Sexual and reproductive health behavior and unmet needs among a sample of adolescents living with HIV in Zambia: a cross-sectional study

Utilisation of Reproductive Health Services among Adolescents in Ghana: Analysis of the 2007 and 2017 Ghana Maternal Health Surveys

Early pubertal development induces early sexual activities among adolescents. In Ghana, despite the high sexual activity among Ghanaian adolescents, sexual and reproductive health (SRH) services are underutilised, primarily due to SRH stigma and a lack of SRH knowledge and information. This study examined the use of SRH services among adolescents aged 15-19 years in Ghana over a ten year period. The study utilised data from the 2007 and 2017 Ghana Maternal Health Surveys (GMHSs). Responses from 2056 and 4909 adolescent females captured in the 2007 and 2017 GMHSs, respectively, were used. The results showed a declining utilisation of SRH services among adolescents from 28.3% in 2007 to 22.5% in 2017. The odds of using family planning among sexually active adolescents increased from 2007 [AOR-0.32, CI-(0.135, 0.77), p < 0.001] to 2017 [AOR-68.62, CI-(36.104, 130.404), p < 0.001]. With increasing age at first sex, adolescents were less likely to use a family planning method in 2007 [AOR-0.94, CI-(0.89,0.99) p < 0.001], but this improved in 2017 [AOR-1.26, CI-(1.220, 1.293), p < 0.001]. Despite this, knowledge of sources for family planning was found to predict its lower utilisation in both 2007 [AOR = 0.15 (95% CI-0.081, 0.283), p < 0.0001] and 2017 [AOR = 0.206 (95% CI-(0.099, 0.426), p < 0.001]. The findings show that even though knowledge of family planning methods predicted low utilisation, knowledge of sources, age at first sex, and educational level positively predicted the utilisation of SRH services from 2007 to 2017. Opportunities for both enhancing the clinical environment and health provider attitudes exist and should be explored for improving SRH outcomes among sexually active adolescents in Ghana.

Study protocol for a type-II hybrid effectiveness-implementation trial to reach teenagers using mobile money shops to reduce unintended pregnancies in Uganda

INTRODUCTION

Unintended teenage pregnancies have become a global public health challenge, particularly in sub-Saharan Africa. There is a notably high prevalence of unintended pregnancies among unmarried teenagers in Uganda. This study will develop an intervention programme using mobile money shops (vendors) as a platform to deliver sexual and reproductive health and rights (SRHR) services to teenagers and assess its effectiveness and scalability in Uganda.

METHODS AND ANALYSES

This hybrid study comprises two integral components: an intervention study to assess the effectiveness of vendor-mediated intervention and implementation research to evaluate the implementation process. 30 vendors will be recruited for both intervention and control arms in 2 municipalities in Eastern Uganda, which have a high unintended pregnancy prevalence rate among unmarried teens aged 15-19 years. A preintervention and postintervention repeated survey involving 600 participants for each arm will be conducted over 4 months. The primary outcome is the rate of condom users among teenage vendor users. The secondary outcomes include the rate of preference for receiving SRHR services at vendors and knowledge regarding SRHR. A difference-in-differences analysis will be used to determine the effectiveness of the intervention. The Bowen model will be employed to evaluate the implementation design.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Ethics Review Committee of Uganda Christen University and JICA Ogata Sadako Research Institute for Peace and Development in Japan. The findings will be widely disseminated. This study was registered with the University Hospital Medical Information Network in Japan (UMIN000053332) on 12 January 2024.

TRIAL REGISTRATION NUMBER

UMIN000053332.

