Preventing HIV Risk Among Adolescent Orphans in Kenya

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DESCRIPTION (provided by applicant): The AIDS pandemic has led to the illness and deaths of millions of adults in severely-affected countries, and has also led to millions of orphans. Worldwide, the number of children under age 18 who have lost one or both parents to AIDS stands at more than 15 million, and estimates are that this number will surpass 25 million by 2010. The vast majority - 11 million-of these children live in sub-Saharan Africa. As orphans reach puberty, they are more likely to become sexually active, placing them at risk of contracting HIV/AIDS themselves through sexual contact. This study will extend a comprehensive intervention ("Reach Out") to a neighboring community and test whether structural support for young adolescent orphans to continue school prevents HIV risk behaviors, over and above the provision of food, safe water, and health care. The study population is the Luo ethnic group in Nyanza Province, Kenya. The prevalence of HIV/AIDS among the Luo is 22%, 3 times higher than in Kenya as a whole. Specific aims for the proposed study are as follows: 1) To extend the Reach Out intervention to a neighboring community and test whether the school support elements delay sexual debut and prevent sexual risk behaviors, using an experimental design; and 2) To conduct a process evaluation of the extension of Reach Out and prepare a manual for further testing and replication. In order to test the effects of the school component on HIV prevention, 100 orphans, aged 13-14, will be randomized to intervention and control groups. The intervention group will receive the full Reach Out model; the control group will receive food and other basic needs, but not school support. Students will respond to a self administered longitudinal survey (Aim 1); Reach Out staff and other community informants will respond to qualitative interviews (Aim 2). Research activities will be jointly conducted by U.S. and Kenyan collaborators. The pilot study will provide a strong foundation for a larger replication and experimental testing of the Reach Out model for the prevention of HIV among orphans in other areas of Kenya and sub-Saharan Africa.