Abstract:
Purpose—This study sought to assess whether risky sexual behaviours and sexual exploitation of
orphaned adolescents differed between family-based and institutional care environments in Uasin
Gishu County, Kenya.
Methods—We analyzed baseline data from a cohort of orphaned adolescents aged 10–18 years
living in 300 randomly-selected households and 19 Charitable Children’s Institutions. The primary
outcomes were having ever had consensual sex, number of sex partners, transactional sex, and
forced sex. Multivariable logistic regression compared these between participants in institutional
care and family-based care, while adjusting for age, sex, orphan status, importance of religion,
caregiver support and supervision, school attendance, and alcohol and drug use.
Results—This analysis included 1,365 participants aged ≥10 years; 712 (52%) living in
institutional environments and 653 (48%) in family-based care. Participants in institutional care
were significantly less likely to report engaging in transactional sex (AOR 0.46 95% CI: 0.3–0.72)
or to have experienced forced sex (AOR=0.57 95% CI: 0.38–0.88) when controlling for age, sex,
and orphan status. These associations remained when adjusting for additional variables.
Conclusion—Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be
at increased risk of transactional sex and sexual violence compared to those in institutional care.
Institutional care may reduce vulnerabilities through the provision of basic material needs and
adequate standards of living that influence adolescents’ sexual risk-taking behaviours. The use of
single items to assess outcomes and non-explicit definition of sex suggest the findings should be
interpreted with caution.
