Education, substance use, and HIV risk among orphaned adolescents in Eastern Zimbabwe

Figures & data

Table 1. Age-adjusted odds-ratios for demographic factors and different forms of substance abuse.

	Males										Females
		Smoking cigarettes		Taking drugs for pleasure		Drinking alcohol		Any substance use			Any substance use
	N	%	AOR (95% CI)	%	AOR (95% CI)	%	AOR (95% CI)	%	AOR (95% CI)	N	%	AOR (95% CI)
Orphanhood
Non-orphan	789	0.9%	1	2.8%	1	6.6%	1	6.6%	1	818	1.0%	1
Maternal	364	1.4%	1.7 (0.56–4.9)	4.9%	1.9 (1.04–3.5)*	7.8%	1.3 (0.82–2.1)	8.5%	1.4 (0.88–2.2)	365	0.5%	0.54 (0.12–2.4)
Paternal	699	0.9%	0.77 (0.27–2.2)	3.6%	1.2 (0.66–2.1)	5.9%	0.80 (0.52–1.2)	6.6%	0.89 (0.59–1.3)	699	0.9%	0.83 (0.29–2.4)
Double	280	1.1%	1.1 (0.30–3.9)	5.4%	2.0 (1.04–3.7)*	7.6%	1.2 (0.72–2.0)	8.6%	1.3 (0.81–2.2)	259	0.4%	0.36 (0.05–2.8)
Community type
Town	245	0.8%	1	0.4%	1	3.7%	1	3.7%	1	262	1.1%	1
Commercial estate	336	11.9%	1.5 (0.28–8.5)	2.7%	7.2 (0.89–57.6)	7.1%	2.2 (0.97–4.8)	7.7%	2.4 (1.1–5.3)*	347	0%	N/A
Subsistence farming	662	1.1%	1.4 (0.28–6.6)	3.8%	10.5 (1.4–78.6)*	7.1%	2.1 (1.01–4.5)*	7.4%	2.2 (1.1–4.7)*	688	1.3%	1.2 (0.32–4.4)
Roadside trading centre	366	0.5%	0.61 (0.09–4.4)	4.4%	10.5 (1.4–80.5)*	6.0%	1.6 (0.69–3.5)	6.6%	1.7 (0.78–3.9)	368	0.8%	0.74 (0.15–3.7)
SES
Poorest quintile	293	1.4%	1	2.0%	1	4.8%	1	4.8%	1	283	0%	N/A
Second quintile	361	0.8%	0.56 (0.12–2.5)	4.2%	2.0 (0.73–5.2)	6.4%	1.3 (0.64–2.6)	7.5%	1.5 (0.78–3.1)	374	0.3%	1
Middle quintile	329	0.9%	0.48 (0.10–2.2)	4.0%	1.4 (0.50–3.7)	7.6%	1.2 (0.60–2.4)	7.9%	1.3 (0.63–2.5)	353	1.4%	5.3 (0.62–45.9)
Fourth quintile	338	0.3%	0.17 (0.02–1.5)	3.0%	1.1 (0.39–3.1)	6.0%	1.0 (0.49–2.0)	6.2%	1.0 (0.51–2.1)	311	1.0%	3.6 (0.38–35.1)
Least poor quintile	286	1.3%	0.75 (0.18–3.1)	2.4%	0.83 (0.27–2.5)	7.0%	1.1 (0.55–2.3)	7.0%	1.1 (0.54–2.3)	342	1.8%	6.6 (0.80–55.5)
Religion
Christian	869	1.0%	1	3.7%	1	7.4%	1	7.5%	1	900	1.4%	1
Traditional	4	0%	N/A	0%	N/A	0%	N/A	0%	N/A	3	0%	N/A
Spiritual	411	0.5%	0.48 (0.10–2.3)	1.2%	0.33 (0.1–0.86)*	4.1%	0.55 (0.3–0.96)*	4.1%	0.54 (0.3–0.95)*	494	0.2%	0.14 (0.02–1.1)
Other	231	0.9%	0.87 (0.19–4.1)	3.0%	0.86 (0.37–2.0)	5.7%	0.78 (0.41–1.5)	6.5%	0.89 (0.49–1.6)	244	0.4%	0.27 (0.04–2.1)
None	89	2.2%	2.0 (0.41–9.4)	7.9%	2.0 (0.83–4.9)	9.1%	1.1 (0.50–2.5)	12.4%	1.6 (0.79–3.3)	17	0%	N/A
School enrolment^a
Not enroled	320	1.9%	1	5.3%	1	9.7%	1	10.6%	1	493	1.4%	1
Enroled	1055	0.3%	0.24 (0.05–1.1)	0.9%	0.27 (0.1–0.64)*	2.6%	0.37 (0.2–0.7)**	2.7%	0.34 (0.2–0.6)**	934	0.6%	0.68 (0.19–2.4)

