THE WIDESPREAD introduction of antiretroviral therapy (ART) in Uganda has dramatically reduced orphanhood among children and adolescents, according to a long-term population-based study in the Rakai region. Orphanhood, which has long been a marker of HIV’s social impact, remains a critical concern for clinicians and public health practitioners supporting vulnerable young populations.
Researchers analysed data from 92,441 children and adolescents under 18 years across 28 continuously surveyed communities from 1995 to 2022. Using a hierarchical Bayesian model, they assessed maternal, paternal, and double orphanhood incidence and prevalence, alongside the impact of ART availability. Poisson regression models examined associations with age, household socioeconomic status, and parental HIV status.
Steep Declines in Orphanhood Prevalence and Incidence
The study revealed a marked drop in orphanhood prevalence, particularly after ART became widely accessible. Overall prevalence fell from 21.5% in 2003–2004 to 6.3% in 2020–2022. Among adolescents aged 15–17 years, rates declined from 49.4% to 14.4% over the same period. Double orphanhood incidence also dropped sharply, from 5.13 per 1000 person-years in 2003–2004 to 0.68 per 1000 person-years in 2020–2022.
Importantly, the proportion of new orphanhood cases attributable to parental HIV infection decreased substantially. Between 2004 and 2022, paternal orphanhood linked to HIV fell from 67% to 11%, while maternal orphanhood fell from 71% to 12%, underscoring the effectiveness of HIV treatment and prevention programmes in mitigating social consequences of the epidemic.
Sustained Risk and Clinical Implications
Despite these gains, a significant burden of orphanhood persists, particularly among adolescents. For clinicians and public health providers, these findings highlight the need for continued support for HIV-affected families, targeted adolescent interventions, and ongoing monitoring of vulnerable populations. Integrating social care with HIV treatment programmes may help further reduce orphanhood and improve long-term outcomes for affected children.
Reference
Khalifa A et al. Incidence and prevalence of orphanhood in Rakai, Uganda: a population-based cohort study, 1995-2022. Lancet Glob Health. 2026;14(2):e251-60.
