILLER.
Cluver, L, Orkin, M, Boyes, M, Kganakga, M, Gardner, F, Makhazi, D, Sherr, L

3. Collaborative research: Science to inform Policy
Collaborative OVC research programme
Universities: Oxford, Wits, UCT, UKZN
NACCA, NGOs e.g. USAID, UNICEF, REPSSI, Save the Children

4. Linked longitudinal studies, 2005-2012: n=7873 children
Orphan resilience study ( )
2005: N=1021 (aged 10-18), 71.5% follow-up
3 provinces South Africa
National Young Carers study ( )
Main study: N=6002 (age: 10-18), pilot: 850 children,
6 randomly-selected sites >30% prevalence, 3 provinces
Urban/rural, 1 year follow-up
Stratified random sampling of census enumeration or tribal areas
2500 matched child-caregiver pairs
Measures and analysis
Standardised scales, national surveys (census, DHS etc.)
Verbal autopsy method (sensitivity 83%, specificity 75%)
Comparing AIDS-orphaned/other orphaned/non-orphaned/parental AIDS-illnesss/other-illness/non-illness.
Multivariate logistic regression, log-linear models, structural equation models, all controlling for socio-demographics

5. FOR SALE
THE SCENE OF THE CRIME…

6. Parental HIV/AIDS predicts child sexual risks

7. Parental HIV/AIDS predicts child sexual risks

8. Parental HIV/AIDS predicts transactional sex

9. IDENTIFYING LIKELY SUSPECTS.
FOR SALE
IDENTIFYING LIKELY SUSPECTS.

10. Parental HIV/AIDS predicts food insecurity

11. Parental HIV/AIDS predicts child stigmatization

12. Parental HIV/AIDS predicts child maltreatment

13. Parental HIV/AIDS predicts child psychological disorder

14. FOR SALE
UNCOVERING COLLUSION...

15. Cumulative impacts of parental HIV/AIDS, abuse and hunger on child transactional sex

16. Increased risk factors, increased child risk of transactional sex

17. Cumulative impacts 15-25 year olds
Cluver, L, Orkin, M, Boyes et al, (2011) ‘Transactional Sex amongst AIDS-orphaned & AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty’. JAIDS

18. Pathways of risk for AIDS-affected children
(structural equation modeling)
AIDS-orphan
Education risks
.13
.06
Poverty
.18
.10
.32
Stigma
Psych.
distress
.12
.24
.43
.08
.22
.14
.72
Abuse
.15
.15
.15
AIDS-sick parent
SEXUAL HEALTH RISKS
mean χ2(679)
Bollen-Stine
mean χ2/df
RMSEA
SRMR
CFI
TLI
640.06
p=.001
1.57
.032
.044
.939
.930

19. Pathways of risk for AIDS-affected children
AIDS-orphan
Education risks
.13
.06
Poverty
.18
.10
.32
Stigma
Psych.
distress
.12
.24
.43
.08
.22
.14
.72
Abuse
.15
.15
.15
AIDS-sick parent
SEXUAL HEALTH RISKS
mean χ2(679)
Bollen-Stine
mean χ2/df
RMSEA
SRMR
CFI
TLI
640.06
p=.001
1.57
.032
.044
.939
.930

20. Pathways of risk for AIDS-affected children
AIDS-orphan
Education risks
.13
.06
Poverty
.18
.10
.32
Stigma
Psych.
distress
.12
.24
.43
.08
.22
.14
.72
Abuse
.15
.15
.15
AIDS-sick parent
SEXUAL HEALTH RISKS
mean χ2(679)
Bollen-Stine
mean χ2/df
RMSEA
SRMR
CFI
TLI
640.06
p=.001
1.57
.032
.044
.939
.930

21. Pathways of risk for AIDS-affected children
AIDS-orphan
Education risks
.13
.06
Poverty
.18
.10
.32
Stigma
Psych.
distress
.12
.24
.43
.08
.22
.14
.72
Abuse
.15
.15
.15
AIDS-sick parent
SEXUAL HEALTH RISKS
mean χ2(679)
Bollen-Stine
mean χ2/df
RMSEA
SRMR
CFI
TLI
640.06
p=.001
1.57
.032
.044
.939
.930

22. Pathways of risk for AIDS-affected children
AIDS-orphan
Education risks
.13
.06
Poverty
.18
.10
.32
Stigma
Psych.
distress
.12
.24
.43
.08
.22
.14
.72
Abuse
.15
.15
.15
AIDS-sick parent
SEXUAL HEALTH RISKS
mean χ2(679)
Bollen-Stine
mean χ2/df
RMSEA
SRMR
CFI
TLI
640.06
p=.001
1.57
.032
.044
.939
.930

23. Pathways of risk for AIDS-affected children
AIDS-orphan
Education risks
.13
.06
Poverty
.18
.10
.32
Stigma
Psych.
distress
.12
.24
.43
.08
.22
.14
.72
Abuse
.15
.15
.15
AIDS-sick parent
SEXUAL HEALTH RISKS
mean χ2(679)
Bollen-Stine
mean χ2/df
RMSEA
SRMR
CFI
TLI
640.06
p=.001
1.57
.032
.044
.939
.930

24. Pathways of risk for AIDS-affected children
AIDS-orphan
Education risks
.13
.06
Poverty
.18
.10
.32
Stigma
Psych.
distress
.12
.24
.43
.08
.22
.14
.72
Abuse
.15
.15
.15
AIDS-sick parent
SEXUAL HEALTH RISKS
mean χ2(679)
Bollen-Stine
mean χ2/df
RMSEA
SRMR
CFI
TLI
640.06
p=.001
1.57
.032
.044
.939
.930

25. Implications for intervention
Children in AIDS-affected families at higher risk for sexual exploitation and HIV-infection.
Preventing transactional sex for AIDS-affected children needs social protection not behavioral interventions
Interactive model of risk shows modifiable pathways from familial AIDS to child sex risk.
Reducing extreme poverty, abuse, stigma and psychological distress could interrupt these risk pathways
Social protection programs must be HIV-sensitive: both to children in AIDS-affected families, and to HIV risk outcomes.

