ArticleJournal of the International AIDS Society2019
Does 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.
Article in Journal of the International AIDS Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 21 citations in OpenAlex.
- Associations Between Substance Use, Sexual Violence, Mental Distress, and Sexual HIV Risk Behaviors Among Adolescent Girls and Young Women in Lesotho.AIDS education and prevention : official publication of the International Society for AIDS Education · 2025Article
- Adverse childhood experiences, positive childhood experiences, suicidal thoughts or behaviors and psychological distress among Kenyan youth-an exploratory analysis of the 2019 Kenya Violence Against Children and Youth Survey (VACS).Child abuse & neglect · 2025Article
- Patterns of adverse childhood experiences and their associations with mental distress, substance use and sexual risk behaviors in Sub-Saharan Africa.Child abuse & neglect · 2024Article
- Adverse childhood experiences, mental distress, self-harm and suicidality, and cumulative HIV risk by sex in Lesotho.Child abuse & neglect · 2024Article
- Strong Father-Child Relationships and Other Positive Childhood Experiences, Adverse Childhood Experiences, and Sexual Risk Factors for HIV among Young Adults Aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study.International journal of environmental research and public health · 2023Article
- Relationship between physical activity and behaviour challenges of adolescents in South Africa.The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa · 2023Article
- Adverse childhood experiences, alcohol consumption, and the modifying role of social participation: population-based study of adults in southwestern Uganda.SSM. Mental health · 2022Article
- Adverse Childhood Experiences among a Sample of Youth Living with HIV in the Deep South.International journal of environmental research and public health · 2022Article
- Intervening for HIV prevention and mental health: a review of global literature.Journal of the International AIDS Society · 2021Review
- Adverse childhood experiences, sexual debut and HIV testing among adolescents in a low-income high HIV-prevalence context.AIDS (London, England) · 2019Article
- Does 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.Journal of the International AIDS Society · 2019Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAdolescent 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.
methodsSelf-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.
resultsInternalizing 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.
conclusionsReducing 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.
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