title: Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings.
abstract: OBJECTIVE
  This study sought to assess whether risky sexual behaviors and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya.
  
  
  METHODS
  We analyzed baseline data from a cohort of orphaned adolescents aged 10-18 years living in 300 randomly selected households and 19 charitable children's institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariate logistic regression compared these between participants in institutional care and family-based care while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use.
  
  
  RESULTS
  This analysis included 1,365 participants aged ≥10 years: 712 (52%) living in institutional environments and 653 (48%) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (adjusted odds ratio, .46; 95% confidence interval, .3-.72) or to have experienced forced sex (adjusted odds ratio, .57; 95% confidence interval, .38-.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables.
  
  
  CONCLUSIONS
  Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents' sexual risk-taking behaviors. The use of single items to assess outcomes and nonexplicit definition of sex suggest the findings should be interpreted with caution.
authors.affiliation: Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Embleton
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Joram
authors.initials: J
authors.lastname: Nyandat
authors.affiliation: Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Ayuku
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Edwin
authors.initials: E
authors.lastname: Sang
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Allan
authors.initials: A
authors.lastname: Kamanda
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors.forename: Samuel
authors.initials: S
authors.lastname: Ayaya
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors.forename: Winstone
authors.initials: W
authors.lastname: Nyandiko
authors.affiliation: Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Gisore
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya; Department of Pediatrics, Indiana University, School of Medicine, Indianapolis, Indiana.
authors.forename: Rachel
authors.initials: R
authors.lastname: Vreeman
authors.affiliation: Department of Mental Health, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors.forename: Lukoye
authors.initials: L
authors.lastname: Atwoli
authors.affiliation: Department of Health Policy, Services, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Omar
authors.initials: O
authors.lastname: Galarraga
authors.affiliation: Department of Pediatrics, Indiana University, School of Medicine, Indianapolis, Indiana.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Ott
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Medicine, College of Health Sciences, School of Medicine, Eldoret, Kenya; Regenstrief Institute, Inc, Indianapolis, Indiana; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Electronic address: paula.braitstein@utoronto.ca.
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D002650:Child Abuse, Sexual / Q000706:statistics & numerical data*; D054540:Child, Orphaned / Q000706:statistics & numerical data*; D005190:Family; D005260:Female; D006801:Humans; D007630:Kenya; D007872:Legal Guardians / Q000145:classification* / Q000706:statistics & numerical data; D008297:Male; D019372:Orphanages / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000145:classification* / Q000706:statistics & numerical data; D018570:Risk Assessment; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000145:classification* / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000145:classification
keywords: Family-based care; Institutional care; Kenya; Orphans; Sexual behavior; Transactional sex