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J Adolesc Health. 2017 Apr;60(4):417-424. doi: 10.1016/j.jadohealth.2016.11.015. Epub 2017 Jan 16.

Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings.

Author information

1
Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.
2
Moi Teaching and Referral Hospital, Eldoret, Kenya.
3
Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
4
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
5
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
6
Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
7
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya; Department of Pediatrics, Indiana University, School of Medicine, Indianapolis, Indiana.
8
Department of Mental Health, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
9
Department of Health Policy, Services, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
10
Department of Pediatrics, Indiana University, School of Medicine, Indianapolis, Indiana.
11
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Medicine, College of Health Sciences, School of Medicine, Eldoret, Kenya; Regenstrief Institute, Inc, Indianapolis, Indiana; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Electronic address: paula.braitstein@utoronto.ca.

Abstract

PURPOSE:

This study sought to assess whether risky sexual behaviors and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya.

METHODS:

We analyzed baseline data from a cohort of orphaned adolescents aged 10-18 years living in 300 randomly selected households and 19 charitable children's institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariate logistic regression compared these between participants in institutional care and family-based care while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use.

RESULTS:

This analysis included 1,365 participants aged ≥10 years: 712 (52%) living in institutional environments and 653 (48%) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (adjusted odds ratio, .46; 95% confidence interval, .3-.72) or to have experienced forced sex (adjusted odds ratio, .57; 95% confidence interval, .38-.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables.

CONCLUSIONS:

Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents' sexual risk-taking behaviors. The use of single items to assess outcomes and nonexplicit definition of sex suggest the findings should be interpreted with caution.

KEYWORDS:

Family-based care; Institutional care; Kenya; Orphans; Sexual behavior; Transactional sex

PMID:
28110864
PMCID:
PMC5389113
DOI:
10.1016/j.jadohealth.2016.11.015
[Indexed for MEDLINE]
Free PMC Article

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