Parental death and HIV infection among adolescents and young adults in South Africa

This dissertation examined the association between parental death and HIV infection among 8,735 young people aged 15-24, utilizing a 2002 household survey from 33 communities. Analyses examined parental loss and HIV in the context of gender, age, and residence with either or both parents, a non-parental adult, or no adult. Survey data indicate that young people of both genders who have experienced parental loss have higher HIV prevalence than their peers, particularly below age 20. For females, loss of a father is associated with the most precise and prolonged elevation in HIV prevalence, while for males, loss of a mother is most detrimental. Taking living situation into account, results indicate that non-residence with a parent or adult is associated with increased prevalence of HIV among young people who have lost one or both parents (YPLP) and young people whose parents are alive (YPPA), although there were important gender differences in how living with no adult affected YPLP. In addition, qualitative data describe the gendered effects of parental loss on HIV risk behavior in two South African communities. Repeated focus group discussions with 54 orphaned or vulnerable young people 14-18 illustrate factors influencing orphan sexual debut and partnership characteristics. The gendered association between HIV and parental loss that is apparent in the survey data may be explained by qualitative findings which indicate that orphan poverty impedes the formation of male orphan sexual partnerships and encourages the formation of female orphan sexual partnerships. Psychosocial aspects of orphanhood may increase HIV risk for both males and females