Meinck F: Cluver.L & Boyes.M Department of Social Policy and Intervention University of Oxford

1. Department of Social Policy and Intervention
Household illness, poverty and physical and
emotional child abuse victimization: Findings
from South Africa’s first prospective cohort
study
Meinck, F; Cluver, L & Boyes, M

2. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Background
 Large burden of disease in South Africa (5)
 Correlation between violence and poor health (6)
 Association between household illness and child
maltreatment (7)
 Children in families where someone is ill with AIDS are
at higher risk for
 Poverty (Cluver et al 2008)
 Bullying (Cluver et al 2010)
 Stigma (Surkan et al 2010)
 Reduced positive parenting (Lachman et al 2013)
 Physical and emotional abuse (Cluver et al 2011)
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Page 2

3. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Background continued
 Children affected by chronic illness are at higher risk for
 Less positive parenting (Evans et al, 2005)
 Negative family functioning (Steele et al, 1997)
 Poverty (Cluver et al, 2013)
 Family poverty and disability is associated with
 Increased psychological stress (Kuo et al, 2012)
 Reduced positive parenting (Lachman et al, 2013)
 Poorer mental health (Kagotho & Ssewamala, 2012)
 Child conduct problems (Lewis & Hammond, 1996)
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4. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Aims
 Is household chronic illness predictive of
child abuse?
 Are there differences in risk for child
abuse victimisation according to type of
household illness?
 Are these relationships mediated by other
factors, namely poverty and disability?
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5. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Research to inform policy
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Collaborative
OVC research
programme
Universities: Oxford,
Wits, UCT, UKZN
NACCA, NGOs e.g.
UNICEF, REPSSI,
Save the Children

6. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Methodology
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National study of Young Carers in
AIDS-ill homes
Interviewed 3516 children in 2 Provinces,
Followed up 3401 children (97%) at T2,
1095 (31.2%) of them AIDS-affected
482 (13.7%) other chronic illness
Sampling
4 Health Districts,
randomly selected
Census
Enumeration
Areas, Door-to-
door sampling in
areas with HIV-
prevalence 30%+
Measurements
Physical & Emotional Abuse:
UNICEF measures for national level
monitoring of OVC
Sexual Abuse: Items from Juvenile
Victimization Questionnaire
All other items: measures validated
or used in SA

7. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Study sites
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Page 7

8. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Child abuse definition
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PHYSICAL ABUSE EMOTIONAL ABUSE SEXUAL ABUSE
any hitting, slapping
or smacking with
items or hands which
hurt or left marks, or
pulling hair or ears
any insults towards
child or family,
making child feel
unwelcome,
threatening child
inappropriate
touching of sexual
organs, having to
touch other’s
genitals, or forced
sex
monthly or more
frequently
monthly or more
frequently
In the last year

9. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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18.2
19.2
16.6
20.7
5.9
0
5
10
15
20
Physical abuse
monthly or more
frequent
Emotional abuse
monthly or more
frequent
Sexual abuse past
year
Baseline
Follow-up
%ofchildrenreportingabuse Prevalence rates of frequent physical and
emotional abuse
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Page 9

10. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Physical, emotional and sexual abuse
according to family health status for boys
0
5
10
15
20
25
Physical Abuse Emotional Abuse Sexual Abuse
%ofchildrenreportingabuse
Healthy
Other-ill
AIDS-ill
p<.001
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Page 10
p<.001

11. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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0
5
10
15
20
25
Physical Abuse Emotional Abuse Sexual Abuse
%ofchildrenreportingabuse
Healthy
Other-ill
AIDS-ill
Physical, emotional and sexual abuse
according to family health status in girls
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p<.001

12. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Differences in poverty and extent of
disability according to health status
0
10
20
30
40
50
60
70
Poverty Disability Poverty & Disability
%ofchildrenreportingpovertyand/orhigh
levelsofdisability
Healthy
Other-ill
AIDS-ill
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p<.001
p<.001
p<.001

13. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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AbuseAIDS-illness
Disability
Poverty
Hypothesized pathways
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14. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Pathway from family AIDS to physical
abuse for boys and girls
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Page 14
AIDS-illness
Frequent
physical abuse
Disability
Poverty
Indirect Effect:
.046* CI 95% (.019 to .083)
.641* CI 95%
(.491 to .791)
r2= .210
3.790* CI 95%
(3.548 to 4.033)
r2= .250
.071* CI 95%
(.027 to .116)
.030* CI 95%
.004 to .055)
Direct effect:
.276* CI 95% (.060 to .493)
Indirect Effect:
.112* CI 95% (.014 to .205)
-2LL = 2989.48
*significant at p<.05

15. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Pathway from other chronic illness to
physical abuse for boys and girls
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other-illness
Frequent
physical abuse
Disability
Poverty
Indirect Effect:
-.027* CI 95% (-.057 to -.011)
-.368* CI 95%
(-.573 to -.163)
r2= .197
.637* CI 95%
(.267 to 1.008)
r2= .045
.074* CI 95%
(.029 to .118)
.046* CI 95%
(.023 to .068)
Direct effect:
-.294* CI 95% (-.581 to -.007)
Indirect Effect:
.029* CI 95% (.012 to .056)
-2LL = 2991.44
*significant at p<.05

16. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Pathway from family AIDS to emotional
abuse for boys
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AIDS-illness
Frequent
emotional abuse
Disability
Poverty
Indirect Effect:
.091* CI 95% (.042 to .162)
.131* CI 95%
(.066 to 1.97)
.018 CI 95%
(-.019 to .055)
Direct effect:
.409* CI 95% (.089 to .730)
Indirect Effect:
.070 CI 95% (-.081 to .203)
.690* CI 95%
(.460 to .920)
r2= .234
3.867* CI 95%
(3.487 to 4.247)
r2= .262
-2LL = 1364.81
*significant at p<.05

17. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Pathway from other chronic illness to
emotional abuse for boys
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other-illness
Frequent
emotional abuse
Disability
Poverty
Indirect Effect:
-.056* CI 95% (-.116 to -.016)
.138* CI 95%
(.073 to .203)
.040* CI 95%
(.009 to .072)
Direct effect:
-.077 CI 95% (-.472 to .317)
Indirect Effect:
.025* CI 95% (.001 to .064)
-.403* CI 95%
(-.701 to -.104)
r2= .220
.614* CI 95%
(.063 to 1.164)
r2= .065
-2LL = 1370.82
*significant at p<.05

18. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Pathway from family AIDS to emotional
abuse for girls
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AIDS-illness
Frequent
emotional abuse
Disability
Poverty
Indirect Effect:
.055* CI 95% (.024 to .102)
.600* CI 95%
(.402 to .799)
r2= .195
.092 * CI 95%
(.041 to .143)
.017 CI 95%
(-.014 to .048)
Direct effect:
-.019 CI 95% (-.240 to .278)
Indirect Effect:
.066 CI 95% (-.054 to .177)
3.727* CI 95%
(3.413 to 4.042)
r2= .243
-2LL = 2031.00
*significant at p<.05

19. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Pathway from other chronic illness to
emotional abuse for girls
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other-illness
Frequent
emotional abuse
Disability
Poverty
Indirect Effect:
-.032* CI 95% (-.068 to -.007)
-.343* CI 95%
(-.626 to -.061)
r2= .183
.093* CI 95%
(.042 to .144)
.019 CI 95%
(-.009 to .046)
Direct effect:
.038 CI 95% (-.286 to .362)
Indirect Effect:
.012 CI 95% (-.003 to .045)
.8645* CI 95%
(.143 to 1.146)
r2= .031
-2LL = 2030.97
*significant at p<.05

20. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
Please cite or re-use presentation only with permission of the authors.
Summary
 High prevalence rates of child abuse across the different
abuse types
 Children affected by AIDS are at higher risk of physical and
emotional abuse
 Indirect effect of poverty and in cases disability for AIDS-ill
families
 Lower levels of poverty in families affected by other chronic
illness
 Negative indirect effect of poverty and positive indirect
effect of disability in families affected by other chronic
illness
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Page 20

21. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Implications
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 Clear differences in risk for child maltreatment
according to illness type
 Importance of recognizing that illness does not
equal illness when providing services to families
with ill members
 Effective poverty reduction may be key in reducing
child abuse victimisation in AIDS-affected families
 Parenting support my be key in reducing abuse in
families affected by all types of illness

22. Department of Social Policy & Intervention
“Child Abuse in Families affected by AIDS”
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Thank you!
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Page 22
The Economic &
Social Research
Council
The Nuffield
Foundation
The National Research
Foundation
The John Fell
FundThe Claude Leon
Foundation
National Department of
Social Development
HEARD, University
of Kwa-Zulu Natal
Franziska.Meinck@spi.ox.ac.uk
www.youngcarers.org.za
Contact details: