ArticleThe Journal of adolescent health : official publication of the Society for Adolescent Medicine2017
Why Are Orphaned Adolescents More Likely to Be HIV Positive? Distinguishing Between Maternal and Sexual HIV Transmission Using 17 Nationally Representative Data Sets in Africa.
Article in The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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12 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis.The Lancet. Global health · 2019Pooled it
- Clinical and psychosocial context of HIV perinatally infected young mothers in Harare, Zimbabwe: A longitudinal mixed-methods study.PloS one · 2025Article
- Orphanhood vulnerabilities for violence and HIV by education, sex, and orphan type among 18-24-year-old youth: findings from the 2018 Lesotho violence against children and youth survey.Psychology, health & medicine · 2024Article
- Clinico-epidemiological characteristics of adolescents and young adults living with HIV in Ghana.The Pan African medical journal · 2024Article
- Mode of HIV acquisition among adolescents living with HIV in resource-limited settings: A data-driven approach from South Africa.PloS one · 2023Article
- Adapting strategies for effective and efficient pediatric HIV case finding in low prevalence countries: risk screening tool for testing children presenting at high-risk entry points in Ethiopia.BMC infectious diseases · 2022Article
- A Challenging Knowledge Gap: Estimating Modes of HIV Acquisition Among Adolescents Entering HIV Care During Adolescence.Global pediatric health · 2022Article
- Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania.Frontiers in public health · 2022Article
- Trends and correlates of HIV prevalence among adolescents in South Africa: evidence from the 2008, 2012 and 2017 South African National HIV Prevalence, Incidence and Behaviour surveys.AIDS research and therapy · 2021Article
- HIV trends and disparities by gender and urban-rural residence among adolescents in sub-Saharan Africa.Reproductive health · 2021Article
- Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project.BMC health services research · 2020Article
- Community-based HIV prevalence in KwaZulu-Natal, South Africa: results of a cross-sectional household survey.The lancet. HIV · 2018Article
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Authors and funding
2 authors at 2 institutions in 1 country.
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Abstract
purposeWhy do orphans have higher rates of HIV infection than nonorphaned peers? Research consistently assumes that orphans acquire HIV primarily through sexual behavior, but infections may instead be due to maternal transmission. Although these two pathways have very different implications for HIV programs and policies, their relative contribution has not been previously examined. In this research, we compare the contribution of maternal and sexual transmission to HIV infection among orphans in Africa.
methodsWe use Demographic and Health Survey data for 21,463 women and 18,359 men from 17 countries. We propose a conceptual framework linking orphanhood to HIV, and use mediation analysis and structural equation modeling to compare the potential contribution of maternal transmission (measured through direct pathways from orphanhood to HIV) and sexual transmission (measured through reports of risky sexual behavior) to orphan HIV infection.
resultsOur results suggest that maternal transmission is the predominant pathway of HIV infection among orphaned adolescents: there is strong evidence for a direct pathway from maternal (odds ratio [OR]: 2.45; 95% confidence interval [CI]: 1.72-3.51 for females and OR: 2.45; 95% CI: 1.53-3.90 for males) and double orphanhood (OR: 2.69; 95% CI: 1.97-3.66 and OR: 2.53; 95% CI: 1.68-3.82, respectively) to HIV; greater excess HIV risk in maternal versus paternal orphans. The contribution of sexual behavior is largely not significant. We do not observe correspondingly high orphan disparities in other sexually transmitted diseases.
conclusionsMaternal transmission is a more likely explanation than sexual transmission for heightened HIV infection among orphans. These results suggest that programs designed to address HIV infection among adolescents should focus on reducing maternal transmission and on identifying and testing undiagnosed HIV among orphans.
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