Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.
OPTENTIA, Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa.
J Int AIDS Soc. 2019 Mar;22(3):e25262. doi: 10.1002/jia2.25262.
Adolescent girls are at high risk of HIV infection in sub-Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) 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 ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision.
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.
Internalizing and externalizing mental health distress fully mediated the positive relationship between ACEs 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 ACEs 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.
Reducing ACEs 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.
在撒哈拉以南非洲地区，少女感染艾滋病病毒的风险很高。心理健康困扰，如虐待、贫困和家庭艾滋病等不良儿童经历（ACEs），可能是少女感染艾滋病病毒的风险行为的重要驱动因素，而教育可能会减轻这些风险。本研究旨在针对南非少女中的 ACEs、心理健康困扰和艾滋病病毒风险行为之间建立一个基于经验的理论模型，并探讨免费学校教育的提供可能产生的调节作用。
2011 年，在南非两个省份使用经过验证的量表对 12 至 17 岁的少女进行了自我报告问卷调查，2012 年进行了 99%的为期一年的随访（n=1498）。抽样包括在四个贫困卫生区随机选择的普查区的每个家庭。采用验证性因子分析来确定测量模型，采用结构方程模型来检验风险和保护途径。
在随访中，基线时的 ACEs 与艾滋病病毒风险行为之间存在正相关，而内在和外在的心理健康困扰则完全中介了这种关系。内在的心理健康困扰与随访中的性风险增加有关，这是通过更高的外在问题来实现的。基线和随访时的免费学校教育通过调节 ACEs 与内在心理健康困扰之间的途径，消除了内在到外在心理健康困扰的途径。它还通过对外在心理健康困扰的直接负面影响，削弱了外在心理健康困扰与随访中艾滋病病毒风险行为之间的途径。
减少 ACEs 和青少年心理健康困扰对于减少南非少女的艾滋病病毒风险行为至关重要。免费学校教育可能是减少这些问题和减轻弱势少女艾滋病病毒风险的重要工具。
