Sexual Risk Behavior among South African Adolescents: Is Orphan Status a Factor?

There is concern that orphans may be at particular risk of HIV infection due to earlier age of sexual onset and higher likelihood of sexual exploitation or abuse; however, there is limited empirical evidence examining this phenomenon. Utilizing data from 1694 Black South African youth aged 14–18, of whom 31% are classified as orphaned, this analysis explores the relationship between orphan status and sexual risk. The analysis found both male and female orphans significantly more likely to have engaged in sex as compared to non-orphans (49% vs. 39%). After adjusting for socio-demographic variables, orphans were nearly one and half times more likely than non-orphans to have had sex. Among sexually active youth, orphans reported younger age of sexual intercourse with 23% of orphans having had sex by age 13 or younger compared to 15% of non-orphans. Programmatic implications of these findings for the care and protection of orphans are discussed.

This is a preview of subscription content, log in to check access.

REFERENCES

  1. Brookes, H., Shisana, O., & Richter, L. (2004). The National Household HIV Prevalence and Risk Survey of South African Children. Cape Town: Human Science Research Council.

    Google Scholar 

  2. Carpenter, S. C., Clyman, R. B., Davidson, A. J., & Steiner, J. F. (2001). The association of foster care or kinship care with adolescent sexual behavior and first pregnancy. Pediatrics, 108(3), E46.

    PubMed  CAS  Article  Google Scholar 

  3. Cerwonka, E. R., Isbell, T. R., & Hansen, C. E. (2000). Psychosocial factors as predictors of unsafe sexual practices among young adults. AIDS Education and Prevention, 12(2), 141–153.

    PubMed  CAS  Google Scholar 

  4. Cote, A. M., Sobela, F., Dzokoto, A., Nzambi, K., Asamoah-Adu, C., Labbe, A. C., et al. (2004). Transactional sex is the driving force in the dynamics of HIV in Accra, Ghana. AIDS, 18(6), 917–925.

    PubMed  Google Scholar 

  5. Department of Health. (2005). National HIV and syphilis antenatal sero-prevalence survey in South Africa 2004.

  6. Eaton, L., Flisher, A. J., & Aaro, L. E. (2003). Unsafe sexual behaviour in South African youth. Social Science and Medicine, 56(1), 149–165.

    PubMed  Article  Google Scholar 

  7. Foster, G., Makufa, C., Drew, R., Mashumba, S., & Kambeu, S. (1997). Perceptions of children and community members concerning the circumstances of orphans in rural Zimbabwe. AIDS Care, 9(4), 391–405.

    PubMed  CAS  Article  Google Scholar 

  8. Foster, G., & Williamson, J. (2000). A review of current literature on the impact of HIV/AIDS on children in sub-Saharan Africa. Aids, 14(Suppl 3), S275–284.

    PubMed  Google Scholar 

  9. Gueye, M., Castle, S., & Konate, M. K. (2001). Timing of first intercourse among Malian adolescents: Implications for contraceptive use. International Family Planning Perspectives, 27(2), 56–70.

    Article  Google Scholar 

  10. Guma, M., & Hendra, N. (2004). The socio-cultural context of child abuse: The betrayal of trust. In L. Richter, A. Dawes, and C. Higson-Smith (Ed.), The sexual abuse of young children in southern Africa. Cape Town: Human Science Research Council Press.

    Google Scholar 

  11. Gregson, S., Nyamukapa, C., Garnett, G. P., Wambe, M., Lewis, J. J. C., & Mason, P. R., et al. (2005). HIV infection and reproductive health in teenage women made vulnerable by AIDS in Zimbabwe. AIDS Care, 17(7): 785–794.

    PubMed  CAS  Google Scholar 

  12. Gregson, S., Nyamukapa, C., Garnett, G. P., Mason, P. R., Zhuwau, T., & Careal, M., et al. (2002). Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. The Lancet, 359, 1896–1903.

    Article  Google Scholar 

  13. Harvey, M. S., & Spigner, C. (1995). Factors associated with sexual behavior among adolescents: A multivariate analysis. Adolescence, 30(118), 253–264.

    PubMed  CAS  Google Scholar 

  14. Hulton, L. A., Cullen, R., & Wamala Khalokho, S. (2000) Perception of the risks of sexual activity and their consequences among Ugandan adolescents. Studies in Family Planning, 31, 35–46.

    PubMed  CAS  Article  Google Scholar 

  15. Hunter, S. S. (1990). Orphans as a window on the AIDS epidemic in Sub-Saharan Africa: initial results and implications of a study in Uganda. Social Science and Medicine, 31(6), 681–690.

    PubMed  CAS  Article  Google Scholar 

  16. Hutton, H. E., Lyketsos, C. G., Zenilman, J. M., Thompson, R. E., & Erbelding, E. J. (2004). Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. American Journal of Psychiatry, 161(5), 912–914.

    PubMed  Article  Google Scholar 

  17. Jejeebhoy, S. J., & Bott, S. (2003) Non-consensual sexual experiences of young people: A review of the evidence from developing countries. New Delhi: Population Council.

