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Maternal HIV Does Not Affect Resiliency among South African Children from Birth to 5 Years of Age

Sat, March 23, 2:30 to 4:00pm, Hilton Baltimore, Floor: Level 2, Key 9

Integrative Statement

“Resiliency” is most often assessed in high income countries, typically among cross-sectional samples, and predominantly based only on children’s behavior. In these contexts, resilience is defined as coping and adaptation following adverse events that threaten development. However, we define resiliency multi-dimensionally based on observations over five years among South African children in low-income townships. Few recent studies consider longitudinal patterns of risk and resilience based on repeated measures of youth, with even less research in low and middle-income countries (LMICs), especially in contexts of widespread poverty and a generalized HIV epidemic both of which threatens healthy development of more than one third of South African children and ultimately resilience.

The aim of the study was to investigate which sociodemographic factors, maternal risk behaviors, protective behaviors, and migration indicators predicted resilience in children living in a peri-urban area of South Africa.

Pregnant women (98%; N=1238; n=407 mothers living with HIV [MLH]) in 24 matched neighborhoods in periurban Khayelitsha, South Africa were recruited and randomized by neighborhood to either: (1) a standard care condition; or (2) a paraprofessional home-visiting intervention condition. About 30% of households migrated to the rural Eastern Cape. Mothers and children were assessed repeatedly with high follow-up rates (92%-85%) at 2 weeks, 6, 18, 36, and 60 months post-birth.

Resilient children were identified based on being consistently normal in growth, cognitive functioning, and behavior. These were examined as predictors of child resiliency over time using χ2 analyses. For our initial analyses, we compared the distribution of each child outcome measurements at each time point by resilient and non-resilient groups using t-tests. We then examined key sociodemographic factors, maternal risk behaviors, protective behaviors, and migration indicators between resilient and non-resilient children, stratified by maternal HIV serostatus and neighborhood prevalence clusters.

MLH have similar rates of resilient children (19%) as their uninfected peers (16%) and having home visits was unrelated to resiliency. Resiliency was significantly associated with food security (p = 0.02), not having a live-in partner (p = 0.02), and the absence of maternal risk behaviors (i.e., never depressed [p = 0.01]; and no intimate partner violence [p = 0.02]). Three neighborhood clusters with low percentages of resilient children (11%) and one with an atypically high percentage of resilient children (27%) were compared. In neighborhoods with atypically high resiliency, migrating to the rural Eastern Cape and having the mother raise the child occurred more often than in low-resilience neighborhoods.

Despite facing significant adversity in the townships, nearly one in five children in these analyses are resilient. The current study extends the literature on childhood resiliency in both the methodology used and the population examined. This study applies the dynamic model of resiliency to a representative population of children in a LMIC by assessing growth, cognition, and behavior over the first five years of life. Moreover, our novel approach includes defining early childhood resilience as children who consistently achieve healthy growth and cognition, as well as who exhibit positive social behaviors based on globally-recognized developmental patterns across the first five years of life.

Authors