In this qualitative study poverty was found to provide the context for transactional sex, early marriage and sexual experimentation among orphans and non-orphans. Lack of basic needs was perceived to lead directly to engaging in these behaviours as a survival strategy to meet such needs or indirectly through school dropout to engage in IGAs whose environments and proceeds predisposed adolescents to transactional sex. School dropout was the only factor perceived to affect orphans more than non-orphans.
Various studies have suggested that AIDS-related illness or death of people in the productive age group increases household poverty, food insecurity and unemployment [27–29]. In our study, these factors were identified to predispose adolescents to risky sexual behaviour. Thus, pregnancy and STI/HIV prevention and care interventions ought to integrate strategies that increase food security and empower caregivers economically to be able to meet adolescent basic needs. This helps to explain why food was the top basic need that contributed to sexual risk behaviour among adolescents irrespective of orphan status.
Our study identified poverty as a hindrance to adolescent orphans’ and non-orphans’ access to basic needs, results that are consistent with other studies [28, 30]. The findings show how poverty contravenes various basic child rights of adolescents leading to sexual risk behaviours.
Early marriage is one of the traditional practices prejudicial to the health of children that elevates adolescent girls’ risk of HIV infection because of the HIV status of their husbands and frequency of intercourse [31–34]. Early marriage among girls is common in many Sub-Saharan African countries including Kenya, which predisposes them to varied reproductive health risks such as early or teenage pregnancy, cervical cancer and sexually transmitted infections including HIV, spousal sexual and physical violence, and less likelihood to use prevention of mother to child transmission or antiretroviral therapy services .
Our findings also suggest that poverty hinders adolescent access to education due to lack of food and school requirements leading to school dropout. Non-schooling has been shown to limit adolescent access to sexual and reproductive health information that contributes to their susceptibility to sexual risks .
The results show that by engaging in IGA, adolescents expose themselves to environments that predispose them to sexual risks. Additionally, domestic work exposes girls to sexual abuse and exploitation as well as transactional sex. For boys engaged in fishing, the context in which small-scale fishing industry is conducted predisposes them to risky sexual behaviour. Examples include the fish-for-sex culture and the mobility of the fishers that make the fishing communities highly susceptible to STI/HIV infection [8, 9, 36, 37].
Risky sexual behaviour such as transactional sex expose adolescents to unplanned pregnancy and STI/HIV infections that hinder the goal of preventing and mitigation HIV/AIDS [15, 19, 35, 38, 39] . Transactional sex often occurs with older partners [20, 40] and the power imbalance in such exchange reduces adolescent ability to negotiate safe sex, thus predisposing them to unprotected sex [41–44].
The lack of a clear difference between orphans and non-orphans in the perceived influence of poverty on sexual behaviour and health outcomes suggests that poverty in itself may be a more influential factor than orphanhood. Our findings on poverty as a predisposing factor for adolescents’ sexual risks is corroborated by another study in the same province that found low household socioeconomic status and educational attainment to be positively associated with transition to sexual activity, marriage and pregnancy among adolescent girls .
The results indicate a need to review the existing poverty reduction strategies and interventions, and the extent to which they address adolescents’ needs. Operations research would help to identify ways to address poverty to reduce sexual risks among adolescent orphans and non-orphans. Our study findings also reveal that while orphanhood may exacerbate vulnerability to risky sexual behaviour, an analysis of the poverty context may provide a better understanding of why both orphan and non-orphan adolescents may be at risk for STI/HIV infection and teenage pregnancy.
Our study has various limitations that should be considered when interpreting the results. It is possible that participants’ selection may have been biased as community leaders assisted in the recruitment of participants. Additionally, it is possible that poverty may not have been discussed exhaustively as only one wave of data collection was conducted. We did not use an iterative approach to data collection. Such an approach would have allowed us to learn from each stage to focus questions at the next stage; instead, we conducted the FGD’s concurrently. Despite these limitations, our findings generate useful information that should refocus attention to the generalized poverty in the province and inform policy and programming on sexual risks for adolescents.