Increasing numbers of perinatally HIV (PHIV+)-infected youth are surviving into adulthood with better access to treatment. However, few studies examine positive outcomes in the face of adversity (resilience) for PHIV+ youth. Social Action Theory (SAT) provided the theoretical framework for this study of PHIV + youth in South Africa (SA), allowing examination of contextual, social, and self-regulatory factors that influence behavioral health. Data were from youth and caregiver baseline interviews, simply pooled from a pilot (N=66) and larger (n=111) randomized control trial (RCT) of the VUKA Family program. For this analysis, outcomes included emotional and behavioral functioning (total difficulties), and prosocial behaviors. Potential SAT correlates included socio-demographics; caregiver health and mental health; parent-child relationship factors; stigma, and child coping, support; and self-esteem. Regression analyses adjusted for age, gender, and study revealed significant associations at the contextual, social, and self-regulation level. Lower total child difficulties scores were associated with lower caregiver depression (β = 3.906,p <.001), less caregiver-reported communication about difficult issues (β = 1.882, p =.009) and higher youth self-esteem (β = -0.119, p =.020). Greater prosocial behaviors were associated with greater caregiver-reported communication (β = 0.722, p =.020) and child use of wishful thinking for coping (β = 5.532, p =.009). Less youth depression was associated with higher caregiver education (β =−0.399, p =.010), greater caregiver supervision (β = −1.261, p =.012), more social support seeking (β = −0.453, p =.002), higher youth self-esteem (β = −0.067, p <.001), lower internalized stigma (β = 0.608, p =.040), and child use of resignation for coping (β = 1.152, p =.041). Our data support evidence-based family interventions that also promote youth self-regulation skills to enhance the health and mental health of PHIV+ youth.
