Little is known about the social and sexual network features of orphan and abandoned children (OAC), yet network differences may contribute to low educational attainment, inappropriate employment, and high-risk sexual behavior, and ultimately put OAC at risk for HIV infection. The long-term goal of this research is to determine key intervenable factors that contribute to OAC disadvantage or resilience, in order to construct viable interventions for promoting OAC health and well-being. The overall objective in this application is to assess OAC social and sexual network composition and variability, and determine how network features are associated with low education, income-generation, and HIV-risk behaviors. The central hypothesis for this work is that the social and sexual networks of OAC are small with low variability and these network features translate into reduced access to educational support, fewer positive employment opportunities and increased sexual risk-behavior. This hypothesis is based upon preliminary research suggesting variability in the size and heterogeneity of OAC education- and employment-related networks. The central hypothesis will be tested by collecting and analyzing both social and sexual network data within the data collection infrastructure of an existing NIH-funded OAC cohort: the positive outcomes for orphans (POFO) study. POFO is in the first of its five-year continuation funding, which will allow this proposed research to collect longitudinal network and outcome data (at two time points). Aim #1a: identify the composition and variance social network characteristics of OAC, including educational and employment-related supports; and Aim #1b: identify the sexual network composition and variance characteristics of OAC, using a network analysis approach for both sub-aims. The working hypothesis for Aim 1 is that OAC's networks are small with limited variability. Aim #2: assess the association between the social network characteristics and health-related outcomes (education, income-generation) and between the sexual network characteristics and HIV-risk outcomes using multilevel modeling with network data. The working hypothesis for this aim is that OAC social and sexual network features are associated with low levels of success in staying in school, obtaining appropriate employment, and high sexual risk-behavior (e.g., age at sexual debut, number of sexual partners, characteristics of sexual partners). Completing the proposed research will impact the lives of OAC by: 1) establishing if OAC network features account for success in educational, income generation, and sexual risk-taking behaviors; 2) providing the basis for interventions to mitigate damage done to OAC to prevent further disenfranchisement as OAC enter their adult lives, and 3) ensuring these OAC have the chance to achieve their full potential. Because this cohort of OAC are transitioning out of structured care settings into their adult lives, this work must be conducted now before they disappear within the context of poverty and disadvantage that characterizes so many orphaned and abandoned children today.

High levels of stigma toward orphaned children, regardless of cause, were found, and more so if HIV was the cause of parental death. Stigma includes beliefs that orphaned and separated children (OSC) cannot be treated like biological children, that OSC should feel grateful to have any family take them in, and that it is acceptable to treat them as servants to compensate for the care they receive. Policy implications are that orphan related stigma is serious, and that reintegration programs and interventions failing to target broader social stigma, or only HIV stigma, may be ineffective.