There is concern that orphans may be at particular risk of HIV infection due to earlier age of sexual onset and higher likelihood of sexual exploitation or abuse; however, there is limited empirical evidence examining this phenomenon. Utilizing data from 1694 Black South African youth aged 14–18, of whom 31% are classified as orphaned, this analysis explores the relationship between orphan status and sexual risk. The analysis found both male and female orphans significantly more likely to have engaged in sex as compared to non-orphans (49% vs. 39%). After adjusting for socio-demographic variables, orphans were nearly one and half times more likely than non-orphans to have had sex. Among sexually active youth, orphans reported younger age of sexual intercourse with 23% of orphans having had sex by age 13 or younger compared to 15% of non-orphans. Programmatic implications of these findings for the care and protection of orphans are discussed.
Similar content being viewed by others
REFERENCES
Brookes, H., Shisana, O., & Richter, L. (2004). The National Household HIV Prevalence and Risk Survey of South African Children. Cape Town: Human Science Research Council.
Carpenter, S. C., Clyman, R. B., Davidson, A. J., & Steiner, J. F. (2001). The association of foster care or kinship care with adolescent sexual behavior and first pregnancy. Pediatrics, 108(3), E46.
Cerwonka, E. R., Isbell, T. R., & Hansen, C. E. (2000). Psychosocial factors as predictors of unsafe sexual practices among young adults. AIDS Education and Prevention, 12(2), 141–153.
Cote, A. M., Sobela, F., Dzokoto, A., Nzambi, K., Asamoah-Adu, C., Labbe, A. C., et al. (2004). Transactional sex is the driving force in the dynamics of HIV in Accra, Ghana. AIDS, 18(6), 917–925.
Department of Health. (2005). National HIV and syphilis antenatal sero-prevalence survey in South Africa 2004.
Eaton, L., Flisher, A. J., & Aaro, L. E. (2003). Unsafe sexual behaviour in South African youth. Social Science and Medicine, 56(1), 149–165.
Foster, G., Makufa, C., Drew, R., Mashumba, S., & Kambeu, S. (1997). Perceptions of children and community members concerning the circumstances of orphans in rural Zimbabwe. AIDS Care, 9(4), 391–405.
Foster, G., & Williamson, J. (2000). A review of current literature on the impact of HIV/AIDS on children in sub-Saharan Africa. Aids, 14(Suppl 3), S275–284.
Gueye, M., Castle, S., & Konate, M. K. (2001). Timing of first intercourse among Malian adolescents: Implications for contraceptive use. International Family Planning Perspectives, 27(2), 56–70.
Guma, M., & Hendra, N. (2004). The socio-cultural context of child abuse: The betrayal of trust. In L. Richter, A. Dawes, and C. Higson-Smith (Ed.), The sexual abuse of young children in southern Africa. Cape Town: Human Science Research Council Press.
Gregson, S., Nyamukapa, C., Garnett, G. P., Wambe, M., Lewis, J. J. C., & Mason, P. R., et al. (2005). HIV infection and reproductive health in teenage women made vulnerable by AIDS in Zimbabwe. AIDS Care, 17(7): 785–794.
Gregson, S., Nyamukapa, C., Garnett, G. P., Mason, P. R., Zhuwau, T., & Careal, M., et al. (2002). Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. The Lancet, 359, 1896–1903.
Harvey, M. S., & Spigner, C. (1995). Factors associated with sexual behavior among adolescents: A multivariate analysis. Adolescence, 30(118), 253–264.
Hulton, L. A., Cullen, R., & Wamala Khalokho, S. (2000) Perception of the risks of sexual activity and their consequences among Ugandan adolescents. Studies in Family Planning, 31, 35–46.
Hunter, S. S. (1990). Orphans as a window on the AIDS epidemic in Sub-Saharan Africa: initial results and implications of a study in Uganda. Social Science and Medicine, 31(6), 681–690.
Hutton, H. E., Lyketsos, C. G., Zenilman, J. M., Thompson, R. E., & Erbelding, E. J. (2004). Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. American Journal of Psychiatry, 161(5), 912–914.
Jejeebhoy, S. J., & Bott, S. (2003) Non-consensual sexual experiences of young people: A review of the evidence from developing countries. New Delhi: Population Council.
