Almost 21% of Zimbabwe's population of roughly 13 million people live with HIV infection while 1.6 million children (23%) have been orphaned. The epidemic is fuIther worsening children's lives by decreasing access to health selvices, education, shelter, clothing, vocational training, legal protection, psychosocial support, good nmtming-and care from family members. Undelstanding the psychosocial effects on chiidIen of being oiphaned or made vulneIable by the epidemic is vital if fwther problems in childhood and later life are to be averted. Objectives 1. To develop a theoretical framework for understanding the relationships between OIphan expelience, psychosocial distress, and child expeIiences and adult life chances. . 2. To compare and contJ:ast levels of psychosocial distIess by fOIm (Le. patemal only, matemal only and double) and dUIation of oIphanhood in Zimbabwe. 3. To assess the cumulative impact of psychosocial distress experienced in childhood on risky behaviour outcomes in adolescence and adult life expeliences. . 4. To assess how appropriate and sensitive the methods and tools used in the study were to the children's plight. Methods Stata version 9.0 was used to conduct statistical analyses of data from three survey sources: the Zimbabwe Oye Baseline Smvey 2004, the Manicaland Child Cohort Study, arid the Manicaland HIV/SID Prevention Project. Qualitative data were collected and used to aid inteIpretation of the statistical results. Results In the national ayC survey (ages 12-17 years), psychosocial distress was more common in . females and younger children. Otphans ovetall and each fOIm of orphan were at greater risk of developing psychosocial distress than non-OIphims. In multivariate analyses, being resident in an urban area (Coeff, 0.16; 95% CI, 0.04-0.28), on a commercial farm (Cooff, 0.46; 95% CI, 0.08-0.84), in the poorest 20% of households (Coeff, 0.14; 95% CI, 0.04-0.24), in a household that had received external SUppOIt (Coeft', 0.21; 95% CI, -0.01-0.44) and not being related to the closest caregiveI (Coeff, 0.14; 95% CI, 0.03-0.24) were associated with psychosocial distress. Being in a female-headed household (Cooff; -0.11; 95% CI, -0.19- -0.02) and receiving psychosocial SUppoIt from the closest caregiver (Cooff, -0.05; 95% CI, -0.09- -0.01) had protective effects against psychosocial distress. Maternal and paternal OIphans were significantly more likely than non-OYC to have engaged in sexual activity. These differences weIe reduced after contJ:olling for psychosocial distress. In Manicaland, eastern Zimbabwe, paternal and double OIphans were at increased risk of psychosocial distJ:ess. OIphans were more likely to have started sex and to have engaged in substance abuse. However, the only (borderline) significantlesult was increased likelihood of patemal orphans having engaged in substance abuse [p=O .056]. Conclusion Orphaned children in Zimbabwe suffer greater psychosocial distress which may lead to incleased likelihood of sexual debut and HIV.infection. The impact of strategies to provide psychosocial support should be evaluated scientifically.Imperial Users onl
