An evidence-based approach towards promoting health and social justice among orphan carers in a high HIV prevalence community in South Africa

Background Substantial attention focuses on challenges associated with AIDS-orphanhood in sub-Saharan Africa, including programs exclusively for orphans and remaining family. Interventions single out AIDS-orphan carers based on the assumption that they face the worst vulnerabilities but this may be inconsistent with an evidence-based approach towards health and social justice. The largest survey conducted on AIDS-orphan carers compares health of AIDS-orphan, other-orphan, and non-orphan carers to determine whether AIDS-exclusivist interventions promote health and social justice in disadvantaged groups. Methods A cross-sectional survey of 1599 adult primary carers was conducted from August 2008-February 2009 in Umlazi, South Africa (HIV prevalence 41.6%). Random sampling of enumeration areas and visits to all households resulted in a representative sample. Using validated measures of general health, depression, and post-traumatic stress, analyses tested differences between AIDS-orphan (n=359), other-orphan (n=171), and non-orphan carers (n=1069) using Pearson's chi-square. Multivariate analyses identified risk and protective factors. Results Participants were African, female (86%), with an average age of 39 years (sd=14). All orphan carers had worse general health and depression than non-orphan carers (p<0.01). AIDS-orphan carers experienced the worst general health and depression; other-orphan carers experienced the worst post-traumatic stress (p<0.01). Risk and protective factors associated with physical and psychological health included economic assets, social grants, employment, and housing. Recommendations AIDS-orphan and other-orphan carers experienced greater health disadvantages than non-orphan carers. AIDS-exclusivist approaches overlook an intervention opportunity for other-orphan carers. South African interventions should be designed for all orphan carers based on modifiable risk and protective factors identified in this research.