title: Potentially traumatic experiences and sexual health among orphaned and separated adolescents in five low- and middle-income countries.
abstract: Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millions more have been separated from their parents. As younger orphans enter adolescence, their sexual health and HIV-related risk behaviors become key considerations for their overall health. Importantly, their high prevalence of exposure to potentially traumatic events (PTEs) may put OSC at additional risk for adverse sexual health outcomes. The Positive Outcomes for Orphans study followed OSC randomly sampled from institution-based care and from family-based care, as well as a convenience sample of non-OSC, at six sites in five low-and middle-income countries. This analysis focused on the 90-month follow-up, during which adolescents 16 and older were assessed for sexual health, including age at sexual debut, past-year sex, past-year condom use, and perceptions of condom use. We specifically examined the relationship between PTEs and sexual health outcomes. Of the 1258 OSC and 138 non-OSC assessed, 11% reported ever having sex. Approximately 6% of participants reported recent sex and 5% reported having recent unprotected sex. However, 70% of those who had recent sex reported that they did not use a condom every time, and perceptions of condom use tended to be unfavorable for protection against sexual risk behavior. Nearly all (90%) of participants reported experiencing at least one lifetime PTE. For those who experienced "any" PTE, we found increased prevalence of recent sex (PR = 1.39 [0.47, 4.07]) and of recent unprotected sex (PR = 3.47 [0.60, 19.91]). This study highlights the need for caregivers, program managers, and policymakers to promote condom use for sexually active OSC and identify interventions for trauma support services. Orphans living in family-based care may also be particularly vulnerable to early sexual debut and unprotected sexual activity.
authors.affiliation: a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Gray
authors.affiliation: b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.|c Terry Sanford Institute of Public Policy, Duke University , Durham , NC , USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
authors.affiliation: a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA.|b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.|d College of Urban and Public Affairs , Portland State University , Portland , OR , USA.
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Messer
authors.affiliation: b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Whetten
authors.affiliation: b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.affiliation: b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.|e Center for Child and Family Health , Duke University , Durham , NC , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: O'Donnell
authors.affiliation: b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.|f Department of Medicine, Division of Infectious Diseases and International Health , Duke University , Durham , NC , USA.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.affiliation: a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA.|b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002648:Child; D054540:Child, Orphaned / Q000523:psychology*; D017280:Condoms / Q000706:statistics & numerical data*; D000069581:Exposure to Violence / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020380:Needs Assessment; D015995:Prevalence; D060728:Reproductive Health / Q000706:statistics & numerical data; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D047568:Unsafe Sex / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data
keywords: LMIC; Orphans; potentially traumatic experiences; sexual debut; sexual health