Evaluating the impact of home visiting programs on HIV risk factors among AIDS-affected youth in South Africa

Background: Youth affected by AIDS are at disproportionate risk for HIV infection. To break this cycle, prevention programs must effectively address this population's unique vulnerabilities, including high rates of poverty, psychosocial distress, and a lack of HIV knowledge. Community-based home-visiting programs are a common strategy for supporting AIDS-affected youth; we evaluate their impact on HIV risk factors. Methods: We conducted a longitudinal evaluation of four home-visiting programs operating in rural South Africa. Information was collected for 1472 youth ages 10-17 at program enrollment in 2010 and at follow-up approximately two years later. Frequencies illustrate changes in risk factors over the study period for beneficiaries enrolled in high and low quality programming. Multi-level regression models test for the effect of program quality, controlling for relevant covariates. Results: Economic security, measured through social grant access and food security, increased among beneficiary families over the study period. However, evidence that home visiting played a role was limited: only uptake of the Foster Care Grant was related to program quality (AOR = 3.6; p<0.001). Approximately one third of youth reported depressive symptomology, regardless of survey round or program model. HIV knowledge was similarly unchanged. Finally, sexual debut was not related to program quality. Conclusion: Home visiting programs are a popular feature of programs serving AIDS-affected populations; however, our results suggest that their impact on HIV risk factors is limited. To genuinely address vulnerability, programs need to integrate specific theory- and evidence-informed approaches, potentially including structured therapy and/or HIV peer education tailored to this population.