The United Nations Children’s Fund (UNICEF) defines an ‘orphan’ as a minor who is below the age of 18 that has lost one or both biological parents to death [1]. Globally as at year 2022, there is approximately 14.9 million orphan children aged 0–17 years with 11.2 million living in sub-Saharan Africa and 960 000 in South Africa [2]. Children aged 0–18 years living in sub-Saharan Africa have been negatively affected by the HIV epidemic due to being orphaned at a tender age [3, 4]. Literature has shown that adolescent orphans are at an increased risk of contracting HIV compared to their non-orphaned counterparts [5]. Data from 19 countries suggest that they are two to three times more likely to contract HIV during adolescence compared to non-orphans [6].
In South Africa, orphanhood among adolescents aged 15–19 years living with HIV (ALHIV) declined from 55.7% in 2012 to 43.7% in 2017, respectively [7]. With the highest rate of orphans being paternal orphans at 17.4% and maternal orphanhood at 13.4% in 2017 [4, 7, 8]. However, the impact of adult mortality on orphanhood in South Africa remains to be seen. Estimates of orphanhood among children younger than 18 years of age using data for 21 countries over a one-year period between 2020–2021, found that South Africa ranked among the top six countries with regards to orphaned children [9]. Literature has shown that adolescent orphans are at an increased risk of contracting HIV. Orphans are often victims of sexual exploitation and are at an increased risk of being physically or sexually exploited by the neighbours, relatives, caregivers, or guardian [5, 7, 10, 11]. They are often coerced to engage in high-risk behaviours at a young age such as unprotected sexual intercourse, early sexual debut, having multiple sexual partners, age disparate sexual relationship, and sex in exchange for money, goods, or other favours [12] which also results in an increased risk of contracting HIV [13].
The mode of contracting HIV among young orphans is not only through risky sexual behaviour, but also through mother to child transmission [14–16]. Some HIV positive orphans are undiagnosed due to the challenge of connecting HIV positive orphans to universal test and treat programs because these programs are not targeted to orphans [17]. This results in an increased number of orphans who are either not diagnosed or initiated on antiretroviral therapy (ART) or are diagnosed and initiated on ART late compared to non-orphaned children [17, 18].
Orphanhood also increases psychological vulnerability with data showing that, ALHIV who have lost their parents to AIDS tend to show symptoms of depression and post-traumatic stress disorder (PTSD) compared to non-orphaned adolescents, and this manifests itself in poor physical and mental health [3, 7, 19]. In addition to the trauma of losing their parents, orphans face many obstacles that can be attributed to the effects of the epidemic. A great number of orphans become the heads of households, are forced to look after themselves and siblings, and are vulnerable to many forms of abuse which affect their psychological well-being [3].
Evidence shows that the combined social vulnerability due to economic hardship, mental distress, and sexual victimization predispose orphans to greater sexual risk taking and exposure to HIV risk [20]. Reducing risk behaviours in this population is crucial to prevent the spread of HIV to achieve an AIDS-free generation. Improved understanding of factors associated with HIV in this population is important for developing tailored and targeted interventions. While there is a growing number of studies that looked at the factors associated with HIV among young people in the general population, fewer have focused on the orphan population [15]. This study aims to examine HIV prevalence and associated factors among reported orphaned adolescents aged 12–24 years in South Africa using the 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey.