The association between adolescent condom use and individual and environmental resilience protective factors

"A spade was called a spade … ": Youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention for youth in South Africa

The youth (15-24 years old) in South Africa remain at high risk of HIV infection despite varied efforts to control the disease. An understanding of the perspectives of relevant stakeholders of HIV-prevention interventions targeting the youth is important to guide research, policy and practice aimed at improving these interventions. This study explores youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention (You Only Live Once) aimed at reducing risky sexual behaviours among the youth in South Africa. Semi-structured interviews were conducted with 10 young people who participated in the intervention, and four intervention implementers at a not-for-profit organisation in Maluti-a-Phofung Local Municipality, South Africa. Data were analysed using thematic analysis. Three main themes emerged from the data: (1) Acceptability and impact of the intervention; (2) Factors influencing intervention implementation; and (3) Recommendations to improve intervention implementation. These findings provide insights into the acceptability, impact, barriers and facilitators of resilience-based HIV-prevention interventions for the youth in South Africa and similar contexts, and how implementation of these interventions could be enhanced. The findings can help researchers, policy makers and health care practitioners in the field of HIV prevention to improve interventions targeting young people.

Evaluating the global, regional, and national impact of syphilis: results from the global burden of disease study 2019

Syphilis is a global public health concern. This study aimed to assess the global and regional burden of syphilis from 1990 to 2019. Disease burden was evaluated using disability-adjusted life-years (DALYs) and prevalence. Data were extracted from the 2019 global burden of disease Study, an open database available for download. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were calculated to evaluate the syphilis burden over time. In 2019, the total number of prevalent cases of syphilis was 49.71 million worldwide. The ASR of prevalence was stable from 1990 to 2019 with an EAPC of 0.00 (95% CI - 0.10-0.11). The number of DALYs caused by syphilis was 7.36 million in 2019, reflecting a reduction of 16.38% compared with that in 1990 (8.80 million). The ASR of DALYs exhibited a decreasing trend from 1990 to 2019 (EAPC =  - 1.01; 95% CI - 1.19 to - 0.84), with the highest rates observed in the younger age group (< 14 years old). In 2019, the highest ASR of DALYs was found in low sociodemographic index (SDI) regions (239.21/100,000), and the lowest in high SDI regions (3.14/100,000). Generally, the ASR of DALYs decreased as the SDI increased. The top three countries with the highest ASR of DALYs for syphilis were the Solomon Islands, Equatorial Guinea, and Liberia. While the global prevalence of syphilis remained persistently high from 1990 to 2019, there has been a recent decrease in the ASR of DALYs. Increased attention should be dedicated to younger populations and regions characterized by low SDIs.

"I always prefer to withdraw than use a condom": contextualising condomless sex among East Asian and sub-Saharan African international students in Sydney

BACKGROUND

Incidence and prevalence of blood-borne viruses and sexually transmissible infections among young people continue to necessitate population-based studies to understand how contextualised sexual health services can be developed and implemented to promote protective behaviours such as consistent condom use. This study examined condomless sexual practice among a sample of East Asian and sub-Saharan African international university students in Sydney, Australia.

METHODS

This qualitative study was methodologically guided by interpretative phenomenological analysis. Data was provided by 20 international students sampled from five universities in Sydney, who participated in either face-to-face or telephone semi-structured in-depth interviews. The interview sessions were audio-recorded, transcribed verbatim, coded in NVivo and analysed using reflexive thematic analysis.

RESULTS

Condomless sexual practices appear to be common among the study group based on participants' self-reports of their own practices and the practices of friends and peers. Three themes contextualising condomless among the study participants were generated from the interview transcripts: (1) unanticipated sex, condom related stigma and alcohol use (2) pleasure-seeking, curiosity and intimacy (3) condomless sex as a gendered practice.

CONCLUSIONS

The result of this study has implications for public health research, practice and policy around design, implementation and evaluation of multi-layered and population-specific sexual health services that are tailored to addressing the needs of international students, who  migrate from traditional sexual cultures to Australia, where sexual norms are more liberal.

