From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe

Abstract

Despite the 15 million children orphaned by AIDS, and fears of sexual vulnerability, little is known about the link between orphanhood and HIV risk. A random sample of 1283 15 to 19-year-old girls in a high-density suburb of Harare was identified in a cross-sectional survey in 2004. A total of 863 agreed to be interviewed and 839 provided a specimen for HIV and herpes simplex virus type-2 (HSV-2) testing. Sexual health outcomes, sexual behaviours and marriage were assessed by type and timing of orphanhood. Half of the participants were single or double orphans. Prevalence of HIV and/or HSV-2 was higher among orphans than non-orphans [17 versus 12%; age-adjusted odds ratio (aOR) = 1.5; 95% confidence interval (CI) 1.0-2.3]. Associations with orphan status were only significant among the 743 never-married participants. In comparison with non-orphaned peers, increased sexual risk (defined as HSV2-positive, HIV-positive or ever pregnant) was seen among maternal orphans (aOR = 3.6; 95% CI, 1.7-7.8), double orphans (aOR = 2.4; 95% CI, 1.2-4.9), and girls who lost their father before age 12 (aOR = 2.1; 95% CI, 0.9-4.8) but not later (aOR = 0.8; 95% CI, 0.3-2.2). Maternal and double orphans were most likely to initiate sex early and to have had multiple partners. Maternal orphans were least likely to have used a condom at first sex, and to have a regular sexual partner. Experience of forced sex was high in all groups. In urban Zimbabwe, female adolescent orphans are at increased risk of HIV and HSV-2 infection. Infection rates vary by type and age of orphanhood, and marital status, and are associated with high-risk sexual behaviours.