title: HIV infection and sexual risk behaviour among youth who have experienced orphanhood: systematic review and meta-analysis.
abstract: BACKGROUND
  Previous research has suggested that orphaned children and adolescents might have elevated risk for HIV infection. We examined the state of evidence regarding the association between orphan status and HIV risk in studies of youth aged 24 years and younger.
  
  
  METHODS
  Using systematic review methodology, we identified 10 studies reporting data from 12 countries comparing orphaned and non-orphaned youth on HIV-related risk indicators, including HIV serostatus, other sexually transmitted infections, pregnancy and sexual behaviours. We meta-analyzed data from six studies reporting prevalence data on the association between orphan status and HIV serostatus, and we qualitatively summarized data from all studies on behavioural risk factors for HIV among orphaned youth.
  
  
  RESULTS
  Meta-analysis of HIV testing data from 19,140 participants indicated significantly greater HIV seroprevalence among orphaned (10.8%) compared with non-orphaned youth (5.9%) (odds ratio = 1.97; 95% confidence interval = 1.41-2.75). Trends across studies showed evidence for greater sexual risk behaviour in orphaned youth.
  
  
  CONCLUSIONS
  Studies on HIV risk in orphaned populations, which mostly include samples from sub-Saharan Africa, show nearly two-fold greater odds of HIV infection among orphaned youth and higher levels of sexual risk behaviour than among their non-orphaned peers. Interventions to reduce risk for HIV transmission in orphaned youth are needed to address the sequelae of parental illness and death that might contribute to sexual risk and HIV infection.
authors: Department of Community Health, Brown University, Providence, RI, USA. Don_Operario@brown.edu
authors: Don
authors: D
authors: Operario
authors: Kristen
authors: K
authors: Underhill
authors: Carolyn
authors: C
authors: Chuong
authors: Lucie
authors: L
authors: Cluver
references: Soc Sci Med. 2004 Apr;58(7):1443-54
references: 14759688
references: Sex Transm Infect. 2009 Apr;85 Suppl 1:i49-55
references: 19307341
references: Acta Paediatr. 2002;91(4):459-65
references: 12061364
references: Epidemiology. 2007 Nov;18(6):805-35
references: 18049195
references: AIDS Behav. 2006 Nov;10(6):627-35
references: 16838071
references: Am J Public Health. 2008 Jan;98(1):133-41
references: 18048777
references: AIDS Educ Prev. 2007 Oct;19(5):383-95
references: 17967109
references: Soc Sci Med. 2009 May;68(10):1810-8
references: 19303688
references: AIDS Care. 2008 Feb;20(2):214-7
references: 18293132
references: J Child Psychol Psychiatry. 2007 Aug;48(8):755-63
references: 17683447
references: AIDS Care. 2005 Oct;17(7):785-94
references: 16120495
references: J Assoc Nurses AIDS Care. 2008 Mar-Apr;19(2):147-57
references: 18328965
references: AIDS Care. 2007 Jul;19(6):781-90
references: 17573599
references: Stud Fam Plann. 2009 Jun;40(2):101-12
references: 19662802
references: AIDS. 2007 Nov 12;21(17):2333-40
references: 18090282
references: Psychosom Med. 2008 Jun;70(5):598-605
references: 18541908
references: Glob Public Health. 2009;4(4):350-66
references: 19462269
references: AIDS Care. 2009 Mar;21(3):261-70
references: 19280403
references: AIDS Care. 1996 Oct;8(5):509-15
references: 8893902
references: AIDS. 2008 Mar 30;22(6):759-66
references: 18356606
references: Demography. 2007 Feb;44(1):35-57
references: 17461335
references: BMJ. 2003 Jun 21;326(7403):1387-9
references: 12816831
references: Demography. 2004 Aug;41(3):483-508
references: 15461011
references: Soc Sci Med. 2005 Aug;61(3):555-64
references: 15899315
references: AIDS Care. 2008 Jul;20(6):726-32
references: 18576175
references: AIDS Care. 2008 May;20(5):527-36
references: 18484320
references: Demography. 2006 Aug;43(3):401-20
references: 17051820
references: J Consult Clin Psychol. 2005 Apr;73(2):221-8
references: 15796629
references: AIDS. 2003 Nov 21;17(17):2509-13
references: 14600523
references: Sex Transm Dis. 2000 Sep;27(8):446-51
references: 10987449
references: J Adolesc Health. 2008 Jan;42(1):102-4
references: 18155037
references: J Acquir Immune Defic Syndr. 2007 Jan 1;44(1):93-8
references: 17075394
references: J Adolesc Health. 1991 Dec;12(8):597-605
references: 1799569
references: Lancet. 2004 Oct 2-8;364(9441):1236-43
references: 15464184
references: AIDS Care. 2008 Oct;20(9):1019-28
references: 18608066