Increased risk of HIV-infection among school-attending orphans in rural Zimbabwe.

Orphans and HIV

Increased risk of HIV-infection among school-attending orphans in rural Zimbabwe.

In Zimbabwe around 1.1 million children have been orphaned due to AIDS. The authors conducted a survey among school-attending youth in rural south-eastern Zimbabwe in 2003, and examined the association between orphaning and risk of HIV. They enrolled 30 communities in three provinces. All students attending Year 2 of secondary school were eligible. Each completed a questionnaire and provided a finger-prick blood specimen for testing for HIV-1 and HSV-2 antibodies. Female participants were tested for pregnancy. Six thousand seven hundred and ninety-one participants were recruited (87% of eligible); 35% had lost one or both parents (20% of participants had lost their father; 6% their mother; and 9% both parents). Orphans were not poorer than non-orphans based on reported access to income, household structure and ownership of assets. There was strong evidence that orphans, and particularly those who had lost both parents, were at increased sexual risk, being more likely to have experienced early sexual debut; to have been forced to have sex; and less likely to have used condoms. Fifty-one students were HIV positive (0.75%). Orphans were three times more likely to be HIV infected than non-orphans (adjusted odds ratio = 3.4; 95% confidence interval: 1.8-6.6). Over 60% of those HIV positive were orphaned. Among school-going youth, the rates of orphaning were very high; there was a strong association between orphaning and increased risk of HIV, and evidence of greater sexual risk taking among orphans. It is essential that we understand the mechanisms by which orphaned children are at increased risk of HIV in order to target prevention and support appropriately.

Editors’ note: The Zimbabwe Demographic Health Survey of 2005-2006 estimated that 36% of children aged 15-17 years were orphaned, with rural young people in this age group more likely to be orphans than urban youth. This study of 6791 school-going adolescents found 35% had lost one or both parents. Although HIV prevalence was below 1%, almost two-thirds of those identified as HIV-positive were orphans. Male orphans were at almost three times greater risk of being infected and female orphans at more than four times greater risk of HIV infection than their non-orphan counterparts. Some of these orphans may have been infected vertically at birth or through breastfeeding but this is unlikely as half had lost only their fathers, the chance of surviving to age 15 in the absence of treatment is low, and there was increased reporting of sexual risk taking by orphans. Although the safety net of the extended family continues to shelter increasing numbers of orphans, programmes to reduce HIV-related risks among these young people are needed now and will be increasingly important as the epidemic continues to deepen.