^aAges 15–18; N/A: No observations in comparison group; *Significant at p < 0.05; **Significant at p<0.01.

Table 2. Effect of vulnerability and proposed protective effects on drug use, smoking, and drinking alcohol in male youth from Manicaland.

	Males
		Smoking cigarettes		Taking drugs for pleasure		Drinking alcohol		Any substance use
	N	%	AOR (95% CI)^b	%	AOR (95% CI)^b	%	AOR (95% CI)^b	%	AOR (95% CI)^b
Orphanhood
Non-orphan	789	0.9%	1	2.8%	1	6.6%	1	6.6%	1
Maternal orphan	364	1.4%	1.7 (0.56–4.9)	4.9%	1.9 (1.01–3.4)*	7.8%	1.2 (0.77–2.0)	8.5%	1.3 (0.84–2.1)
Paternal orphan	699	0.9%	0.77 (0.27–2.2)	3.6%	1.2 (0.64–2.1)	5.9%	0.77 (0.50–1.2)	6.6%	0.86 (0.57–1.3)
Double orphan	280	1.1%	1.1 (0.30–3.9)	5.4%	2.0 (1.04–3.8)*	7.6%	1.1 (0.67–1.9)	8.6%	1.2 (0.76–2.0)
School enrolment – all children^a
Not enroled	320	1.9%	1	5.3%	1	9.7%	1	10.6%	1
Enroled	1055	0.3%	0.25 (0.06–1.1)	0.9%	0.26 (0.11–0.63)**	2.6%	0.32 (0.18–0.57)***	2.7%	0.30 (0.17–0.53)***
School enrolment – maternal orphans^a
Not enroled	89	2.2%	1	10.1%	1	11.5%	1	13.5%	1
Enroled	226	0%	N/A	0.9%	0.13 (0.02–0.72)*	3.1%	0.30 (0.09–0.97)*	3.1%	0.30 (0.10–0.91)*
School enrolment – paternal orphans^a
Not enroled	161	2.5%	1	8.1%	1	9.4%	1	11.2%	1
Enroled	431	0%	N/A	0.7%	0.15 (0.04–0.60)**	2.3%	0.36 (0.15–0.90)*	2.3%	0.32 (0.13–0.78)*
School enrolment – double orphans^a
Not enroled	71	1.4%	1	11.3%	1	11.4%	1	14.1%	1
Enroled	169	0%	N/A	1.2%	0.17 (0.03–0.95)*	3.6%	0.33 (0.09–1.2)	3.6%	0.32 (0.09–1.1)

^aAges 15–18; N/A: No observations in comparison group;

^bAdjusted for age, site type, SES, and religion.

*, **, *** Significant at p<0.05, p<0.01, p<0.001

Figure 1. Conceptual model and observed relationships between orphanhood, substance use, education, and HIV risk behaviour.

Table 3. Association between orphanhood, drug use, smoking, and drinking alcohol on sexual risk behaviours in male youth from Manicaland.

