Access to antiretroviral therapy (ART) and male circumcision likely had positive effects on adolescents, including reducing orphanhood, and are a triumph of global efforts to support HIV treatment and preventative strategies, according to a paper published in The Lancet HIV.
Investigators from Uganda and Columbia University examined the prevalence of orphanhood among adolescents between the ages of 15 and 19 years, before and after the roll-out of ART and male circumcision, in order to determine if increasing preventative measures against HIV would be associated with lower probability of orphanhood. Both of these measures became widely available in the Rakai region of Uganda in 2004 and 2007, respectively, the authors noted when explaining what region their study was focused on.
The study authors added that orphanhood increased markedly in the 1980s and 1990s in sub-Saharan Africa due to HIV-related mortality. Orphan status in sub-Saharan Africa has been linked to adverse health and social consequences in adolescents, they explained, including mental distress, premature truncation of education, child marriage, and increased behavioral risks for HIV transmission.
The investigators classified the adolescents and the risks for maternal-only, paternal-only, and double orphanhood over 11 survey rounds between 2001 and 2018. The risk factors included community HIV prevalence, household socioeconomic status, and adolescent age.
Prior to 2007 when male circumcision became widely available, the study authors determined that the proportion of adolescents that experienced any type of orphanhood was between 52 and 53 percent. By round 18 of the surveys, the proportion declined to 23 percent, they found. They wrote that this represented a relative decline of 61 percent between survey round 8 and round 18.
In the same period, they noted, double orphanhood declined from 20 percent to 3 percent, while paternal-only orphanhood declined from 24 percent to 13 percent. Maternal-only orphanhood also declined from that period from 8 to 6 percent.
The study authors determined that household socioeconomic status increased steadily from 2001 to 2018.
The investigators observed an increase in ART use among people living with HIV from between 0 and 30 percent at round 11 in communities up to between 78 percent and 93 percent at round 18, they wrote.
Additionally, male circumcision prevalence among adolescent and adult men (measured between 15 and 49 years) rose from 15 percent in round 8 to 65 percent in round 18, the study authors noted. They also observed the community prevalence of HIV among 30 to 49-year-olds which ranged between 17 and 21 percent through all the rounds. HIV prevalence was 2 to 5 times higher in communities with the highest prevalence, compared with communities with the lowest prevalence, of male circumcision.
Overall, the study authors wrote that time period was not statistically significant after ART and male circumcision were added to their analysis model, which they wrote suggested that the declines in orphanhood of all types can be explained by ART and male circumcision, not time itself.
“The impact of male circumcision on orphanhood was confined 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,” the study authors wrote. “Our findings are consistent with previous research on the impact of ART and male medical circumcision on HIV infection and mortality due to HIV infection.”