The AIDS pandemic has led to the illness and death of millions of adults, and has also resulted in millions of orphans. This study examines the context of schooling and sexual debut among a particularly vulnerable group, adolescent orphan girls in Zimbabwe. The study uses a rigorous randomized controlled trial design to test whether modest support can retain orphan girls in school through the transition to high school and whether religious schooling adds greater protection than secular schooling for HIV risk behaviors. The Methodist Church provides an important infrastructure for education, as well as services for orphans, in Zimbabwe. The study specifically focuses on young female orphans because of their greater likelihood of HIV infection, greater likelihood of school dropout, and greater vulnerability to sexual abuse due to loss of parental protection.
Specific aims for the proposed study are: 1) To test experimentally whether modest assistance can help orphan girls stay in school through the transition to high school, and whether attending a church-run high school is more protective against HIV risk behaviors than attending a secular school; 2) To compare the content and consistency of sex and HIV-related messages taught through church-sponsored versus secular secondary schools; and 3) To examine how female orphans perceive HIV messages from church-sponsored compared to secular secondary schools, and to explore the context in which the girls make decisions about sexual behavior.
For Aim 1, methods include use of an experimental design and self- administered surveys completed by orphan adolescent girls in Manicaland Province, Zimbabwe.
For Aims 2 and 3, concept mapping techniques are used to gather and analyze information from adults (church personnel, teachers and administrators) and orphan teen girls. Research activities will be jointly conducted by U.S. and Zimbabwean collaborators. The research addresses a problem of the highest public health significance. HIV prevalence in Zimbabwe is among the highest in the world, as is the proportion of AIDS orphans. The study will contribute to the knowledge base concerning the extent and nature of religious organizations' involvement in HIV-related activities, mechanisms by which the United Methodist Church and its schools influence orphan risk and protective factors, and the context in which young Zimbabwean women make decisions about sex. ? ? ?

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1-RPHB-B (50))
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Newcomer, Susan
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Pacific Institute for Research and Evaluation
United States
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Luseno, Winnie Kavulani; Zhang, Lei; Iritani, Bonita J et al. (2017) Influence of school support on early marriage experiences and health services utilization among young orphaned women in Zimbabwe. Health Care Women Int 38:283-299
Iritani, Bonita J; Cho, Hyunsan; Rusakaniko, Simbarashe et al. (2016) Educational Outcomes for Orphan Girls in Rural Zimbabwe: Effects of a School Support Intervention. Health Care Women Int 37:301-22
Luseno, Winnie; Zhang, Lei; Rusakaniko, Simbarashe et al. (2015) HIV infection and related risk behaviors: does school support level the playing field between orphans and nonorphans in Zimbabwe? AIDS Care 27:1191-5
Hallfors, Denise Dion; Cho, Hyunsan; Rusakaniko, Simbarashe et al. (2015) The impact of school subsidies on HIV-related outcomes among adolescent female orphans. J Adolesc Health 56:79-84
Luseno, Winnie K; Hallfors, Denise Dion; Cho, Hyunsan et al. (2014) Use of HIV and HSV-2 biomarkers in sub-saharan adolescent prevention research: a comparison of two approaches. J Prim Prev 35:181-91
Mpofu, Elias; Hallfors, Denise Dion; Mutepfa, Magen Mhaka et al. (2014) A Mixed Methods Mapping of Church versus Secular School Messages to Influence Sexual Decision-Making as Perceived by Zimbabwean Orphan Girl Students. J Mix Methods Res 8:363-376
Hallfors, Denise D; Cho, Hyunsan; Iritani, Bonita J et al. (2013) Preventing HIV by providing support for orphan girls to stay in school: does religion matter? Ethn Health 18:53-65
Miller, Ted; Hallfors, Denise; Cho, Hyunsan et al. (2013) Cost-effectiveness of school support for orphan girls to prevent HIV infection in Zimbabwe. Prev Sci 14:503-12
Mpofu, Elias; Mutepfa, Magen Mhaka; Hallfors, Denise Dion (2012) Mapping structural influences on sex and HIV education in church and secular schools in Zimbabwe. Eval Health Prof 35:346-59
Hallfors, Denise; Cho, Hyunsan; Rusakaniko, Simbarashe et al. (2011) Supporting adolescent orphan girls to stay in school as HIV risk prevention: evidence from a randomized controlled trial in Zimbabwe. Am J Public Health 101:1082-8

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