Jessor, R., Costa, F., & Jessor, L. (1983). Time of first intercourse: A prospective study. Journal of Personality and Social Psychology, 44(3), 608–626.
Karim, A. M., Magnani, R. J., Morgan, G. T., & Bond, K. C. (2003). Reproductive health risk and protective factors among unmarried youth in Ghana. International Family Planning Perspectives, 29(1), 14–24.
Kaufman, C. E., & Stavrou, S. E. (2004). Bus fare, please: The economics of sex and gifts among adolescents in urban South Africa. Culture, Health and Sexuality, 6, 377–391.
Kirby, D. (1999). Looking for reasons why. The antecedents of adolescent sexual risk-taking, pregnancy and childbearing. Washington, DC: National Campaign to Prevent Pregnancy.
Luke, N. (2001) Cross-generational and transactional sexual relations in Sub-Saharan Africa: A review of the evidence on prevalence and implications for negotiation of safe sex practices for adolescent girls. Washington: International Center for Research on Women.
MacPhail, C., & Campbell, C. (2001). ‘I think condoms are good but, aai, I hate those things’: condom use among adolescents and young people in a Southern African township. Social Science and Medicine, 52(11) 1613–1627.
Magnani, R. J., Karim, A. M., Weiss, L. A., Bond, K. C., Lemba, M., & Morgan, G. T. (2002). Reproductive health risk and protective factors among youth in Lusaka, Zambia. Journal of Adolescent Health, 30(1), 76–86.
Makame, V., Ani, C., & Grantham-McGregor, S. (2002). Psychological well-being of orphans in Dar El Salaam, Tanzania. Acta Paediatr, 91(4), 459–465.
Meekers, D., & Ahmed, G. (2000). Contemporary patterns of adolescent sexuality in urban Botswana. Journal of Biosocial Science, 32(4), 467–485.
Muula, A. S., Misiri, H., Munthali, L., Kalengo, S., Kachali, F., Mbewe, M., et al. (2003). The living situations of orphans in periurban Blantyre, Malawi. South African Medical Journal, 93(12), 920–1.
Ngom, P., Magadi, M. A., & Owuor, T. (2003). Parental presence and adolescent reproductive health among the Nairobi urban poor. Journal of Adolescent Health, 33(5), 369–377.
O’Donnell, B. L., O’Donnell, C. R., & Stueve, A. (2001). Early sexual initiation and subsequent sex-related risks among urban minority youth: the reach for health study. Family Planning Perspectives, 33(6), 268–275.
Pettifor, A. E., Rees, H. V., Steffenson, A., Hlongwa-Madikizela, L., McPhail, C., & Vermaak, K., et al. (2004) HIV and sexual behaviour among young South Africans: A national survey of 15–24 year olds. Johannesburg: RHRU, University of the Witwatersrand.
Pettifor, A. E., Van der Straten, A., Dunbar, M. S., Shiboski, S. C., & Padian, N. S. (2004). Early age of first sex: a risk factor for HIV infection among women in Zimbabwe. Aids, 18(10), 1435–1442.
Rau, B. (2003). HIV/AIDS and child labour. A state-of-the art review with recommendations for action. Synthesis report, Paper No. 6. Geneva, Switzerland: International Labour Organization, International Programme on the Elimination of Child Labour.
Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., et al. (1997). Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association, 278(10), 823–832.
Romer, D., Stanton, B., Galbraith, J., Feigelman, S., Black, M. M., & Li, X. (1999). Parental influence on adolescent sexual behavior in high-poverty settings. Archives of Pediatrics and Adolescent Medicine, 153(10), 1055–1062.
Sengendo, J., & Nambi, J. (1997). The psychological effect of orphanhood: a study of orphans in Rakai district. Health Transition Review, 7(Suppl), 105–124.
Sharpe, U., Ssentongo, R., Ssenyonga, A., & Ssamula, B. (1993, July). Orphans sexual behaviour in Masaka diocese, Uganda. Paper presented at the Ixth International Conference on AIDS, Berlin (abstract WS-D26–5).
Shisana, O. & Simbayi, L. (2002). Nelson Mandela/HSRC study of HIV/AIDS. South African national HIV prevalence, behavioural risks and mass media. Capetown, South Africa: Human Sciences Research Council.
