Abstract
This paper examines the effect of orphanhood and HIV status of adults in a household on onset of sexual activity among adolescent girls and boys aged 15-17 years in sub-Saharan Africa. Multilevel logistic regression models were applied to pooled Demographic and Health Surveys data from nineteen countries of sub-Saharan Africa where HIV test data were collected during 2003-2008 from nationally representative samples of men and women of reproductive age. The results highlight increased vulnerability among adolescent boys and girls living in households where an adult is infected with HIV, and adolescent boys who are paternal orphans. On average, adolescent boys and girls living in households where at least one adult is HIV-positive have about 25% higher odds of having initiated sexual activity compared with their counterparts of similar characteristics in households where no adult is HIV-positive. Furthermore, adolescent boys who are paternal orphans have about 25% higher odds of having initiated sexual activity than their non-orphan counterparts of similar individual characteristics. Further analysis reveals that household circumstances relating to living arrangements and poverty are important pathways through which household HIV/AIDS status is linked to adolescent sexual debut. The findings underscore the importance of international efforts in the sub-Saharan Africa region to address the plight of other children in HIV/AIDS-affected households, beyond orphans.
Highlights
HIV/AIDS poses a significant threat to adolescents' health and life prospects in sub-Saharan Africa (SSA) where AIDS remains the single largest cause of death, accounting for threequarters of the estimated 1.6 million global deaths from HIV/AIDS in 2012 (UNAIDS 2013)
Many children in sub-Sahara Africa live in impoverished households due to reasons other than HIV/AIDS and are vulnerable as those in HIV/AIDS impacted households, HIV/AIDS vulnerability is characterized by unique factors and circumstances, and occurs at a scale that separates its impact from that of other impoverishing conditions in sub-Sahara African countries
The bivariate distributions of onset of sexual activity by age presented in Table 3 suggest that there are considerable variations in the timing of sexual debut across countries in sub-Saharan
Summary
HIV/AIDS poses a significant threat to adolescents' health and life prospects in sub-Saharan Africa (SSA) where AIDS remains the single largest cause of death, accounting for threequarters of the estimated 1.6 million global deaths from HIV/AIDS in 2012 (UNAIDS 2013). The numbers of orphans represents only a fraction of the number of children adversely affected by HIV/AIDS, with millions of other children, especially adolescents, facing various psychological and economic problems, including responsibilities of caring for ailing parents and siblings when the HIV-infected parents are still alive (UNICEF, 2006; Abebe & Skovdal, 2010). Many adolescents orphaned by AIDS lose their childhood and are forced by circumstances to become producers of income or food, or caregivers for sick family members. In many cases, they become increasingly vulnerable to abuse, exploitation, and ill-health, including high risk sexual activity (Mmari, 2011; Operario, et al, 2011). Many children in sub-Sahara Africa live in impoverished households due to reasons other than HIV/AIDS and are vulnerable as those in HIV/AIDS impacted households, HIV/AIDS vulnerability is characterized by unique factors and circumstances (e.g. stigma and prolonged AIDS-related illness and opportunistic infections), and occurs at a scale that separates its impact from that of other impoverishing conditions in sub-Sahara African countries
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