Views of adolescents living with perinatally acquired HIV on HIV status disclosure in Eswatini

HIV is recognised as a multifaceted chronic disease, bearing psychosocial consequences that potentially impact on the personal and social well-being of those living with it. Adolescents and youth bear a significant proportion of the burden of the HIV epidemic but they have low rates of disclosure of their HIV status. This study aims to determine the views of adolescents living with perinatally acquired HIV on HIV status disclosure among 361 adolescents aged 15-19 in Eswatini. A cross-sectional study was conducted on adolescents who already knew their status, and data were collected using a structured questionnaire. A majority of the participants, 55% (n = 200), were females, and 44% (n = 160) were males. A low number of adolescents (22%) had disclosed their HIV status to anyone. Adolescents who found it difficult to understand disclosure themselves had low levels of onward disclosure (27%) compared to adolescents who better understood the disclosure event. Our results revealed that adolescents' prevalence of HIV status disclosure was low. This raises concerns as some of the adolescents were in relationships with partners who were not aware of their status. However, older adolescents displayed some level of disclosure self-efficacy in that a higher proportion of them disclosed better than younger adolescents.

"We will tell when we are ready": perinatally HIV-infected adolescents and self-disclosure of their status in Eswatini

Access to antiretroviral therapy (ART) has promoted a significant decrease in mortality of vertically HIV-infected children. As a result, there has been an increasing growth of this population that reaches adolescence. These adolescents face problems such as self-disclosure and the stigma of the disease. This study aimed to determine the process followed by perinatally HIV-infected adolescents in self-disclosing their HIV status to significant others and the barriers and promoters of perinatally HIV-infected adolescents' disclosure of their HIV status to others. Data were collected from 15-19-year-old adolescents through 23 in-depth individual interviews and three focus groups. For adolescents, a clear barrier to disclosure was being told when they were younger by a parent to keep their status secret from other people. Lack of trust and fear of breaches of confidentiality which would lead to stigma and discrimination also hindered disclosure. For those adolescents who disclosed, they did so face to face and through short text messages. Adolescents expressed the need to be capacitated to self-disclose and also called for HIV and AIDS education to the general public as a way of fighting stigma and discrimination in their communities and in society. For adolescents to be able to disclose, they have to work through issues of acceptance of their own HIV status first. This study is the first-ever study to document difficulties faced by adolescents in the self-disclosure of their status in Eswatini.

Prevalence and Factors Associated with Risky Sexual Behaviors Among Sexually Active Female Adolescents in Zambia

Despite decades long commitment to women's reproductive health rights, sexually transmitted diseases and unintended pregnancies continue to be major public health concerns in sub-Saharan Africa. In order to provide an evidence base for future policy and services, this study aims to explore the prevalence and factors associated with risky sexual behaviors (RSB) among sexually active Zambian female adolescents using a nationally representative sample. Data on females, aged 15-19 (n = 3000), were obtained from the 2018 Zambia Demographic and Health Survey, an interviewer-administered, nationally representative survey that used multistage sampling. The study conducted multiple logistic regression to explore the correlates of RSB. Of the 3000 respondents, 49.7% (1490) reported ever having sexual intercourse of which 71.1% reported engaging in RSB. Among sexually active female adolescents, the following RSB percentage were reported: intercourse before age 16 (50.6%), nonuse of condoms at last intercourse (37.8%), engaging in transactional sex (6.2%), alcohol use at last intercourse (4.6%), and multiple sexual partners (1.9%). Educational attainment and household wealth showed strong inverse trends with RSB risk and there were notably large geographic differences in RSB within Zambia (22.1% in Lusaka region vs. 62.4% in Western province). The multiple logistic regression results revealed that those who were younger, unmarried, with less than secondary education, without access to Internet, and residents of Western Zambia were significantly more likely to have engaged in RSB (AOR: 1.74-7.69, p < 0.05). Given the negative health outcomes associated with RSB, Zambian adolescent health care programs may strategically target limited resources to the identified risk groups.

Preferences for accessing sexual and reproductive health services among adolescents and young adults living with HIV/AIDs in Western Kenya: A qualitative study

