Orphans and HIV Risk in Tanzania

Globally, more than 16 million children have been orphaned by AIDS. Without continuous antiretroviral treatment, that number will increase to 25 million by 2010.

For young people, losing one or both parents significantly increases the likelihood of earlier sexual debut and their risk for HIV, as previous studies have shown.

Why do orphans engage in high risk sexual activity? What are the potential risk and protective factors? Does risk differ because of orphan status? Researchers Kristin Mmari, Robert Wm. Blum, Annie Michealis, Kaglemo Kiro and Mark Urassa sought to answer these and other questions in a study among HIV among orphans and non-orphans in Tanzania.

The researchers used in-depth interviews and focus groups among adolescents ages 14 to 18 in Kisesa Ward (a sub-district in Tanazania), said Blum, PhD, MD, MPH, the William H. Gates Sr. Chair and Professor of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Fifty-two adolescents (including orphans and non-orphans) participated and discussed their personal experiences and sexual life histories.

Among the 52 adolescents interviewed,13 reported having either exchanged sex for money or having had unprotected sex. (In Tanzania, Unicef reports the mean age for sexual debut is 16 years.) “I was fifteen years old the first time I tried sex,” an adolescent girl told interviewers. “The man came to me and he said he would give me money, 5000 shillings (about $5) [for sex]. … I did it because I needed clothes.” Indeed, if males have money, there is an expectation they would give money to girl with whom they have had sex.

“Lack of information was another issue that we heard repeatedly,” Blum said. “Adults are providing less information today.” He related one participant’s comments that the tradition of the “night fire” when parents talked with children and imparted ethical lessons has disappeared. “We’ve forgotten our culture,” said one adolescent.

Study participants agreed that female orphans are at highest risk for HIV. Risk factors include not being enrolled in school and the fact that caregivers are not providing young people with needed resources and moral guidance.

“The study is a starting point for examining risk and protective factors among orphans,” Blum said. “The findings suggest that HIV interventions for orphans may be most effective by targeting females and parents/caregivers of orphans.”

Blum presented the study findings April 28 to attendees of the conference

Brian W. Simpson, editor of Johns Hopkins Public Health magazine.