AIDS and Behavior

, Volume 17, Issue 3, pp 939–950 | Cite as

Orphan Status and Time to First Sex Among Adolescents in Northern Malawi

  • Paul Mkandawire
  • Eric Tenkorang
  • Isaac N. Luginaah
Original Paper


This study examines the effects of orphanhood status on the timing of first sexual intercourse among youth in Malawi. Log-normal models were applied to survey data collected between May and August 2009 from 1,214 adolescents aged 12–18 in Mzuzu, Northern Malawi. Results of this study show that orphanhood is a significant predictor of age at first sex. Male double orphans experienced first sexual intercourse earlier than their male non-orphan peers. Similarly, female maternal and paternal orphans had their sexual debut faster than their non-orphan counterparts. The introduction of social support variables accounted for the orphanhood disadvantage. These findings suggest that in order to delay sexual initiation and reduce HIV risk among orphans in Malawi, policy efforts should focus on enhancing factual knowledge about HIV/AIDS, household food security, social support, and other measures that will strengthen existing social support networks and connectedness of surviving family members.


Orphanhood Northern Malawi First sex HIV/AIDS 


Este estudio examina los efectos del primer encuentro sexual en jóvenes huérfanos en Malawi. Modelos con distribución logarítmica normal fueron utilizados en los datos de este estudio colectados en el periodo de Mayo a Agosto de 2009 provenientes de 1,214 adolescentes de 12-18 años en Mzuzu, al norte de Malawi. Los resultados de este estudio demuestran que los datos provenientes de los huérfanos son significativos para la predicción de la edad del primer encuentro sexual. Huérfanos masculinos de ambos padres experimentaron el primer encuentro sexual a una edad temprana comparado con sus contrapartes de la misma edad pero sin ser huérfanos. De manera similar, huérfanas de ambos padres tuvieron su primer encuentro sexual a una edad mas joven comparadas con las no huérfanas. La aplicación de variables de soporte social pudieron explicar las desventajas de los huérfanos. Los resultados anteriores sugieren que con el fin de retrasar el primer encuentro sexual y reducir el riesgo de contraer VIH entre huérfanos en Malawi, la política a seguir consistiría en esfuerzos enfocados en incrementar el conocimiento sobre VIH/SIDA, seguridad en alimentación domestica, soporte social, entre otras medidas las cuales reforzaran las redes existentes de soporte social y la conectividad de los miembros de familia.

