Potentially traumatic experiences and sexual health among orphaned and separated adolescents in five low- and middle-income countries

Abstract

Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millions more have been separated from their parents. As younger orphans enter adolescence, their sexual health and HIV-related risk behaviors become key considerations for their overall health. Importantly, their high prevalence of exposure to potentially traumatic events (PTEs) may put OSC at additional risk for adverse sexual health outcomes. The Positive Outcomes for Orphans study followed OSC randomly sampled from institution-based care and from family-based care, as well as a convenience sample of non-OSC, at six sites in five low-and middle-income countries. This analysis focused on the 90-month follow-up, during which adolescents 16 and older were assessed for sexual health, including age at sexual debut, past-year sex, past-year condom use, and perceptions of condom use. We specifically examined the relationship between PTEs and sexual health outcomes. Of the 1258 OSC and 138 non-OSC assessed, 11% reported ever having sex. Approximately 6% of participants reported recent sex and 5% reported having recent unprotected sex. However, 70% of those who had recent sex reported that they did not use a condom every time, and perceptions of condom use tended to be unfavorable for protection against sexual risk behavior. Nearly all (90%) of participants reported experiencing at least one lifetime PTE. For those who experienced “any” PTE, we found increased prevalence of recent sex (PR = 1.39 [0.47, 4.07]) and of recent unprotected sex (PR = 3.47 [0.60, 19.91]). This study highlights the need for caregivers, program managers, and policymakers to promote condom use for sexually active OSC and identify interventions for trauma support services. Orphans living in family-based care may also be particularly vulnerable to early sexual debut and unprotected sexual activity.

Sexual debut and risk behaviors among orphaned and vulnerable children in Zambia: which protective deficits shape HIV risk?

“…The loss of a parental income source, or unplanned adoption of new dependents, increases financial strain on a household, rendering basic expenses on food, health, and education unaffordable (Kasedde et al, 2014;Lee et al, 2014;Olanrewaju et al, 2015;Rivers et al, 2010). Untethered to sources of parental stimulation and psychosocial support in schools and in the household, OVC may experience re-traumatizing neglect and distress that can impair decisionmaking and drive sexual experimentation to cope with these emotional and material deficits (Cluver et al, 2007(Cluver et al, , 2011Gray et al, 2016;Thurman et al, 2006;Whetten et al, 2011). This subsequently exposes OVC to harms like earlier and non-condom sex, as well as sexual coercion (Gray et al, 2016;Operario et al, 2011).…”

“…Untethered to sources of parental stimulation and psychosocial support in schools and in the household, OVC may experience re-traumatizing neglect and distress that can impair decision-making and drive sexual experimentation to cope with these emotional and material deficits ( Cluver et al, 2007 , 2011 ; Gray et al, 2016 ; Thurman et al, 2006 ; Whetten et al, 2011 ). This subsequently exposes OVC to harms like earlier and non-condom sex, as well as sexual coercion ( Gray et al, 2016 ; Operario et al, 2011 ). Deficits in protective assets, therefore, act synergistically in shaping the HIV risk environment for OVC.…”

Experiences of trauma and psychometric properties of the Life Events Checklist among adults in Uganda

“…The Life Events Checklist (LEC-5; Weathers et al, 2013) for the Diagnostic and Statistical Manual of Mental Disorders , 5 th edition (DSM-5; [ 22 ] is a widely used measure. The LEC has previously been applied in many cultural settings, including Africa [ 23 , 24 ]. However, to our knowledge, it has not been used in the Ugandan setting before.…”

Internet and mobile technologies: addressing the mental health of trauma survivors in less resourced communities

“…Torture is endemic in countries affected by pervasive conflict, with 21% of participants in 84 surveys reporting personal experiences of torture (Steel et al 2009 ). Gray et al ( 2016 ) highlighted the prevalence of potentially traumatic experiences (PTEs) in their study of orphaned and separated adolescents in five LMICs, finding that nearly all (90%) of participants reported experiencing at least one lifetime PTE. In a comprehensive review of survivors of mass conflict and displacement, Steel et al ( 2009 ) confirmed a dose–response effect for exposure to potentially traumatic events in relation to both depression and post-traumatic stress disorder (PTSD).…”