Lorraine Sherr, Sarah Skeen, Mark Tomlinson, Ana Macedo Exposure to violence and psychological well-being in children affected by HIV/AIDS in South Africa and Malawi Violence against children Violence against children occurs in every society A quarter of adults report being physically abused as children Children exposed to violence more at risk for a number of negative outcomes Substance use Risky sexual behaviour/ HIV infection Perpetrati on of rape and sexual violence Being bullies Being abusive parents Being victims of violence Society Community Family Child Gender inequality High alcohol use Community violence Developmental disability Chronic illness Intimate partner violence Parental substance use HIV stigma/social isolation Shared risk factors for children affected by HIV and violence against children State of the research Sub-Saharan Africa: lack of empirical evidence about the prevalence and risk factors for violence against children Most research from the region on PTSD symptoms in adolescents, mainly South Africa Very little about young children AIM: assess the rates of child violence exposure in homes and communities and link to mental health status in children 4 13y affected by HIV UCL and Stellenbosch University Phase 1 funded by SIDA-NORAD, through HelpAge Supported by Coalition for Children Affected by AIDS Child Community Care study Baseline 989 children and primary caregivers Participation in CBO programme Follow up 15 months later Results: 28 CBOs 24 rural, 4 urban 71.4% set up by people from the community 89.3% services delivered by local people More than half were multiply funded (53.6%). 12 out of 28 had an office space for administration and building and garden to work with children. Sample characteristics 989 children and their carers 84.3% in South Africa Children 4 13 years, M=8.9 (SD=2.84) 48.6% boys 13.7% HIV positive 30.9% lost one parent, 26.7% lost both parents Carers 94.9% female carers, mean age 43.5 (SD=15.0) 19.4% HIV positive High rates of exposure to violence Child depression p0.001 Trauma symptoms p0.0001 Self-esteem p0.0001 Emotional & behavioural problems All p0.0001 p Exposure to violence and delinquent behaviours (10-13y only) p0.001 Harsh discipline and delinquent behaviours (10-13y only) Multivariate analysis: mental health outcomes reported,* Significant at p0.05, ** Significant at p0.01, ***Significant at p South Africa AgeMale HIV positive Domestic violence Comm- unity violence Harsh physical discipline Harsh psych- ological discipline Depressive symptoms *** Trauma symptoms -.23*** * ***.16***0.06 Self Esteem.87*.12** *** ***-0.03 Int & Ext problems ***.07*.08**.07*.24***.12*** Multivariate analysis: delinquent behaviours (age 10-13y only) Predictors of delinquent behaviour: Living in South Africa (Adjusted OR: 3.03, 95% CI: , p