Palabras clave

huérfanos norte de Malawi primer encuentro sexual VIH/SIDA 


  1. 1.
    Desgrees du Lou A. Reproductive Health and AIDS in sub-Saharan Africa: problems and prospects. Popul Engl Sel. 1999;11:61–87.Google Scholar
  2. 2.
    Akwara AP, Madise JN, Hinde A. Perception of risk of HIV/AIDS and sexual behaviour in Kenya. J Biosoc Sci. 2003;35:385–411.PubMedCrossRefGoogle Scholar
  3. 3.
    Tenkorang E, Rajulton F, Maticka-Tyndale E. Perceived risks of HIV/AIDS and first sexual intercourse among youth in Cape Town, South Africa. AIDS Behav. 2009;13(2):234–45.PubMedCrossRefGoogle Scholar
  4. 4.
    Hulton LA, Cullen R, Khalokho SW. Perceptions of the risks of sexual activity and their consequences among Ugandan adolescents. Stud Fam Plan. 2000;31(1):35–46.CrossRefGoogle Scholar
  5. 5.
    Zulu ME, Dodoo FN-A, Chika-Ezeh A. Sexual risk-taking in the slums of Nairobi, Kenya, 1993–1998. Popul Stud. 2002;56(3):311–23.CrossRefGoogle Scholar
  6. 6.
    Harrison A, Xaba N, Kunene P. Understanding safe sex: gender narratives of HIV and pregnancy prevention by rural South African school-going youth. Reprod Health Matters. 2001;9:63–71. doi:10.1016/S0968-8080(01)90009-6.PubMedCrossRefGoogle Scholar
  7. 7.
    Hallett TB, Gregson S, Lewis JJC. Sexual debut cross-generational sex and delaying age at epidemics: impact of reducing cross-generational sex and delaying age at sexual debut. Sex Transm Infect. 2007;83:i50–4. doi:10.1136/sti.2006.023606.PubMedCrossRefGoogle Scholar
  8. 8.
    Bongaarts J. Late marriage and the HIV epidemic in sub-Saharan Africa. Popul Stud. 2007;61(1):73–83.CrossRefGoogle Scholar
  9. 9.
    Zaba B, Boerma T, White R. Monitoring the AIDS epidemic using HIV prevalence data among young women attending antenatal clinics: prospects and problems. AIDS. 2000;14(11):1633–45.PubMedCrossRefGoogle Scholar
  10. 10.
    Hallman K. Gendered socioeconomic conditions and HIV risk behaviour among young people in South Africa. Afr J AIDS Res. 2005;4(1):37–50.CrossRefGoogle Scholar
  11. 11.
    Cooper D, Hoffman M, Carrara H, et al. Determinants of sexual activity and its relation to cervical cancer risk among South African women. BMC Publ Health. 2007;7(1):341–48.CrossRefGoogle Scholar
  12. 12.
    McGrath N, Nyirenda M, Hosegood V, Newell M-L. Age at first sex in rural South Africa. Sex Trans Infect. 2009;85:49–55.CrossRefGoogle Scholar
  13. 13.
    Thurman R, Brown L, Richter L, Maharaj P, Magnani R. Sexual risk behavior among South African adolescents: is orphan status a factor? AIDS Behav. 2006;10:627–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Birdthistle IJ, Floyd S, Machingura A, et al. From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe. AIDS. 2008;22(6):759–66.PubMedCrossRefGoogle Scholar
  15. 15.
    Munthali A, Zulu E, Madise N, et al. Adolescent sexual and reproductive health in Malawi: results from the 2004 National Survey of Adolescents. Occasional Report. New York: Guttmacher Institute; 2006. Available at: Accessed 20 Jan 2011.
  16. 16.
    Craddock S. Disease, social identity, and risk: rethinking the geography of AIDS. Trans Inst British Geogr. 2000;25(2):153–68.CrossRefGoogle Scholar
  17. 17.
    Campbell C, Nair Y, Maimane S, et al. Supporting people with AIDS and their carers in South Africa: possibilities and challenges. Health Place. 2008;14(3):507–18.PubMedCrossRefGoogle Scholar
  18. 18.
    Mkandawire P, Luginaah IN, Tobias J. Landscapes of economic deprivation and locally distilled liquor (kachasu): an emerging risk milieu for HIV/AIDS in urban Northern Malawi. Environ Plan A. 2011;43(10):2384–98.CrossRefGoogle Scholar
  19. 19.
    Foster G, Williamson J. A review of current literature on the impact of HIV/AIDS on children in sub-Saharan Africa. AIDS. 2000;14(3):S275–84.PubMedGoogle Scholar
  20. 20.
    Miller BC. Family influences on adolescent sexual and contraceptive behavior. J Sex Res. 2002;39(1):22–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Tenkorang E, Family structure and child outcomes: a longitudinal study of sexual behaviour of Canadian adolescents. Master’s Thesis, Population Studies Centre, University of Western Ontario, 2004.Google Scholar
  22. 22.
    Cluver L, Gardner F, Operario D. Psychological distress amongst AIDS-orphaned children in urban South Africa. J Child Psychol Psychiatry. 2007;48(8):755–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;3:455–74.CrossRefGoogle Scholar
  24. 24.
    Tenkorang E, Jones A, Gyimah S. Perceptions of HIV/AIDS risk and sexual behavior of young people in Ghana. Can J Dev Stud. 2010;31(4):329–47.Google Scholar
  25. 25.
    Tenkorang E, Gyimah S, Maticka-Tyndale E, Adjei J. Superstition, witchcraft and AIDS prevention in sub-Saharan Africa: the case of Ghana. Cult Health Sex. 2011;13(9):1001–14.PubMedCrossRefGoogle Scholar
