HIV-associated orphanhood and children's psychosocial distress: theoretical framework tested with data from Zimbabwe.
OBJECTIVE
We measured the psychosocial effect of orphanhood in a sub-Saharan African population and evaluated a new framework for understanding the causes and consequences of psychosocial distress among orphans and other vulnerable children.


METHODS
The framework was evaluated using data from 5321 children aged 12 to 17 years who were interviewed in a 2004 national survey in Zimbabwe. We constructed a measure of psychosocial distress using principle components analysis. We used regression analyses to obtain standardized parameter estimates of psychosocial distress and odds ratios of early sexual activity.


RESULTS
Orphans had more psychosocial distress than did nonorphans. For both genders, paternal, maternal, and double orphans exhibited more-severe distress than did nonorphaned, nonvulnerable children. Orphanhood remained associated with psychosocial distress after we controlled for differences in more-proximate determinants. Maternal and paternal orphans were significantly more likely than were nonorphaned, nonvulnerable children to have engaged in sexual activity. These differences were reduced after we controlled for psychosocial distress.


CONCLUSIONS
Orphaned adolescents in Zimbabwe suffer greater psychosocial distress than do nonorphaned, nonvulnerable children, which may lead to increased likelihood of early onset of sexual intercourse and HIV infection. The effect of strategies to provide psychosocial support should be evaluated scientifically.
Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, England, UK. c.nyamukapa03@imperial.ac.uk
Constance A
CA
Nyamukapa
Simon
S
Gregson
Ben
B
Lopman
Suzue
S
Saito
Helen J
HJ
Watts
Roeland
R
Monasch
Matthew C H
MC
Jukes
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D054540:Child, Orphaned / Q000523:psychology*; D003075:Coitus; D016001:Confidence Intervals; D005190:Family; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D015995:Prevalence; D011610:Psychosocial Deprivation; D012424:Rural Population; D017678:Sex Distribution; D013315:Stress, Psychological / Q000209:etiology*; D014505:Urban Population; D015030:Zimbabwe / Q000453:epidemiology