Echoes of crisis: HIV risk behaviour and responses in the aftermath of multiple crises among South African vulnerable youth in an exploratory longitudinal study

Abstract

The COVID-19 pandemic caused 10.5 million children and adolescents worldwide to lose a caregiver, with South Africa facing this crisis alongside the world's largest HIV epidemic. This study examines how overlapping crises shape HIV-related risk behaviours and mental health among affected young people. Using longitudinal data from 389 participants aged 9-18; researchers assessed HIV risk behaviours, mental health symptoms and social risks at two time points. Half the sample (50.4%) experienced COVID-19-associated orphanhood. Overall, HIV risk behaviours were common, reported by 78.9% at baseline and 73.5% at follow-up. However, reductions occurred only among non-orphaned children; those experiencing COVID-19 orphanhood showed a slight increase in risk behaviours over time. Orphanhood, older age, bullying, domestic violence and community violence were associated with higher HIV risk, while female sex and larger households were protective. Mental health symptoms were significantly worse among children living in HIV-affected households who also experienced COVID-19 orphanhood (66.7% at baseline), a pattern that persisted at follow-up. These findings highlight the heightened vulnerability of children facing multiple, overlapping crises. Effective HIV prevention and support strategies must account for the compounded impacts of pandemic-related loss, violence and pre-existing HIV burdens to protect long-term wellbeing.