    Google Scholar 

  18. Jessor, R., Costa, F., & Jessor, L. (1983). Time of first intercourse: A prospective study. Journal of Personality and Social Psychology, 44(3), 608–626.

    Article  Google Scholar 

  19. Karim, A. M., Magnani, R. J., Morgan, G. T., & Bond, K. C. (2003). Reproductive health risk and protective factors among unmarried youth in Ghana. International Family Planning Perspectives, 29(1), 14–24.

    PubMed  Article  Google Scholar 

  20. Kaufman, C. E., & Stavrou, S. E. (2004). Bus fare, please: The economics of sex and gifts among adolescents in urban South Africa. Culture, Health and Sexuality, 6, 377–391.

    Article  Google Scholar 

  21. Kirby, D. (1999). Looking for reasons why. The antecedents of adolescent sexual risk-taking, pregnancy and childbearing. Washington, DC: National Campaign to Prevent Pregnancy.

    Google Scholar 

  22. Luke, N. (2001) Cross-generational and transactional sexual relations in Sub-Saharan Africa: A review of the evidence on prevalence and implications for negotiation of safe sex practices for adolescent girls. Washington: International Center for Research on Women.

    Google Scholar 

  23. MacPhail, C., & Campbell, C. (2001). ‘I think condoms are good but, aai, I hate those things’: condom use among adolescents and young people in a Southern African township. Social Science and Medicine, 52(11) 1613–1627.

    PubMed  CAS  Article  Google Scholar 

  24. Magnani, R. J., Karim, A. M., Weiss, L. A., Bond, K. C., Lemba, M., & Morgan, G. T. (2002). Reproductive health risk and protective factors among youth in Lusaka, Zambia. Journal of Adolescent Health, 30(1), 76–86.

    PubMed  Article  Google Scholar 

  25. Makame, V., Ani, C., & Grantham-McGregor, S. (2002). Psychological well-being of orphans in Dar El Salaam, Tanzania. Acta Paediatr, 91(4), 459–465.

    PubMed  CAS  Article  Google Scholar 

  26. Meekers, D., & Ahmed, G. (2000). Contemporary patterns of adolescent sexuality in urban Botswana. Journal of Biosocial Science, 32(4), 467–485.

    PubMed  CAS  Article  Google Scholar 

  27. Muula, A. S., Misiri, H., Munthali, L., Kalengo, S., Kachali, F., Mbewe, M., et al. (2003). The living situations of orphans in periurban Blantyre, Malawi. South African Medical Journal, 93(12), 920–1.

    PubMed  Google Scholar 

  28. Ngom, P., Magadi, M. A., & Owuor, T. (2003). Parental presence and adolescent reproductive health among the Nairobi urban poor. Journal of Adolescent Health, 33(5), 369–377.

    PubMed  Article  Google Scholar 

  29. O’Donnell, B. L., O’Donnell, C. R., & Stueve, A. (2001). Early sexual initiation and subsequent sex-related risks among urban minority youth: the reach for health study. Family Planning Perspectives, 33(6), 268–275.

    PubMed  CAS  Article  Google Scholar 

  30. Pettifor, A. E., Rees, H. V., Steffenson, A., Hlongwa-Madikizela, L., McPhail, C., & Vermaak, K., et al. (2004) HIV and sexual behaviour among young South Africans: A national survey of 15–24 year olds. Johannesburg: RHRU, University of the Witwatersrand.

    Google Scholar 

  31. Pettifor, A. E., Van der Straten, A., Dunbar, M. S., Shiboski, S. C., & Padian, N. S. (2004). Early age of first sex: a risk factor for HIV infection among women in Zimbabwe. Aids, 18(10), 1435–1442.

    PubMed  Article  Google Scholar 

  32. Rau, B. (2003). HIV/AIDS and child labour. A state-of-the art review with recommendations for action. Synthesis report, Paper No. 6. Geneva, Switzerland: International Labour Organization, International Programme on the Elimination of Child Labour.

    Google Scholar 

  33. Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., et al. (1997). Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association, 278(10), 823–832.

    PubMed  CAS  Article  Google Scholar 

  34. Romer, D., Stanton, B., Galbraith, J., Feigelman, S., Black, M. M., & Li, X. (1999). Parental influence on adolescent sexual behavior in high-poverty settings. Archives of Pediatrics and Adolescent Medicine, 153(10), 1055–1062.

    PubMed  CAS  Google Scholar 

  35. Sengendo, J., & Nambi, J. (1997). The psychological effect of orphanhood: a study of orphans in Rakai district. Health Transition Review, 7(Suppl), 105–124.

    PubMed  Google Scholar 

  36. Sharpe, U., Ssentongo, R., Ssenyonga, A., & Ssamula, B. (1993, July). Orphans sexual behaviour in Masaka diocese, Uganda. Paper presented at the Ixth International Conference on AIDS, Berlin (abstract WS-D26–5).

