ABSTRACT
BACKGROUND: Approximately 153 million children worldwide are orphaned and vulnerable to potentially traumatic events (PTEs). Gender differences in PTEs in low- and middle-income countries (LMIC) are not well-understood, although support services and prevention programs often primarily involve girls. METHODS: The Positive Outcomes for Orphans study used a two-stage, cluster-randomized sampling design to identify 2837 orphaned and separated children (OSC) in five LMIC in sub-Saharan Africa and Asia. We examined self-reported prevalence and incidence of several PTE types, including physical and sexual abuse, among 2235 children who were ≥10 years at baseline or follow-up, with a focus on gender comparisons. RESULTS: Lifetime prevalence by age 13 of any PTE other than loss of a parent was similar in both boys [91.7% (95% confidence interval (CI) (85.0-95.5)] and girls [90.3% CI (84.2-94.1)] in institutional-based care, and boys [92.0% (CI 89.0-94.2)] and girls [92.9% CI (89.8-95.1)] in family-based care; annual incidence was similarly comparable between institution dwelling boys [23.6% CI (19.1, -29.3)] and girls [23.6% CI (18.6, -30.0)], as well as between family-dwelling boys [30.7% CI (28.0, -33.6)] and girls [29.3% CI (26.8,-32.0)]. Physical and sexual abuse had the highest overall annual incidence of any trauma type for institution-based OSC [12.9% CI (9.6-17.4)] and family-based OSC [19.4% CI (14.5-26.1)], although estimates in each setting were no different between genders. CONCLUSION: Prevalence and annual incidence of PTEs were high among OSC in general, but gender-specific estimates were comparable. Although support services and prevention programs are essential for female OSC, programs for male OSC are equally important.
ABSTRACT
Little research has been conducted in less wealthy nations to evaluate the prevalence of severe life traumas in general population groups and the impact of such traumas. Previous studies in wealthy nations have found that experiencing severe traumas can cause elevated levels of anxiety, but few studies have examined this association in non-disaster situations in less wealthy nations. Trauma and trauma-related anxiety are associated with greater sexual risk taking behaviours, lower HIV medication adherence levels and poorer health outcomes in wealthy nations. The objectives of this manuscript are: (1) to compare rates of trauma in two HIV-positive samples from areas that have not experienced disaster situations that are recognized by the international community as traumatic events; and (2) to examine whether the reported traumatic experiences are similarly associated with self-reported mental and physical health. The samples come from a region of a wealthy nation that consistently experiences large increases in incident AIDS cases and where the epidemic is largely transmitted heterosexually (Deep South, United States; n =611) and a region in a less wealthy nation with relatively high HIV prevalence and incidence rates and where transmission is also primarily heterosexual (Moshi, Tanzania; n =72). Compared to the US sample, the Tanzanian sample reported significantly higher rates of trauma in the areas of illness, injury, accidents and "other" significant traumas, a higher prevalence of anxiety and poorer physical health. The experience of trauma was similarly associated with greater mental health symptomatology and poorer physical health in both samples. Further investigation into the area of trauma and its sequelae is warranted, particularly in relation to risk behaviours and HIV medication adherence. At a time of increasing anti-retroviral therapy (ART) availability in less wealthy nations, additional focus on trauma care could improve ART adherence rates and reduce risk behaviors, thereby assisting in stemming the further spread of the epidemic.