Silberschmidt, M., & Rasch, V. (2001). Adolescent girls, illegal abortions and “sugar-daddies” in Dar es Salaam: vulnerable victims and active social agents. Social Science and Medicine, 52(12), 1815–1826.
Small, S. A., & Luster, T. (1994). Adolescent sexual activity: An ecological, risk-factor approach. Journal of Marriage and Family, 56(1), 181–192.
South Africa Demographic and Health Survey. (1998). South African Medical Research Council, Measure Evaluation, USAID.
Swart-Kruger, J., & Richter, L. M. (1997). AIDS-related knowledge, attitudes and behaviour among South African street youth: reflections on power, sexuality and the autonomous self. Social Science and Medicine, 45(6), 957–966.
The Transitions to Adulthood Study Team. (2004). “Transistions to Adulthood in the Context of AIDS in South Africa: The Impact of Exposure to Life Skills Education on Adolescent Knowledge, Skills and Behavior,” Horizons Final Report. Washington D.C.: Population Council. Avaialble from: http://www.popcouncil.org/pdfs/horizons/lfsklsfnl.pdf.
Turner, A. G., Magnani, R. J., & Shuaib, M. (1996). A not quite as quick but much cleaner alternative to the Expanded Programme on Immunization (EPI) Cluster Survey design. International Journal of Epidemiology, 25(1), 198–203.
UNAIDS. (1999). Differences in HIV Spread in Four sub-Saharan African cities. Lusaka, Zambia.
UNAIDS, UNICEF, and USAID. (2004). Children on the Brink 2004. A Joint Report of New Orphan Estimates and a Framework for Action.
UNICEF. (1996). Children Orphaned by AIDS. Front-line responses from eastern and southern Africa.
UNICEF. (2003). Africa's Orphaned Generation. New York.
UNICEF. (2005). Orphans, HIV and AIDS. Vulnerable Young People. Available: http://www.unicef.org/voy/explore/aids/explore_196.html Accessed 3/10/05.
Veale, A., & Dona, G. (2003). Street children and political violence: a socio-demographic analysis of street children in Rwanda. Child Abuse and Neglect, 27(3), 253–269.
Vundule, C., Maforah, F., Jewkes, R., & Jordaan, E. (2001). Risk factors for teenage pregnancy among sexually active adolescents in Cape Town. South African Medical Journal, 91, 73–80.
Williams, C. T., & Latkin, C. A. (2005). The role of depressive symptoms in predicting sex with multiple and high-risk partners. Journal of Acquired Immune Deficiency Syndromes: JAIDS, 38(1), 69–73.
World Health Organization, Child and Adolescent Health and Development. (2005). HIV/AIDS and Adolescents. Why are young people particularly affected by HIV/AIDS?). Available: http://www.who.int/child-adolescent-health/HIV/HIV_adolescents_link1.htm Accessed 3/10/05.
Acknowledgements
This was a collaborative research project of the University of Natal-Durban School of Development Studies, the HORIZONS Project and the Policy Research Division of the Population Council, and Tulane University School of Public Health and Tropical Medicine under the auspices of the FOCUS on Young Adults and MEASURE-Evaluation Projects. This research was supported by the U.S. Agency for International Development through the Horizons program (under the terms of Cooperative Agreement No. HRN-A-00-97-00012-00), the FOCUS on Young Adults Program (CCP-3-73-A00-6002-00), the MEASURE/Evaluation Project (HRN-A-00-97-00018-00), and by a Rockefeller Foundation Grant to the Population Council's Policy Research Division. In addition to the partners and supporters of this research, we also extend great appreciation to the young South Africans who responded so willingly to these questionnaires. All those who conducted the interviews deserve a special thanks for their dedication and professionalism through the study period. I also wish to thank Janet Rice, Ph.D. for her statistical guidance. Lastly, we thank the anonymous reviewers and journal Editor for their useful comments.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thurman, T.R., Brown, L., Richter, L. et al. Sexual Risk Behavior among South African Adolescents: Is Orphan Status a Factor?. AIDS Behav 10, 627–635 (2006). https://doi.org/10.1007/s10461-006-9104-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-006-9104-8