Author ORCID Identifier


Date of Award

Fall 1-5-2024

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Shannon Self-Brown, PhD

Second Advisor

Greta Massetti, PhD

Third Advisor

Xiangming Fang, PhD


Introduction: HIV continues to be a global health threat despite recent decades of progress. Adolescent girls and young women (AGYW) in sub-Saharan Africa experience a disproportionately high burden of HIV. Lesotho is the country with the second highest adult prevalence of HIV globally. Further, little is known about the caregiving context in Lesotho and the associations between caregiver factors and non-familial violence, HIV risk, and HIV infection. We aimed to understand the associations between risk and protective factors in the caregiving context simultaneously on non-familial violence and HIV-related outcomes in Lesotho to inform prevention strategy recommendations.

Methods: Data are from the 2018 Lesotho Violence Against Children and Youth Survey, a cross-sectional, nationally representative household survey of youth ages 13 to 24 years (nfemale=7,101; nmale=1,467). We used structural equation modeling to explore relationships between positive relationships with parents, caregiver supervision, family violence, non-familial violence, composite HIV risk, and HIV infection, simultaneously, controlling for marital status, sex, orphan status, food insecurity, and age. We constructed one model with the full sample and a second with AGYW only.

Results: In the structural model for both samples, having a positive relationship with a mother and father were protective against exposure to non-familial violence, while exposure to familial violence was associated with a higher probability of experiencing non-familial violence, controlling for all of the variables in the model. In both samples, higher levels of caregiver supervision were independently associated with lower scores on the HIV risk composite, whereas exposure to non-familial was independently associated with higher scores on the HIV risk composite. We found a positive adjusted association between higher scores on the HIV risk score and HIV infection for both samples.

Conclusions: In both samples, we found that positive parent-child relationships were protective against experiencing non-familial violence, with relationships with fathers emerging as the strongest protective correlate. Caregiver supervision was associated with lower scores on the HIV risk composite in both samples. Exposure to violence was associated with exposure to other forms of violence and higher scores on the HIV risk composite in both samples as well. Caregiver factors should be further explored and tested as targets for HIV and violence prevention and response efforts in Lesotho as they may be protective against multiple adverse childhood outcomes.


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