Despite the need, adolescents and young adults (AYAs) in resource-limited settings have limited access to sexual and reproductive health (SRH) care services for improved health outcomes. This is worse for AYAs living with HIV in resource-limited settings where much is unknown about contexts and issues inhibiting access to SRHs. We explored adolescents', healthcare workers, and caregivers' preferences for access to sexual and reproductive health services for adolescents and young adults living with HIV. We conducted 30 in-depth interviews and 8 focus group discussions among a subset of AYA aged 14-24 living with HIV, healthcare workers, and caregivers/parents. We recruited participants from Lumumba Sub-County Hospital (KLM) and Kisumu County Referral Hospitals in Kisumu County (KCH). Trained and experienced qualitative research assistants 5-10 years older than the adolescents conducted interviews and facilitated discussions using guides designed to elicit detailed views and perspectives on sex and sexuality, access to SRH services, challenges of AYA living with HIV, and potential interventions to improve access to SRH services. Audio files were transcribed verbatim and translated to English where necessary before coding and analysis. We applied constant comparative analysis for theme and content to arrive at our conclusions. Our analysis yielded two main themes: preferences for a venue for SRH services and choices for qualities of an SRH counsellor. We found that AYAs generally preferred receiving SRH services to be co-situated within clinical facilities. We also observed gender differences in the qualities of SRH providers, with male AYAs preferring older male service providers compared to females who preferred younger female providers close to their age. The study highlighted the preferences of AYAs for accessing SRH, which need to be considered when designing their health programs. Further, AYAs seem to endite health systems to individualize access to SRH for AYAs living with HIV by providing a combination of attributes that meet individual preferences.

Health-related needs reported by adolescents living with HIV and receiving antiretroviral therapy in sub-Saharan Africa: a systematic literature review

Introduction

Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) have specific health needs that can be challenging to deliver. Sub‐Saharan Africa (SSA) is home to 84% of the global population of ALHIV, of whom about 59% receive ART. Several studies in SSA have demonstrated health service gaps due to lack of synchronized healthcare for ALHIV receiving ART. We conducted a systematic review of health‐related needs among ALHIV on ART in SSA to inform decisions and policies on care.

Methods

We searched MEDLINE, Web of Science, EMBASE, PsycINFO, Cochrane library and grey literature for studies reporting health‐related needs among ALHIV receiving ART in SSA, between January 2003 and May 2020.

Results and discussion

Of the 2333 potentially eligible articles identified, 32 were eligible. Eligible studies were published between 2008 and 2019, in 11 countries: Zambia (7), Uganda (6), Tanzania (4), South Africa (4), Kenya (3), Ghana (2), Zimbabwe (2), Rwanda (1), Malawi (1), Botswana (1) and Democratic Republic of Congo (1). Seven categories of health needs among ALHIV were identified. In descending order of occurrence, these were: psychosocial needs (stigma reduction, disclosure and privacy support, and difficulty accepting diagnosis); dependency of care (need for family and provider support, and desire for autonomy); self‐management needs (desire for better coping strategies, medication adherence support and reduced ART side effects); non‐responsive health services (non‐adolescent friendly facility services and non‐compatible school system); need for food, financial and material support; inadequate information about HIV (desire for more knowledge to fight misinformation and misconception); and developmental and growth needs (desire to experience sex, parenthood and love). Ecological analysis identified different priority needs between ALHIV, their caregivers and healthcare providers, including psychosocial needs, financial challenges and non‐responsive health services, respectively.

Conclusions

To respond effectively to the health needs of ALHIV and improve ART adherence, interventions should focus on stigma reduction, disclosure challenges and innovative coping mechanisms for ART. Interventions that address the health needs of ALHIV from the perspective of carers and providers, such as financial support schemes and adolescent‐friendly healthcare strategies, should supplement efforts to improve adolescent ART adherence outcomes.

The sexual and reproductive health needs of young people living with HIV in Gauteng, South Africa

Background

HIV has been the focus of health systems strengthening in South Africa for the past two decades. Despite progress, sexual and reproductive health (SRH) challenges such as contraception, condom usage and HIV disclosure of young people living with HIV (YPLHIV) remain inadequately addressed. Therefore, the purpose of the study was to describe the SRH needs of YPLHIV and make recommendations to address identified gaps.

Objectives

To explore and describe the SRH needs and potential systemic gaps of YPLHIV with an aim to make recommendations for improvement and contribute to the development of an integrated approach to SRH care in HIV programming.

Method

A quantitative cross-sectional research design with purposive sampling was utilised. YPLHIV were recruited from five healthcare facilities in Gauteng, South Africa, for face-to-face interviews.

