title: From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe.
abstract: 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.
authors: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Isolde.Birdthistle@lshtm.ac.uk
authors: Isolde J
authors: IJ
authors: Birdthistle
authors: Sian
authors: S
authors: Floyd
authors: Auxillia
authors: A
authors: Machingura
authors: Netsai
authors: N
authors: Mudziwapasi
authors: Simon
authors: S
authors: Gregson
authors: Judith R
authors: JR
authors: Glynn
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002650:Child Abuse, Sexual; D054540:Child, Orphaned; D003906:Developing Countries; D005220:Fathers; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006306:Health Surveys; D006561:Herpes Simplex / Q000635:transmission; D018258:Herpesvirus 2, Human; D006801:Humans; D009035:Mothers; D012307:Risk Factors; D012725:Sexual Behavior; D014505:Urban Population; D015030:Zimbabwe