Orphanhood decreases with antiretroviral therapy and male circumcision

Researchers at Columbia University School of Public Health Mailman found a marked reduction in orphanhood, especially double orphanhood, among adolescents in Rakai, Uganda, consistent with the availability of antiretroviral therapy (ART) since 2004 and male circumcision in 2007. So far, little has been known about the contribution of combined HIV prevention, including ART and male circumcision, to recent trends in orphanhood. The study was published in HIV lancet.

Orphanhood fell from 52 percent in 2001-2002 to 23 percent by 2016-18, while double orphanhood fell from 20 percent to 3 percent. The largest declines were in double orphanhood (83 percent), followed by paternal orphanhood (44 percent) and maternal orphanhood (29 percent).

Our findings show that trends in orphanhood are significantly related to the prevalence of ART use in the community, male circumcision, HIV prevalence and socioeconomic status. Our findings highlight how combined HIV prevention reduces adult mortality and orphanhood among their adolescent children

John Santelli, MD, MPH, lead author of the study and professor of public and family health and pediatrics, Columbia University Mailman School of Public Health

In sub-Saharan Africa, orphans increased significantly in the 1980s and 1990s due to HIV-related parental mortality. Adolescent HIV-related orphanhood in sub-Saharan Africa is associated with adverse physical and mental health and social consequences in addition to the behavioral risk of HIV among adolescents.

Santelli and colleagues from Colombia, Johns Hopkins University, the University of Washington, the University of Uganda in Makerer University and the Rakai Health Science Program studied the prevalence of orphanhood among adolescents aged 15-19, before and after the introduction of ART in 2004 and male circumcision in 2007, using data from 28 continuously monitored communities in the Rakai Community Cohort Survey. They assessed adjusted ratios of the relative risk of orphanhood for maternal, father-only and double orphanhood compared to non-orphans in 11 rounds of study between 2001 and 2018. They examined the relationship between orphanhood and the prevalence of ART among people living with HIV and the spread of male circumcision, including traditional circumcision, control of the spread of HIV in the community, the socio-economic status of the household and the age of adolescents.

The prevalence of ART among people living with HIV in the Rakai region of south-central Uganda increased from 11 per cent in 2005-2006 to 78 per cent in 2016-18. The male circumcision rate rose from 19 per cent in 2005-06 to 65 percent in 2016-18. A 10% increase in the prevalence of ART use in the community is associated with a reduction in maternal orphanhood and double orphanhood. In the post-ART era, a 10 percent increase in the prevalence of male circumcision in the community is associated with a reduction in paternal orphanhood and double orphanhood.

“The impact of male circumcision is limited to paternal orphanhood and double orphanhood, which is consistent with research showing that male medical circumcision prevents transmission from HIV-positive women to HIV-negative men, but not from HIV-positive men to HIV -negative women. “, Said Dr. Fred McCumby of Makere University and senior author of the report. “We know that reducing HIV infection among men will reduce infection among women over time.” The use of ART among people living with HIV also reduces HIV transmission and possibly HIV-related orphanhood.

“Prior to our study, we knew that the combination of ART and male circumcision was very effective in preventing HIV transmission; “We now know that it is also effective in reducing orphanhood,” Santelli said. “Reducing orphanhood promises improved health and social outcomes for young people, including improved mental health, higher education and reduced child marriage.”

A full list of co-authors and their institutions is published in PDF.

The study was supported by the Eunice Kennedy Shriver National Institute for Child Health and Human Development, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health and the Department of Internal Studies of the National Institute of Allergy and Infectious Diseases.


Columbia University’s Mailman School of Public Health

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