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Multicenter Study
. 2008 Jan;98(1):133-41.
doi: 10.2105/AJPH.2007.116038. Epub 2007 Nov 29.

HIV-associated orphanhood and children's psychosocial distress: theoretical framework tested with data from Zimbabwe

Constance A Nyamukapa  1 , Simon Gregson, Ben Lopman, Suzue Saito, Helen J Watts, Roeland Monasch, Matthew C H Jukes
Affiliations
Multicenter Study

HIV-associated orphanhood and children's psychosocial distress: theoretical framework tested with data from Zimbabwe

Constance A Nyamukapa et al. Am J Public Health. 2008 Jan.

Abstract

Objectives: We measured the psychosocial effect of orphanhood in a sub-Saharan African population and evaluated a new framework for understanding the causes and consequences of psychosocial distress among orphans and other vulnerable children.

Methods: The framework was evaluated using data from 5321 children aged 12 to 17 years who were interviewed in a 2004 national survey in Zimbabwe. We constructed a measure of psychosocial distress using principle components analysis. We used regression analyses to obtain standardized parameter estimates of psychosocial distress and odds ratios of early sexual activity.

Results: Orphans had more psychosocial distress than did nonorphans. For both genders, paternal, maternal, and double orphans exhibited more-severe distress than did nonorphaned, nonvulnerable children. Orphanhood remained associated with psychosocial distress after we controlled for differences in more-proximate determinants. Maternal and paternal orphans were significantly more likely than were nonorphaned, nonvulnerable children to have engaged in sexual activity. These differences were reduced after we controlled for psychosocial distress.

Conclusions: Orphaned adolescents in Zimbabwe suffer greater psychosocial distress than do nonorphaned, nonvulnerable children, which may lead to increased likelihood of early onset of sexual intercourse and HIV infection. The effect of strategies to provide psychosocial support should be evaluated scientifically.

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Figures

FIGURE 1—
FIGURE 1—
Theoretical framework on the causes and consequences of psychosocial distress among children orphaned and made vulnerable by HIV/AIDS. Note. Dotted line indicates that the pathway does not involve psychosocial distress. The effects of the different processes in the framework are expected to vary depending on the social context.
FIGURE 2—
FIGURE 2—
Effects of orphan and vulnerable child status on (a) psychosocial distress, (b) early sexual intercourse, and (c) high-risk sexual intercourse: Survey on Orphans and Other Vulnerable Children in Rural and Urban High Density Zimbabwe 2004. Note. Horizontal lines represent the 95% confidence intervals.
See this image and copyright information in PMC

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