1. CHILDREN'S POVERTY AND MORBIDITY OVERRIDE AIDS-RELATED ORPHANHOOD IN PREDICTING STIGMA AND BULLYING Pantelic, M., Langhaug, L., Moonga F.,Wespi, K., Ammann, P., and Gschwend, A.

2. 2 UNICEF 2012  55,100 orphans in sub-Saharan Africa  15,000 HIV/AIDS-related orphans BACKGROUND

3. 3 Stigma, bullying Familial HIV/AIDS PovertyMorbidity MULTIPLE ADVERSITIES FACING ORPHANS

4. 4 Stigma Depression Anxiety Bullying Depression Anxiety PTS Conduct problems Suicide ideation + attempts REPERCUSSIONS OF STIGMATIZATION AND BULLYING Boyes & Cluver 2013, Boyes et al. 2014, Geel et al. 2014

5. 5  Little known about what factors stigmatize orphans Existing research identifies AIDS-related orphanhood as a key stigmatizing marker (Boyes & Cluver 2013) Limited programmatic implications Other markers?  Interventions should be sensitive to the needs of orphans RESEARCH RATIONALE

6. 6  How are 3 stigma markers associated with perceived stigma and bullying victimization in Zambian orphans? RESEARCH QUESTION AIDS- related orphanhood Poverty Morbidity

7. 7  Cross-sectional survey (n=957) Swiss Academy for Development  Total population sampling of orphaned adolescents (n=484) ChildFund Zambia registers  5 communities in Kafue District, Zambia  Ethics approval obtained from University of Zambia  Same-sex face-to-face interviews METHOD

8. 8  Stigma: brief Stigma-by-Association scale (Boyes et al. 2012)  Bullying victimization: adapted Multidimensional Peer- Victimization Scale (Mynard & Joseph 2000)  Food insecurity: # of days without food in the past week (Makame et al. 2002, Cluver et al. 2009)  Physical health: past month frequency of somatic complaints  AIDS-related orphanhood: verbal autopsy (WHO 2005) MEASURES

9. 9  15 % lost parent due to HIV/AIDS  25 % reported hunger for 2+ days in past wk  56 % reported 3+ somatic complaints in past mo  72 % reported any perceived stigma  89 % reported any bullying victimization DESCRIPTIVE RESULTS (ORPHAN SAMPLE)

10. 10 Perceived Stigma Bullying Victimization Standardized β Orphaned by AIDS.02.01 Poor health.17***.22*** Food insecurity.23***.16*** ***denotes significance at p<.001 adjusting for age and gender RESULTS

11. 11  Together, poor health and food insecurity accounted for: 10.3 % (R 2 change =.103) of the variation in perceived stigma 9.1 % (R 2 change =.091) of the variation in bullying victimization RESULTS

12. 12 Orphan stigma and bullying scores by food insecurity and health RESULTS

13. 13  AIDS-related orphanhood NOT associated with stigma or bullying victimization in our sample  Extreme poverty and morbidity were associated with stigma and bullying of orphans.  Potential for: Poverty alleviation and health promotion programs Whole-school approaches (Vreeman and Carroll 2007) SUMMARY & IMPLICATIONS

14. 14 Encouraging note: We might not be able to change parental cause of death, but we can affect child poverty and health. SUMMARY & IMPLICATIONS

15. THANK YOU

16. 16  Do orphan poverty and ill health mediate a link between AIDS-related orphanhood and stigma and bullying?  Univariate regressions to check whether AIDS-related orphanhood predicts stigma and/or bullying independently of orphan poverty and orphan health  Again, no associations between AIDS-related orphanhood and the two outcomes were found  No mediation pathway POST HOC CONFIRMATORY ANALYSIS

17. 17  InterVA software, probabilistic epidemiological model  Standard WHO model DETERMINING PARENTAL CAUSE OF DEATH