Embleton, L., Nyandat, J., Ayuku, D., et al. Journal of Adolescent Health (January 2017), pii: S1054-139X(16)30868-0, doi:10.1016/j.jadohealth.2016.11.015, e-publication ahead of print.
This study used baseline data from the Orphaned and Separated Children’s Assessment Related to their Health and Well-Being Project to examine whether risky sexual behaviors and sexual exploitation in orphaned adolescents differed between family-based and institutional care environments. It included a cohort of 1,365 orphaned adolescents aged 10–18 years, 712 (52%) living in institutional environments and 653 (48%) in family-based care in Uasin Gishu County, Kenya. Multivariate logistic regression compared primary outcomes (ever having consensual sex, number of sex partners, transactional sex, and forced sex) among participants, adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use. The findings suggested that the care environment influenced orphaned adolescents’ sexual behaviors and risks. Participants in institutional care were less likely to report engaging in transactional sex or experiencing forced sex. Adult supervision played a role in reducing the risk of a forced first sexual encounter; being in school was associated with reduced sexual risks. The authors suggested cautious interpretation of study findings, but concluded that adolescents in family-based care may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities by providing basic material goods and improved living standards.