Luseno Winnie, Zhang Lei, Rusakaniko Simbarashe, Cho Hyunsan, Hallfors Denise
a Pacific Institute for Research & Evaluation , Chapel Hill , NC , USA.
b Department of Community Medicine , University of Zimbabwe , Harare , Zimbabwe.
AIDS Care. 2015;27(9):1191-5. doi: 10.1080/09540121.2015.1036726. Epub 2015 May 1.
Research is limited on whether providing school support to female adolescent orphans mitigates their HIV risk disadvantage compared to other female adolescents. This paper examines 2011 Zimbabwe Demographic and Health Survey (ZDHS) HIV-related biomarker and behavior data for orphaned and nonorphaned rural adolescent females to compare findings from a similar sample participating in a randomized controlled trial (RCT) testing school support as HIV prevention. HIV status, marriage, pregnancy, sexual debut, school dropout, years of schooling, and socioeconomic status were analyzed with the combined data-sets. Bivariate analyses compared variables between RCT comprehensive intervention and delayed partial intervention conditions, and between ZDHS orphan and nonorphan groups. Multivariable analyses included a series of group comparisons as follows: ZDHS orphans vs. ZDHS nonorphans; RCT orphans in each condition vs. ZDHS nonorphans; RCT orphans in each condition vs. ZDHS orphans. Analyses methods accounted for the complex survey sampling design within each data-set. A total of 751 observations were included. All orphan groups had consistently higher odds of HIV infection than ZDHS nonorphans. ZDHS orphans had higher odds of marriage, pregnancy, and sexual debut than ZDHS nonorphans. Comprehensive intervention participants had lower odds of marriage, sexual debut, and school dropout than ZDHS nonorphans. RCT participants in both conditions had lower odds of marriage, sexual debut, and school dropout than ZDHS orphans. The findings indicate that orphans are at a distinct disadvantage to HIV risk compared to nonorphans, and much of this is likely related to vertical transmission. We found no evidence that provision of school fees to orphans will reduce their risk of HIV infection relative to nonorphans but further evidence that such programs may reduce risk behaviors including early sexual debut, child marriage, and school dropout. Further research is needed to determine how these programs can be sustainably scaled-up in resource-limited settings.
与其他女性青少年相比，为青春期女性孤儿提供学校支持是否能减轻她们感染艾滋病毒的风险劣势，这方面的研究有限。本文研究了2011年津巴布韦人口与健康调查（ZDHS）中农村青春期女性孤儿和非孤儿的艾滋病毒相关生物标志物及行为数据，以比较参与一项将学校支持作为艾滋病毒预防措施的随机对照试验（RCT）的类似样本的研究结果。利用合并数据集分析了艾滋病毒感染状况、婚姻、怀孕、首次性行为、辍学、受教育年限和社会经济地位。双变量分析比较了随机对照试验综合干预组和延迟部分干预组之间的变量，以及津巴布韦人口与健康调查中的孤儿组和非孤儿组之间的变量。多变量分析包括以下一系列组间比较：津巴布韦人口与健康调查中的孤儿与非孤儿；每种情况下随机对照试验中的孤儿与津巴布韦人口与健康调查中的非孤儿；每种情况下随机对照试验中的孤儿与津巴布韦人口与健康调查中的孤儿。分析方法考虑了每个数据集中复杂的调查抽样设计。总共纳入了751个观察对象。所有孤儿组感染艾滋病毒的几率始终高于津巴布韦人口与健康调查中的非孤儿。津巴布韦人口与健康调查中的孤儿结婚、怀孕和首次性行为的几率高于非孤儿。综合干预参与者结婚、首次性行为和辍学的几率低于津巴布韦人口与健康调查中的非孤儿。两种情况下随机对照试验的参与者结婚、首次性行为和辍学的几率均低于津巴布韦人口与健康调查中的孤儿。研究结果表明，与非孤儿相比，孤儿在感染艾滋病毒风险方面存在明显劣势，其中很大一部分可能与垂直传播有关。我们没有发现证据表明为孤儿提供学费会降低他们相对于非孤儿感染艾滋病毒的风险，但有进一步证据表明此类项目可能会减少包括过早性行为、童婚和辍学在内的风险行为。需要进一步研究以确定如何在资源有限的环境中可持续地扩大这些项目的规模。