Results

One hundred and six YPLHIV with a median age of 18 years were enrolled. A large proportion (57/106; 53.8%) of respondents reported being either single or double orphaned. Sex-related discussions with parents were reported by only 36/106 (34.0%). History of teenage pregnancy was reported in 39/70 (56.0%) of female respondents. A high prevalence of multiple sexual partnerships 41/97 (42.2%) was noted. Consensual partner HIV disclosure was low at 47/97 (48.4%) and the male gender was associated with low 10/35 (28.6%) disclosure of serostatus to sexual partners.

Conclusion

Multiple SRH needs were identified. Interventions are needed to improve parental guidance on SRH issues, increase contraception knowledge and access, and provide better male-centred care.

“We Should Be Taught Self-Respect, Self-Confidence and Self-Love”: Youth Perspectives of Adult Influences on Their Sexuality and Relationships Among South African Adolescents Living With HIV

Introduction

Of the 1.75 million adolescents aged 10–19 years living with HIV globally, 84% reside in sub-Saharan Africa. This problem is most acute in South Africa, where there are 720,000 adolescents living with HIV (ALHIV). ALHIV navigate the same challenges as other adolescents—such as puberty and first relationships—as well as challenges specific to their HIV-status—including stigma, disclosure, and concerns about HIV transmission. This dual burden calls for tailored sexual and reproductive health (SRH) programs. Here, we qualitatively explore the reflections of South African ALHIV on SRH education, communication, and discussion provided by adults in schools, clinics, and the home related to their unique SRH needs.

Methods

This paper reports on qualitative data from a mixed-methods study to inform interventions that meet the SRH needs of ALHIV. In-depth interviews (N = 20) were conducted with ALHIV recruited from two clinics in Cape Town, South Africa. Nine males and 11 females aged 16–19 participated in semi-structured in-depth interviews to discuss their sexual health as ALHIV. The interview guide explored 1) perceived SRH needs; 2) healthy living with HIV; 3) future goals; 4) intimate relationships; 5) psychosocial challenges; and 6) preferred interventions. Data were thematically applied to an iteratively-developed codebook and analyzed by the cross-cultural research team using NVivo 12.

Results

These qualitative data reveal the pressing needs among ALHIV for open communication and accurate information about sexuality and HIV, given the risk to themselves and their partners as they enter intimate relationships. Three themes emerged from the data: 1) Intergenerational pressures coming from caregivers, clinicians, and teachers often stigmatize the sexual heath behaviors of ALHIV; 2) When present, open intergenerational communication can provide ALHIV with crucial information, resources, and social support that supports healthy decisions, and 3) ALHIV offer specific ideas about how adults can support their decision-making in the transition to adulthood.

Conclusions

Findings highlight adolescents' recommendations for programs involving open communication, stigma-reduction around sexuality, and support from both peer and adult mentors. This study lays the foundation for strategies to improve intergenerational communication about sexual health to promote positive approaches to sexuality for ALHIV.

Factors associated with pregnancy uptake decisions among seropositive HIV people receiving antiretroviral therapy in sub‐Saharan Africa: A systematic review

Aim

This study determined the factors associated with pregnancy uptake decision among seropositive HIV people receiving antiretroviral therapy in sub‐Saharan Africa.

Design

Systematic review.

Methods

The population, intervention, comparison and outcomes framework was adopted to search for literature after a scoping review using the preferred reporting items for systematic reviews and meta‐analyses guidelines adopted in searching, and screening articles from four databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Google scholar) to find 12 articles suitable for this study.

Results

Motivators of pregnancy uptake among HIV‐positive women include desire to have children, knowledge about PMTCT, cultural duty for married women to have children, and household income. Demotivating factors included the modern method of contraception and burden associated with pregnancy.

Conclusion

There is a need to improve on services that reduce conception‐related risks especially for women who choose to conceive and to incorporate fertility‐related counselling into HIV treatment services.

"We just do it … we are dead already": Exploring the sexual behaviors of youth living with HIV

INTRODUCTION

This study aims to describe the sexual behaviors of youth living with human immunodeficiency virus (HIV) in Malawi. As a high-risk population, understanding the contextual factors that shape their sexual behaviors is of particular interest when designing strategies to reduce HIV transmission.

