Franziska Meinck
University of Oxford
Franziska Meinck is a postdoctoral research fellow in the Centre for Evidence-Based Interventions at the University of Oxford. She holds a BA in Social Work, an MSc in Evidence-Based Social Interventions and a DPhil in Social Interventions. Her research focuses on the epidemiology of child abuse in South Africa and on the psychometric properties of child abuse measures.
Objectives: Social protection are policies and programmes aimed at ameliorating economic and social vulnerabilities to poverty and deprivation and considered existential for HIV prevention in sub-Saharan Africa. Studies have examined and shown how social may reduce HIV risks. However, no studies have examined whether social protection may improve outcomes for children with adverse childhood experiences (ACEs). This study investigates pathways from ACEs to HIV-risk behaviours among adolescent girls and explored if access to free schooling may impact these pathways.
Methods: Data from a prospective cohort of 3515 10-17 year old adolescents (56.7% female) was collected in South Africa using validated international measures. Participants were randomly sampled from census enumeration areas with at least 30% HIV-prevalence and followed-up a year later (n=3402, 97% retention, <2.5% refusal rate at baseline). Structural equation modelling focused on all female adolescents aged 11+ (n=1498) to investigate longitudinal pathways from ACEs to HIV risk behaviours and moderation of these pathways.
Results: There was no direct effect of structural deprivation (physical, emotional and sexual abuse, family AIDS and poverty) on HIV risk behaviours (multiple partners, infrequent condom use, and sex drunk or on drugs). Instead, the relationship was fully doubly mediated in sequence by internalising behaviours (depression, anxiety and suicidality) and externalising behaviours (delinquency, peer problems and drug and alcohol use). Access to free schooling (free school, books and school meals) directly reduced risk for externalising behaviour and sexual risk behaviour and moderated the pathway from ACEs to internalising behaviours.
Conclusion: This study finds pathways from ACEs to HIV-risk behaviour via internalising and externalising behaviours among adolescent girls in South Africa. Further it identified potential protective effects of access to free schooling which should be considered in policy efforts to mitigate negative outcomes of ACE exposure.