	Males
		Condom use at last sexual encounter^a		Partners in last 30 days^a	Engaging in transactional sex^a		Sexual debut before the age of 15		Ever had sex
	N	%	AOR (95% CI)^c	Change (95% CI)^c	%	AOR (95% CI)^c	%	AOR (95%CI)^c	%	AOR (95%CI)^c
Smoking
Non-smoker	1594	69.9%	1	0	3.2%	1	0.4%	1	5.9%	1
Smoker	15	80.0%	1.6 (0.24–10.4)	1.2 (−1.2–+3.7)	20.0%	7.6 (1.1–52.3)*	6.7%	10.0 (1.1–92.2)*	66.7%	23.6 (7.0–79.3)***
Drug use
Does not use drugs	1555	68.4%	1	0	1.4%	1	0.4%	1	5.1%	1
Uses drugs	51	79.2%	1.4 (0.39–4.7)	0.67 (−1.1–+2.4)	16.7%	18.6 (1.8–197)*	3.9%	5.1 (0.85–30.2)	47.1%	8.0 (4.2–15.3)***
Alcohol
Does not drink	1502	64.5%	1	0	1.6%	1	0.2%	1	4.1%	1
Drinks	102	80.5%	2.9 (0.87–9.6)	1.6 (0.01–3.1)*	9.8%	6.6 (0.58–73.9)	4.9%	14.4 (3.4–87.8)**	40.2%	8.7 (5.2–14.5)***
Any form of substance use
No substance use	1501	64.5%	1	0	1.6%	1	0.2%	1	4.1%	1
Substance use	108	80.5%	2.9 (0.87–9.6)	1.6 (0.01–3.1)*	9.8%	6.6 (0.58–73.9)	4.6%	15.8 (3.0–83.2)**	38.0%	8.0 (4.8–13.4)***
Orphanhood
Non-orphan	789	71.1%	1	0	2.2%	1	0.5%	1	5.7%	1
Maternal orphan	364	73.1%	0.81 (0.25–2.6)	1.4 (0.50–4.4)*	11.5%	5.4 (0.69–42.3)	0.5%	1.0 (0.21–5.2)	7.1%	1.1 (0.70–1.9)
Paternal orphan	699	67.3%	0.73 (0.27–2.0)	1.9 (0.01–3.7)*	5.8%	1.0 (0.15–6.8)	0.5%	1.1 (0.26–4.3)	7.4%	1.3 (0.82–2.0)
Double orphan	280	68.1%	0.50 (0.14–1.8)	2.5 (0.51–4.6)*	9.1%	2.3 (0.26–20.6)	0.7%	1.2 (0.23–6.1)	7.9%	1.3 (0.76–2.2)
Orphanhood – adjusting for substance use
Non-orphan	789	71.1%	1	0	2.2%	1	0.5%	1	5.7%	1
Maternal orphan	364	73.1%	0.67 (0.19–2.3)	1.3 (−0.37–+3.0)	11.5%	4.3 (0.54–34.0)	0.5%	0.95 (0.18–5.1)	7.1%	1.0 (0.61–1.7)
Paternal orphan	699	67.3%	0.85 (0.31–2.4)	−0.1 (−1.5–+1.4)	5.8%	1.2 (0.16–8.5)	0.5%	1.2 (0.29–5.0)	7.4%	1.4 (0.87–2.2)
Double orphan	280	68.1%	0.45 (0.12–1.7)	1.7 (−0.08–+3.5)	9.1%	1.7 (0.2–14.7)	0.7%	1.3 (0.25–7.4)	7.9%	1.3 (0.72–2.2)
School enrolment^b
Not enroled	320	82.8%	1	0	2.9%	1	0.6%	1	11.0%	1
Enroled	1055	61.9%	0.30 (0.06–1.6)	−1.2 (−3.3–+0.9)	4.8%	1.1 (0.05–22.0)	0.3%	0.85 (0.13–5.7)	2.0%	0.35 (0.19–0.64)***
School enrolment – adjusting for substance use^b
Not enroled	320	82.8%	1	0	2.9%	1	0.6%	1	11.0%	1
Enroled	1055	61.9%	0.31 (0.06–1.6)	−1.1 (−3.2–+0.9)	4.8%	1.3 (0.05–32.2)	0.3%	2.0 (0.23–16.6)	2.0%	0.45 (0.24–0.86)*

^aAmong sexually active; ^bAges 15–18; ^cAdjusted for age, community type, SES, and religion.

Figure 2. Drug use (a) and alcohol consumption (b) in male orphans and non-orphans under age 19 by school enrolment status.