  26. 26.
    Gregson S, Nyamukapa CA, Garnett GP, et al. HIV infection and reproductive health in teenage women orphaned and made vulnerable by AIDS in Zimbabwe. AIDS Care. 2005;17(7):785–94.PubMedCrossRefGoogle Scholar
  27. 27.
    Meekers D. Immaculate conceptions in Sub-Saharan Africa: exploratory analysis of inconsistencies in the timing of first sexual intercourse and first-birth. Soc Biol. 1995;42:151–61.PubMedGoogle Scholar
  28. 28.
    UNAIDS, Report on the Global AIDS Epidemic. Geneva: UNAIDS, 2010. Available at: Accessed 20 Jan 2011.
  29. 29.
    Malawi Government, Malawi population and housing census report, National Statistical Office, Zomba Malawi, 2008. Available at: Accessed 20 Jan 2011.
  30. 30.
    Malawi Government, Malawi Welfare Monitoring Survey Report. Malawi Government: Zomba, 2009. Available at: Accessed 20 Jan 2011.
  31. 31.
    Harrigan J. Food insecurity, poverty and the Malawian starter pack: fresh start or false start? Food Policy. 2008;33(3):237–49.CrossRefGoogle Scholar
  32. 32.
    UNICEF, Maternal and Newborn Health. New York: UNICEF, 2004. Available at: Accessed 20 Jan 2011.
  33. 33.
    Tabachnick BG, Fidell LS. Using multivariate statistics. New York: Pearson; 2007.Google Scholar
  34. 34.
    Lawless JF. Statistical models and methods for lifetime data. New York: Wiley; 1982.Google Scholar
  35. 35.
    Royston P. The lognormal distribution as a model for survival time in cancer, with an emphasis on prognostic factors. Stat Neerlandica. 2001;55:89–104.CrossRefGoogle Scholar
  36. 36.
    Bryceson D, Fonseca J. Risking death for survival: peasant responses to hunger and HIV/AIDS in Malawi. World Dev. 2006;34(8):1666–2006.Google Scholar
  37. 37.
    Devereux S. The impact of draught and floods on food security and policy options to alleviate negative effects. Agric Econ. 2007;37(1):47–58.CrossRefGoogle Scholar
  38. 38.
    Tarasuk V. Household food insecurity with hunger is associated with women’s food intakes, health and household circumstances. J Nutr. 2001;13(13):2670–6.Google Scholar
  39. 39.
    Ssewamala F, Han C, Neilands T, Ismayilova L, Sperber E. Effects of assets on sexual risk-intentions among orphaned adolescents in Uganda. Am J Public Health. 2010;100(3):483–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Evans E, Becker S. Caring for parents with HIV and AIDS: global issues and policy responses. Bristol: The Policy Press; 2009.Google Scholar
  41. 41.
    Skovdal M, Ogutu V, Aoro C, Aoro C, Campbell C. Young carers as social actors: coping strategies of children caring for ailing or ageing guardians in Western Kenya. Soc Sci Med. 2009;69(4):587–95.PubMedCrossRefGoogle Scholar
  42. 42.
    Lloyd CB, Jehrman JR, Stromquist NP, Cohen B, editors. The changing transitions to adulthood in developing countries. Washington DC: NAP; 2005.Google Scholar
  43. 43.
    Ismayilova L, Ssewamala F, Karimli L. Family support as a mediator of change in sexual risk-taking attitudes among orphaned adolescents in Rural Uganda. J Adolesc Health. 2011. doi: 10.1016/jadohealth.2011.06.008.
  44. 44.
    Birdthistle I, Floyd S, Nyagadza A, et al. Is education the link between orphanhood and HIV/HSV-2 risk among female adolescents in rural Zimbabwe? Soc Sci Med. 2009;68(10):1810–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Malawi Government, Malawi Orphan and Other Vulnerable Children Policy, Ministry of Gender, Child Welfare and Community Services, 2003. Available at: Accessed 20 Jan 2011.
  46. 46.
    MwNyasaTimesBNL, 2 January 2010. Available at: Accessed 20 Jan 2011.
  47. 47.
    Angell M. The ethics of clinical research in the third world. New Engl J Med. 1997;337:847–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Poulin M. Reporting on first sexual experience: the importance of interviewer-respondent interaction. Demogr Res. 2010;22(11):237–88.PubMedCrossRefGoogle Scholar
  49. 49.
    Mensch BS, Hewett PC, Gregory R. Sexual behavior and STI/HIV status among adolescents in rural Malawi: an evaluation of the effect of interview mode on reporting. Stud Fam Plan. 2008;39(4):321–34.CrossRefGoogle Scholar
  50. 50.
    Willet JD, Singer JB. Applied longitudinal data analysis: modeling change and event history. New York: Oxford University Press; 2003.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Paul Mkandawire
    • 1
  • Eric Tenkorang
    • 2
  • Isaac N. Luginaah
    • 3
  1. 1.Social Science Centre 1424, Department of GeographyThe University of Western OntarioLondonCanada
  2. 2.Department of Sociology Room AA4049AMemorial University of NewfoundlandSt. John’sCanada
  3. 3.Social Science Centre 1409, Department of GeographyThe University of Western OntarioLondonCanada

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