HIV Infection and Related Risk Behaviors: Does School Support Level the Playing Field between Orphans and Non-orphans in Zimbabwe?

摘要

Research is limited on whether providing school support to female adolescent orphans mitigates their HIV risk disadvantage compared to other female adolescents. This paper examines 2011 Zimbabwe Demographic and Health Survey (ZDHS) HIV-related biomarker and behavior data for orphaned and non-orphaned rural adolescent females to compare findings from a similar sample participating in a randomized controlled trial (RCT) testing school support as HIV prevention. HIV status, marriage, pregnancy, sexual debut, school dropout, years of schooling, and socioeconomic status were analyzed with the combined datasets. Bivariate analyses compared variables between RCT comprehensive intervention and delayed partial intervention conditions, and between ZDHS orphan and non-orphan groups. Multivariable analyses included a series of group comparisons as follows: ZDHS orphans vs ZDHS non-orphans; RCT orphans in each condition vs. ZDHS non-orphans; RCT orphans in each condition vs. ZDHS orphans. Analyses methods accounted for the complex survey sampling design within each dataset. A total of 751 observations were included. All orphan groups had consistently higher odds of HIV infection than ZDHS non-orphans. ZDHS orphans had higher odds of marriage, pregnancy and sexual debut than ZDHS non-orphans. Comprehensive intervention participants had lower odds of marriage, sexual debut and school dropout than ZDHS non-orphans. RCT participants in both conditions had lower odds of marriage, sexual debut and school dropout than ZDHS orphans. The findings indicate that orphans are at a distinct disadvantage to HIV risk compared to non-orphans, and much of this is likely related to vertical transmission. We found no evidence that provision of school fees to orphans will reduce their risk of HIV infection relative to non-orphans but further evidence that such programs may reduce risk behaviors including early sexual debut, child marriage and school dropout. Further research is needed to determine how these programs can be sustainably scaled-up in resource-limited settings.