1. a prospective national study Lucie Cluver, Lorraine Sherr, Mark Orkin, Mark Boyes Suicide and AIDS-affected children in South Africa

2. National longitudinal study: 6850 children, 2500 adult caregivers, 2008-2012 Longitudinal national survey Main study: N=6000 (age: 10-18) 3 provinces South Africa; 6 sites >30% prevalence; 5 languages Stratified random sampling of census EAs Every household with a child aged 10-17 Urban/rural, 1 year follow-up in 2 provinces (n=3401, 97% follow-up) Measures Standardised scales: (suicidality: MINI International Psychiatric Interview for children & adolescents) Analyses: Principal components analysis, MV hierarchical logistic regression, multiple mediation in PROCESS Ethics Approved by University of Cape Town, Oxford, KwaZulu-Natal, Province Health & Education Depts Social & health service referrals.for prior HIV risk

3. AIDS- orphan HIV Risk Behaviour Abuse AIDS- sick parent Psych. distress Stigma Poverty.08.13.22.10.15.32.43.72.15.24.12 mean χ 2 (679) Bollen- Stine mean χ 2 /df RMSEASRMRCFITLI 640.06p=.0011.57.032.044.939.930 Family AIDS increases childhood adversities Cluver, Orkin, Boyes, Sherr, Nikelo, Makhasi (2013). Soc. Sci & Medicine. Analyses funded by RIATT. Education risks.18.14 Violence.14.48.21

5. AIDS-related adversities and child suicide attempts: mediated by mental health distress Mental health: clinical levels of depression, anxiety, post-traumatic stress Note: All regression weights are unstandardised. Analysis controls for child age and gender, suicide behaviour at baseline, poverty, living in informal vs. formal housing, urban vs. rural location, and province (all measured at baseline).

6. Family AIDS increases abuse, hunger & violence For already-exposed children, mental health care may reduce suicide risks Together, these raise suicide attempts from 2% - 6% (cumulative OR 2.46 CI 1.00–6.05). We need to mitigate adversities for AIDS- affected families

7. The Nuffield Foundation Funders: thank you. www.youngcarers.org.za National Department of Social Development The National Research Foundation HEARD, University of KwaZulu-Natal The John Fell Fund The Claude Leon Foundation The Economic & Social Research Council Regional Interagency Task Team for Children Affected by AIDS – Eastern & Southern Africa