Community Violence Exposure and Adolescent Pregnancy in Chicago

This study examined the association between community violence exposure (CVE), sex without contraception, and adolescent pregnancy in Chicago. A self-administered, online survey was conducted among 15- to 19-year-old girls from the South and West sides of Chicago from October to March 2018. Participants were recruited via community organization partnerships and social media advertising. The survey included questions about CVE, sexual behaviors, and covariates that are known to contribute to sexual risk taking. CVE was measured via a validated index of seven questions that measured individual experiences with violence. Multivariable and logistic regression analyses were performed to examine the association between CVE, penile-vaginal intercourse without contraception, and ever being pregnant. The final sample included 644 girls. Levels of CVE were high: 62.87% of girls reported that a close friend or relative died because of violence and 41.60% were a victim of violence. Nearly half (48.69%) of girls had penile-vaginal intercourse and 6.01% had been pregnant. For each standard deviation increase in CVE score, the odds of penile-vaginal intercourse without contraception (odds ratio [OR] = 1.69, 95% confidence interval [CI] = [1.27, 2.25]) and the odds of ever being pregnant (OR = 1.87, 95% CI = [1.36, 2.57]) increased. These results remained significant when adjusting for demographic, psychosocial, institutional, and interpersonal factors. Findings suggest that girls in Chicago who are exposed to higher levels of community violence have an increased likelihood of experiencing penile-vaginal intercourse without contraception and teenage pregnancy, even when adjusting for other predictors to teenage pregnancy.

Associated factors and sex differences in condom non-use among adolescents: Brazilian National School Health Survey (PeNSE)

Background

Condom non-use among sexually active adolescents is a major cause of unintended pregnancy and sexually transmitted infections. In order to promote condom use, it is essential to understand factors associated with condom non-use.

Aim

Our aim was to evaluate sex differences and associated factors of condom non-use based on the nationally representative Brazilian National School Health Survey.

Methods

The study participants were 100,962 adolescents 13–18 years old, 9th graders from both public and private schools throughout Brazil. The following factors were considered as explanatory group variables for the outcome of condom non-use among adolescents: school and health service, sexual behavior, substance use, and self-reported body and health perception. Poisson regression model was performed.

Results

Of the total students, 28% (n = 28,157) had had sexual intercourse at least once. (boys, 37.1%; girls, 19.5%). Of these, 69.2% had used condoms the last time they had intercourse (girls: 68%; boys: 69.9%). The variables associated with condom non-use for both sexes were not having accessed a health service or approached a health professional for health-related care; not having received pregnancy prevention counseling or guidance on AIDS or STI prevention at school; early sexual initiation; no additional contraception method; substance use; feeling alone; not being satisfied with their own body; feeling fat or thin; and poor self-reported health. The number of sexual partners was also associated with condom non-use; however, contrasting behavior was indicated between sexes. A higher number of sexual partners indicated less use of condoms among girls, while for boys, a higher number of sexual partners indicated higher condom use.

Conclusion

High condom non-use appears to be associated with lack of health care access and sexual health education, poor sexual practices, substance use, and poor self-perception, indicating areas for health promotion programs.

Championing the resilience of sub-Saharan adolescents: pointers for psychologists

In this article, I argue that an ecological systems approach to resilience – specifically, one that is sensitive to how contextual determinants shape successful adaptation differentially – offers a meaningful way to enable sub-Saharan adolescents to adapt well to the apparently intractable risks to their health and well-being. Accordingly, I draw on studies of child and adolescent resilience from sub-Saharan Africa and the global North to show that the resilience field has largely moved beyond individual-focused theories of resilience that have the (long-term) potential to jeopardize adolescent health and well-being and advance neoliberal agendas. I emphasize that the recent attention to differentially impactful resilience-enablers casts suspicion on incautious application of universally recurring resilience-enablers. Allied to this, I problematize the delay in the identification of resources that impact the resilience of sub-Saharan adolescents differentially. Finally, I distil implications for resilience-directed praxis and research that have the potential to advance the championship of adolescent resilience in sub-Saharan Africa.