Effect of Savings-Led Economic Empowerment on HIV Preventive Practices among Orphaned Adolescents in Rural Uganda: Results from the Suubi-Maka Randomized Experiment

Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. 

Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents' cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10-17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. 

Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US 12.32, ±1.12) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group. The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home, pursue vocational training, and start a business. Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores, most commonly toward perceived risk of HIV (95.8%), sexual abstinence or postponement (91.6%), and consistent condom use (93.4%). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score. 

To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.

Purchase full article at:  http://goo.gl/ghiOMJ

By:  Jennings L1, Ssewamala FM2, Nabunya P3.

• 1 Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
• 2 International Center for Child Health and Asset Development , Columbia University School of Social Work , New York , NY , USA.
• 3 School of Social Service Administration , University of Chicago , Chicago , IL , USA.

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Treating Unresolved Grief and Posttraumatic Stress Symptoms in Orphaned Children in Tanzania: Group-based Trauma-focused Cognitive Behavioral Therapy

The study was designed to test the feasibility and child clinical outcomes for a group-based application of Trauma-focused Cognitive Behavior Therapy (TF-CBT) for orphaned children with unresolved grief in Moshi, Tanzania. 

Sixty-four orphaned children with at least mild symptoms of unresolved grief and/or traumatic stress and their guardians participated in the open trial. The evidence-based TF-CBT protocol was adapted for group delivery, resulting in 12 weekly sessions for child and guardians separately with conjoint activities and three individual visits. Using a task-sharing approach, the intervention was delivered by lay counselors with no prior mental health experience. Primary outcomes assessed were symptoms of unresolved grief and posttraumatic stress (PTS); secondary outcomes included symptoms of depression and overall behavioral adjustment. All assessments were conducted pre-treatment, post-treatment, and 3- and 12-months after the end of treatment. 

Results showed improved scores on all outcomes post-treatment, sustained at 3 and 12 months. Effect sizes (Cohen’s d) for baseline to post-treatment were 1.36 for child reported grief symptoms; 1.87 for child-reported PTS, and 1.15 for caregiver report of child PTS.

Below:  Scatterplots comparing baseline and post-treatment the Posttraumatic Stress Disorder Reaction-Index (PTSD-RI), the Strengths and Difficulties Questionaire (SDQ), the Short Mood and Feelings Questionaire (SMFQ), and the Grief Screening Scale (GSS) scores for guardian and child participants

Full article at: http://goo.gl/Nmq5Xb

By: Karen O’Donnell, Shannon Dorsey, Wenfeng Gong, Jan Ostermann, Rachel Whetten, Judith A. Cohen, Dafrosa Itemba,Rachel Manongi, and Kathryn Whetten

The Center for Child and Family Health, Duke University;

More at:  https://twitter.com/hiv_insight

Sexual Behavior among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer, Psychosocial Support, and Entrepreneurship

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. 

Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. 

• Significant predictors of increased female sexual activity included 
• less program exposure, 
• higher age, 
• younger age at most recent parental death, 
• fewer years of schooling, 
• higher food consumption, 
• higher psychological resilience, 
• and lower general self-efficacy. 
• Significant predictors of increased male sexual activity included 
• more program exposure, 
• higher age, 
• better food consumption, 
• having a living father, 
• and literacy. 

Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. 

Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission.

Via: http://goo.gl/680j1q  Purchase full article at: http://goo.gl/Sjuxg6

By: Goodman ML1,2,3, Selwyn BJ2, Morgan RO2, Lloyd LE2, Mwongera M4, Gitari S4, Keiser PH3.

• 1a Sodzo International.
• 2b Division of Management, Policy and Community Health, School of Public Health , University of Texas , Houston.
• 3c Center for Global Health Education , University of Texas Medical Branch , Galveston.
• 4d Community Health Department , Maua Methodist Hospital , Meru County , Kenya 

More at:  https://twitter.com/hiv_insight

Predictors of Mental Health Resilience in Children Who Have Been Parentally Bereaved by AIDS in Urban South Africa

Children parentally bereaved by AIDS experience high rates of mental health problems. However, there is considerable variability in outcomes, and some show no mental health problems even when followed over time. Primary aims were to identify predictors of resilient adaptation at child, family and community levels within a group of AIDS-orphaned children, and to consider their cumulative influence. A secondary aim was to test whether predictors were of particular influence among children orphaned by AIDS relative to non-orphaned and other-orphaned children. 

AIDS-orphaned (n = 290), other-orphaned (n = 163) and non-orphaned (n = 202) adolescents living in informal settlements in Cape Town, South Africa were assessed on two occasions 4 years apart (mean age 13.5 years at Time 1, range = 10-19 years). Self-report mental health screens were used to operationalise resilience in AIDS-orphaned children as the absence of clinical-range symptoms of PTSD, anxiety, depression, conduct problems, and suicidality. 

A quarter of AIDS-orphaned children (24 %) showed no evidence of mental health problems at either wave. Child physical health, better caregiving quality, food security, better peer relationship quality, and lower exposure to community violence, bullying or stigma at baseline predicted sustained resilience. 

There were cumulative influences across predictors. Associations with mental health showed little variation by child age or gender, or between orphaned and non-orphaned children. Mental health resilience is associated with multiple processes across child, family and community levels of influence. Caution is needed in making causal inferences.

Via: http://ht.ly/Sdsu7 

By: Collishaw S1, Gardner F, Lawrence Aber J, Cluver L.
1Child and Adolescent Psychiatry, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK