Hiv Testing Among Orphaned and Separated Youth in Ethiopia, Kenya and Tanzania: The Potential Role of Living Arrangements
General Material Designation
[Thesis]
First Statement of Responsibility
Pack, Allison Prickett
Subsequent Statement of Responsibility
Golin, Carol
.PUBLICATION, DISTRIBUTION, ETC
Name of Publisher, Distributor, etc.
The University of North Carolina at Chapel Hill
Date of Publication, Distribution, etc.
2019
GENERAL NOTES
Text of Note
158 p.
DISSERTATION (THESIS) NOTE
Dissertation or thesis details and type of degree
Ph.D.
Body granting the degree
The University of North Carolina at Chapel Hill
Text preceding or following the note
2019
SUMMARY OR ABSTRACT
Text of Note
Introduction: Orphaned and separated youth (OSY) in Sub-Saharan Africa are thought to have higher rates of HIV risk behavior and twice the odds of HIV infection compared to non-orphaned youth. Yet, evidence also suggests OSY have lower rates of HIV testing than non-orphaned youth. OSY may therefore experience unique barriers to HIV testing. Methods: The dissertation used data from 423 OSY participating in the ongoing NICHD-funded (R01HD046345-04) Positive Outcomes for Orphans study. Aim 1 examined the extent to which orphan-specific living arrangements (whether OSY lived in residential or family-based care environments and whether they lived with siblings) longitudinally predicted recent HIV testing. Aim 2 assessed whether perceived social support mediated a relationship between living with siblings and recent HIV testing. Aim 3 explored whether living with siblings and recent HIV testing varied by gender. Aims were theory-informed and used standard survey methods appropriate for use with complex survey data. Results: Results from Aim 1 revealed over a third of the sample reported recent HIV testing, and female OSY were more likely than male OSY to report recent testing. Nevertheless, orphan-specific living arrangements were not related to recent HIV testing. Similarly, results from Aim 2 revealed perceived social support did not mediate a relationship between living with siblings and recent HIV testing. However, female OSY and OSY living in residential care centers, had higher perceived social support than male OSY and OSY living in family-based care environments, respectively. Furthermore, the higher an OSY's perceived social support, the more likely they were to report recent HIV testing. For Aim 3, results revealed living with siblings did not differentially affect recent HIV testing for male and female OSY. Conclusion: Rather than focusing on where or with whom OSY live, this dissertation suggests it may be prudent to assess the quality of living arrangements, and how that quality affects health outcomes. This dissertation also identified a modifiable factor - perceived social support - which could be targeted by future HIV testing interventions. Together, findings have the potential to meaningfully affect the lives of OSY by informing future policy decisions and HIV testing interventions.