26. Cluver, L (2011)‘Children of the AIDS pandemic’. Nature, 474 27-29.
Boyes, M. E. & Cluver, L. (2012). Performance of the Revised Children's Manifest Anxiety Scale in a sample of children and adolescents from poor urban communities in Cape Town. European Journal of Psychological Assessment
Boyes, M, Mason, S, & Cluver, L (2012). Validation of a brief stigma-by-association scale for use with HIV/AIDS-affected youth in South Africa. AIDS Care.
Cluver, L, Orkin, M, Boyes, M & Gardner, F (2012) Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychiatry and Psychology.
Cluver, L, Orkin, M, Boyes, M, Gardner, F, & Meinck, (2011) ‘Transactional Sex amongst AIDS-orphaned and AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty’. JAIDS
Cluver, L, Orkin, M, Boyes, M & Gardner, F (2011) Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychiatry and Psychology.
Cluver, L, Operario, D, Lane, T, Kganakga, M (2011). Educational shortfalls among ‘Young Carers’ in the South African AIDS Epidemic. Journal of Adolescent Research.
Kuo, C, Operario, D & Cluver. L (in press) Depression amongst carers of AIDS-orphaned and other children in Umlazi Township, South Africa. Global Public Health.
Cluver, L, Bowes, L & Gardner, F (2010) Risk and protective factors for bullying victimisation amongst AIDS-affected and vulnerable children in South Africa. Child Abuse and Neglect
Cluver, L & Orkin, M (2009) Stigma, bullying, poverty and AIDS-orphanhood: Interactions mediating psychological problems for children in South Africa. Social Science and Medicine.
Cluver, L, Finch, D & Seedat, S (2009) Predictors of post-traumatic stress symptomology amongst AIDS-orphaned children. Journal of Traumatic Stress, 22 (2)
Cluver, L, Gardner, F & Operario, D (2009). Effects of poverty on the psychological health of AIDS-orphaned children. AIDS Care 21 (6)
Operario, D, Underhill, K, Chuong, C, Cluver, L. (2011) HIV infection and sexual risk behaviour among youth who have experienced orphanhood: systematic review and meta-analysis. Journal of the International AIDS Society, 14, 25.
Cluver, L, Gardner, F & Operario, D (2008) Effects of stigma on the mental health of adolescents orphaned by AIDS. Journal of Adolescent Health 42 (4)
Cluver, L, Gardner, F & Operario, D (2007). Psychological distress amongst AIDS-orphaned children in urban South Africa Journal of Child Psychiatry & Psychology & Allied Disciplines 48(8)
Cluver, L & Operario (2008) Review: Intergenerational linkages of AIDS: Vulnerability of orphaned children for HIV infection. Institute of Development Studies Bulletin, 39(5) 28-35
Cluver, L & Gardner, F (2007) The Mental Health of Children orphaned by AIDS: A review of International and South African Research. Journal of Child and Adolescent Mental Health 19(1) 1-17
Cluver, L. & Gardner, F. (2007) Risk and protective factors for well-being of children orphaned by AIDS in Cape Town, South Africa: a qualitative study of children’s views AIDS Care 19(3)
Cluver, L. & Gardner, F. (2006) Psychological well-being of children orphaned by AIDS in Cape Town, South Africa Annals of General Psychiatry. 5, 8. BioMed Press.
Cluver, L, Gardner, F & Operario, D (2009). Effects of caregiving on psychological distress amongst AIDS-orphaned children in South Africa. Vulnerable Children and Youth Studies
Richter, L, Stein, A and Cluver, L (2009) Infants and young children affected by AIDS. HIV/AIDS in South Africa 25 years on: Psychosocial perspectives. Eds Rohleder, P, Swartz, L, Kalichman, S, Simbayi, L. Springer Press.
Operario, D, Cluver, L, Pettifor, A, MacPhail, C and Rees, H (2008) Orphanhood and Completion of Compulsory School Education Among Young People in South Africa. Journal of Research on Adolescence 18(1),
Operario, D, Pettifor, A, Cluver, L, MacPhail, C and Rees, H (2007), Prevalence of Parental Death among young people in South Africa and Risk for HIV Infection: Results from a National Representative Sample. Journal of Acquired Immune Deficiency Syndromes (JAIDS) 44,
Cluver, L, Orkin, M., Boyes, M. E., Madisha, L., and Baban, R. (in press). Child development in sub-Saharan Africa: Identifying challenges and planning solutions. In M. Tomlinson, C. Hanlon, L. Swartz, P. Cooper, and A. Sameroff (Eds). Infant and child development in Africa: Perspectives from the continent. City
Cluver, L, Kganakga, M, Boyes, M (in press) ‘Children affected by HIV/AIDS: Psychsocial Interventions for School-Aged Children’. Eds Sherr, L, Heyman, J, Kidman, R. Children Affected by AIDS: Moving from Research to Action. Oxford University Press.

27. Thank you. www.youngcarers.org.za
The Economic & Social Research Council
HEARD, University of KwaZulu-Natal
National Department of Social Development
The Nuffield Foundation
The Claude Leon Foundation
The John Fell
Fund
The National Research Foundation