• Evidence shows that parental AIDS-illness and death have severe negative impacts on children. However, we need to understand why AIDS hasthese effects.
• This study aims to identify these pathways, and thus identify important targets for interventions.
• Three key outcomes are examined: psychological, HIV-infection risks and educational.
• Cross-sectional survey of 6,002 children aged 10–17.
• Rural and urban sites in the Western Cape, Mpumalanga and KwaZulu-Natal, South Africa.
• Validated scales and symptom checklists were used. Structural equation modelling in AMOS 19 identified pathways of risk. AIDS-orphanhood and parental AIDS-illness raise risks of poverty and parental disability. Through these linkages, AIDS-affected children are more likely to be stigmatised outside the home, and exposed to physical, emotional and sexual abuse or rape. It is these ‘interlinking factors’ that cause psychological distress such as depression, anxiety and suicidal behaviour. And it is psychological distress that leads to higher rates of HIV infection risks (such as transactional sex and low condom use) amongst AIDS-affected adolescents.