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

AIDS. 2008 Mar 30;22(6):759-66. doi: 10.1097/QAD.0b013e3282f4cac7.


Background: Despite the 15 million children orphaned by AIDS, and fears of sexual vulnerability, little is known about the link between orphanhood and HIV risk.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Case-Control Studies
  • Child
  • Child Abuse, Sexual
  • Child, Orphaned*
  • Developing Countries*
  • Fathers
  • Female
  • HIV Infections / transmission*
  • Health Surveys
  • Herpes Simplex / transmission
  • Herpesvirus 2, Human
  • Humans
  • Mothers
  • Risk Factors
  • Sexual Behavior
  • Urban Population
  • Zimbabwe