  37. Shisana, O. & Simbayi, L. (2002). Nelson Mandela/HSRC study of HIV/AIDS. South African national HIV prevalence, behavioural risks and mass media. Capetown, South Africa: Human Sciences Research Council.

    Google Scholar 

  38. Silberschmidt, M., & Rasch, V. (2001). Adolescent girls, illegal abortions and “sugar-daddies” in Dar es Salaam: vulnerable victims and active social agents. Social Science and Medicine, 52(12), 1815–1826.

    PubMed  CAS  Article  Google Scholar 

  39. Small, S. A., & Luster, T. (1994). Adolescent sexual activity: An ecological, risk-factor approach. Journal of Marriage and Family, 56(1), 181–192.

    Article  Google Scholar 

  40. South Africa Demographic and Health Survey. (1998). South African Medical Research Council, Measure Evaluation, USAID.

  41. Swart-Kruger, J., & Richter, L. M. (1997). AIDS-related knowledge, attitudes and behaviour among South African street youth: reflections on power, sexuality and the autonomous self. Social Science and Medicine, 45(6), 957–966.

    PubMed  CAS  Article  Google Scholar 

  42. The Transitions to Adulthood Study Team. (2004). “Transistions to Adulthood in the Context of AIDS in South Africa: The Impact of Exposure to Life Skills Education on Adolescent Knowledge, Skills and Behavior,” Horizons Final Report. Washington D.C.: Population Council. Avaialble from: http://www.popcouncil.org/pdfs/horizons/lfsklsfnl.pdf.

  43. Turner, A. G., Magnani, R. J., & Shuaib, M. (1996). A not quite as quick but much cleaner alternative to the Expanded Programme on Immunization (EPI) Cluster Survey design. International Journal of Epidemiology, 25(1), 198–203.

    PubMed  CAS  Google Scholar 

  44. UNAIDS. (1999). Differences in HIV Spread in Four sub-Saharan African cities. Lusaka, Zambia.

  45. UNAIDS, UNICEF, and USAID. (2004). Children on the Brink 2004. A Joint Report of New Orphan Estimates and a Framework for Action.

  46. UNICEF. (1996). Children Orphaned by AIDS. Front-line responses from eastern and southern Africa.

  47. UNICEF. (2003). Africa's Orphaned Generation. New York.

  48. UNICEF. (2005). Orphans, HIV and AIDS. Vulnerable Young People. Available: http://www.unicef.org/voy/explore/aids/explore_196.html Accessed 3/10/05.

  49. Veale, A., & Dona, G. (2003). Street children and political violence: a socio-demographic analysis of street children in Rwanda. Child Abuse and Neglect, 27(3), 253–269.

    PubMed  Article  Google Scholar 

  50. Vundule, C., Maforah, F., Jewkes, R., & Jordaan, E. (2001). Risk factors for teenage pregnancy among sexually active adolescents in Cape Town. South African Medical Journal, 91, 73–80.

    PubMed  CAS  Google Scholar 

  51. Williams, C. T., & Latkin, C. A. (2005). The role of depressive symptoms in predicting sex with multiple and high-risk partners. Journal of Acquired Immune Deficiency Syndromes: JAIDS, 38(1), 69–73.

    PubMed  Article  Google Scholar 

  52. World Health Organization, Child and Adolescent Health and Development. (2005). HIV/AIDS and Adolescents. Why are young people particularly affected by HIV/AIDS?). Available: http://www.who.int/child-adolescent-health/HIV/HIV_adolescents_link1.htm Accessed 3/10/05.

Download references

Acknowledgements

This was a collaborative research project of the University of Natal-Durban School of Development Studies, the HORIZONS Project and the Policy Research Division of the Population Council, and Tulane University School of Public Health and Tropical Medicine under the auspices of the FOCUS on Young Adults and MEASURE-Evaluation Projects. This research was supported by the U.S. Agency for International Development through the Horizons program (under the terms of Cooperative Agreement No. HRN-A-00-97-00012-00), the FOCUS on Young Adults Program (CCP-3-73-A00-6002-00), the MEASURE/Evaluation Project (HRN-A-00-97-00018-00), and by a Rockefeller Foundation Grant to the Population Council's Policy Research Division. In addition to the partners and supporters of this research, we also extend great appreciation to the young South Africans who responded so willingly to these questionnaires. All those who conducted the interviews deserve a special thanks for their dedication and professionalism through the study period. I also wish to thank Janet Rice, Ph.D. for her statistical guidance. Lastly, we thank the anonymous reviewers and journal Editor for their useful comments.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Tonya R. Thurman.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Thurman, T.R., Brown, L., Richter, L. et al. Sexual Risk Behavior among South African Adolescents: Is Orphan Status a Factor?. AIDS Behav 10, 627–635 (2006). https://doi.org/10.1007/s10461-006-9104-8

Download citation

Key words

  • Orphans
  • South Africa
  • First sex
  • Sexual abuse
  • HIV risk behavior
  • Survival sex
  • Transactional sex