Orphanhood, Gender, and HIV Infection among Adolescents in South Africa: A Mixed Methods Study

Elizabeth F. Jackson, University of North Carolina at Chapel Hill
Sharon Weir, University of North Carolina at Chapel Hill
William Miller, University of North Carolina at Chapel Hill
Audrey Pettifor, University of North Carolina at Chapel Hill
Frieda Behets, University of North Carolina at Chapel Hill
Suzanne Maman, University of North Carolina at Chapel Hill

This study examines the relationship between parental death and HIV infection among South African adolescents. Prevalence of HIV and HIV risk behaviors among 8,735 young people 15-24 is assessed, utilizing a household survey from 33 communities. Survey data indicate that orphaned adolescents of both genders have higher HIV prevalence than their peers, particularly before age 20. Our study points to the important roles of both parental bereavement and non-residence with a parent in adolescent HIV risk. In addition, pathways through which orphanhood may affect HIV risk are assessed by gender, using the proximate determinants framework for factors affecting the sexual transmission of HIV. Finally, qualitative data are used to supplement survey findings by describing the gendered effects of orphanhood on HIV risk behavior in two South African communities. Repeated focus group discussions and interviews with 57 orphaned or vulnerable young people 14-19 illustrate factors influencing orphan sexual debut and partnership characteristics.