Open AccessDoes free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model
Author(s) -
Meinck Franziska,
Orkin FM,
Cluver Lucie
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25262
Subject(s) - mental health , medicine , distress , mental distress , poverty , adolescent health , psychiatry , longitudinal study , affect (linguistics) , clinical psychology , psychology , nursing , economics , economic growth , communication , pathology
Adolescent girls are at high risk of HIV infection in sub‐Saharan Africa. Mental health distress, driven by adverse childhood experiences ( ACE s) such as abuse, poverty and family HIV , may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACE s, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision. Methods Self‐report questionnaires using validated scales were completed by adolescent girls aged 12 to 17 at baseline in two provinces in South Africa in 2011, with a 99% one‐year follow‐up in 2012 (n = 1498). Sampling included every household in randomly selected census enumeration areas of four deprived health districts. Confirmatory factor analysis was employed to identify measurement models and a structural equation model was developed to test pathways of risk and protection. Results Internalizing and externalizing mental health distress fully mediated the positive relationship between ACE s at baseline and HIV risk behaviour at follow‐up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow‐up via higher externalizing problems. Free schooling provision at baseline and follow‐up eliminated the pathway from internalizing to externalizing mental health distress by moderating the pathway between ACE s and internalizing mental health distress. It also weakened the pathway from externalizing mental health distress to HIV risk behaviour at follow‐up through a direct negative effect on externalizing mental health distress. Conclusions Reducing ACE s and adolescent mental health distress is essential for reducing HIV risk behaviour among girls in South Africa. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls.