Are adolescent orphans more likely to be HIV-positive? A pooled data analyses across 19 countries in sub-Saharan Africa

Kidman, Rachel; Anglewicz, Philip

doi:10.1136/jech-2015-206744

Cited by 23 publications

(31 citation statements)

References 41 publications

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“…12 School attendance has proved a significant tool in the fight against HIV/AIDS. 15 Moreover, AIDS orphans and non-HIV-related orphans tend to be more vulnerable to sexual victimization when they lack the opportunity of education, 5…”

Section: Economic Sanctions Child Health and Hivmentioning

confidence: 99%

“…For instance, 13.4 million children were living without one or both parents in 2016 because of AIDS . And as Kidman and Anglewicz find, orphans who lose their mother or both parents are two to three times more likely to become HIV infected. While sanction literature finds negative effects of sanctioning on health and marginalized populations, little research has examined the effects on child HIV.…”

Section: Introductionmentioning

confidence: 99%

“…School attendance has proved a significant tool in the fight against HIV/AIDS . Moreover, AIDS orphans and non‐HIV‐related orphans tend to be more vulnerable to sexual victimization when they lack the opportunity of education, which increases their risk of HIV infection and AIDS‐related death. For example, the United Nations (UN), Organization of American States (OAS), and the United States imposed economic sanctions on Haiti in 1991 in response to the coup d'état, which resulted in a 70% unemployment rate and thousands of children's deaths under the age of 5 .…”

Section: Introductionmentioning

confidence: 99%

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Economic sanctions and child HIV

Kim

2019

Health Planning & Management

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Summary Approximately 1.8 million children under age 15 were living with HIV. This study is the first to empirically examine the impact of sanctions on children's new HIV infection and AIDS‐related death rates. Using sanction and HIV/AIDS data that are available for 71 developing countries from 1990 to 2012, this study reveals that sanctions increase children's new HIV infection and their AIDS‐related death rates. This study increases understanding about the consequences of sanctions, especially their effect on a marginalized population and is in line with previous literature. The significant impacts of sanctions on children's HIV/AIDS suggest that the leader in a country targeted by sanctions needs to consider extending programs to respond to children's HIV/AIDS both during sanctioning and after it is lifted.

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Section: Economic Sanctions Child Health and Hivmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Economic sanctions and child HIV

Kim

2019

Health Planning & Management

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“…A growing number of studies have identified adolescent orphans as a high-risk group for HIV; several have found that orphans are two to three times more likely to have acquired HIV by the time they reach adolescence than non-orphaned peers. 6,7 Humanitarian groups, governments, and donors have specifically targeted orphans in HIV prevention initiatives. 8,9 …”

mentioning

confidence: 99%

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

Kidman

Anglewicz

2017

Journal of Adolescent Health

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Purpose Why do orphans have higher rates of HIV infection than non-orphaned 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. Methods We use Demographic and Health Surveys 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. Results Our 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 2.45; 95% confidence interval 1.72–3.51 for females and 2.45; 1.53–3.90 for males) and double orphanhood (odds ratio 2.69; 1.97–3.66 and 2.53; 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 STDs. Conclusion Maternal 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 identifying and testing undiagnosed HIV among orphans.

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“…So far, studies of HIV risk factors or risk factors for the uptake of interventions against HIV have generally been limited to specific sub-populations, [3][4][5][6][7] sub-national regions, 3,[5][6][7][8][9] or countries. [10][11][12][13][14][15][16][17] Recent studies included up to 31 SSA countries, but narrowly focused their inquiries to examine, for example, the association between socio-economic inequalities, 18 high-risk sexual behavior, 19 smoking, 20 or HIV-related stigma 21 with HIV testing, treatment uptake, ART adherence, or HIV prevalence.…”

Section: Introductionmentioning

confidence: 99%

Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence

Merzouki¹,

Estill

Orel³

et al. 2019

Preprint

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ObjectiveHIV incidence varies widely between sub-Saharan African (SSA) countries. This variation coincides with a substantial sociobehavioural heterogeneity, which complicates the design of effective interventions. In this study, we investigated how socio-behavioural heterogeneity in sub-Saharan Africa could account for the variance of HIV incidence between countries.MethodsWe used unsupervised machine learning to analyse data from the Demographic and Health Surveys of 29 SSA countries completed after 2010. We preselected 48 demographic, socio-economic, behavioural and HIV-related attributes to describe each country. We used Principle Component Analysis to visualize sociobehavioural similarity between countries, and to identify the variables that accounted for most sociobehavioural variance in SSA. We used hierarchical clustering to identify groups of countries with similar sociobehavioural profiles, and we compared the distribution of HIV incidence and sociobehavioural variables within each cluster.FindingsThe most important characteristics, which explained 69% of sociobehavioural variance across SSA among the variables we assessed were: religion; male circumcision; number of sexual partners; literacy; uptake of HIV testing; women’s empowerment; accepting attitude toward people living with HIV/AIDS; rurality; ART coverage; and, knowledge about AIDS. Our model revealed three groups of countries, each with characteristic sociobehavioural profiles. HIV incidence was mostly similar within each cluster and different between clusters (median(IQR); 0.5/1000(0.6/1000), 1.8/1000(1.3/1000) and 5.0/1000(4.2/1000)).ConclusionOur findings suggest that sociobehavioural factors play a key role in determining the course of the HIV epidemic, and that similar techniques can help to design and predict the effects of targeted country-specific interventions to impede HIV transmission.Research in contextKnowledge before this studyWe searched PubMed with the terms: “HIV”, “inequality”, “factors” and “sub-Saharan Africa” for articles published in English before February 28th, 2019. The reviewed literature was usually limited to a certain sub-population, sub-national region, or country; but some recent studies covered up to 31 sub-Saharan African countries. Based on a relatively small number of variable (5 to 13), and using descriptive statistics, regressions and concentration indices, previous works analysed the association between socio-economic inequalities, male circumcision, high-risk sexual behaviour, or HIV-related stigma, with HIV testing, uptake of treatment, ART adherence, or HIV prevalence.Contribution of this studyTo our knowledge, this is the first study where unsupervised machine learning techniques (Principle Component Analysis and hierarchical clustering) were used to analyse the sociobehavioural heterogeneity in sub-Saharan Africa (SSA) and how it associates with the variability of HIV incidence in the region. We identified three distinct sociobehavioural profiles, which were associated with different geographical regions and different levels of HIV incidence in SSA. Because the association between the variability of HIV incidence across SSA and its underlying sociobehavioural factors is still not well understood, we believe that our analysis that compares 29 SSA countries based on 48 sociobehavioural characteristics brings significant value to the field. Identifying and comparing sociobehavioural profiles of countries helps to design and predict the effect of tailored country-specific interventions to impede HIV transmission.

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Are adolescent orphans more likely to be HIV-positive? A pooled data analyses across 19 countries in sub-Saharan Africa

Cited by 23 publications

References 41 publications

Economic sanctions and child HIV

Economic sanctions and child HIV

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

Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence

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