METHODS

Semi-structured qualitative interviews were used to collect information about sexual behaviors from 22 youth (12 females and 10 males) living with HIV aged from 15 to 24 years. All participants were recruited from a specialized HIV clinic in Malawi. Thematic analysis was applied to identify current themes.

RESULTS

The majority of participants were sexually active. Engaging in sexual behaviors was largely related to social processes identified in three main themes: (1) Risk-taking in pursuit of confidence and maturity; (2) A lack of voice in decision making concerning practising safe sex; (3) Perceived barriers to safe sex practice such as poverty, dropping out of school, and personal perspectives about transmitting HIV to others.

CONCLUSION

Our results suggest that prevention strategies targeting youth social and economic vulnerabilities to social influences are needed to enhance their personal and social skills. We suggest nurturing cultural and religious ceremonies and involving elders to equip youth with skills and knowledge for the prevention of HIV transmission.

Understanding the factors associated with HIV and STIs diagnosis among Black heterosexual men in Ottawa and Windsor, Ontario

Background: The African, Caribbean and Black (ACB) men living in Canada share a heightened risk of infection by Human Immunodeficiency Virus and other sexually transmitted illnesses (STIs) and the associated risky behaviours such as suboptimal use of family planning services such as condom use. The African, Caribbean and Black (ACB) heterosexual men living in Canada are disproportionately exposed to HIV and other sexually transmitted infections. The present paper aims to assess the relationship between knowledge, attitude and use of condom with diagnosis of HIV and STIs among ACB heterosexual men in Ontario.

Design and Methods: This was a cross-sectional study on 430 participants consisting of black heterosexual men living two communities, Ottawa and Windsor in Ontario. The outcome variables were ever being diagnosed with HIV (Yes/No) and other STIs (Yes/No). Data were analysed using descriptive, and logistic regression techniques.

Results: Findings indicated that 70.20% did not have good knowledge of HIV, 68.10% had positive attitude towards condom use, and 62.82% were not regular condom user. Men who reported experiencing difficulty in accessing healthcare services had significantly higher odds of reporting HIV and STI diagnosis. Men with positive attitude towards condom use had lower odds of both HIV (odds ratio= 0.48, 95%CI=0.30,0.76) and STI diagnosis (odds ratio= 0.27, 95%CI=0.08,0.90). Similarly, condom users also had lower odds of both HIV and (odds ratio= 0.21, 95%CI=0.09,0.49) STI diagnosis (odds ratio= 0.62, 95%CI=0.39,0.99).

Conclusions: A large proportion of the sample with positive attitude to condom use was not a reflection of the large sample who did not have correct knowledge of HIV. Several factors were also found to be associated with heightened odds of being diagnosed with HIV and other STIs. The most notable of these factors were experiences of difficulty in accessing healthcare and utilisation of condoms.

Sexual and reproductive health needs of young people living with HIV in low- and middle-income countries: a scoping review

Background

Young people living with HIV(YPLWH) in low-and middle-income countries are entering adolescence and young adulthood in significant numbers. The majority of the HIV-related research on these young people has focused on clinical outcomes with less emphasis on their sexual and reproductive health (SRH). There is an increasing awareness of the importance of understanding and addressing their SRH needs, as many are at elevated risk of transmitting HIV to their sexual partners and young women, in particular, are at significant risk for transmitting HIV to their infants. The purpose of this scoping review is to synthesize research investigating the SRH needs of young people living with HIV in low- and middle-income countries.

Methods

We searched electronic databases for studies focusing on young people aged 10–24 years and 27 studies met inclusion criteria.

Results

This review identified four themes characterizing research on SRH among young people living with HIV: knowledge of SRH, access to SRH services, sexual practices, and future family planning and childrearing.

Conclusions

Our findings suggest a need for additional research on comprehensive sexuality education to equip YPLWH with knowledge to facilitate desirable SRH outcomes, interventions on sero-status disclosure and condom use, and health provider capacity to provide SRH services in their pre-existing HIV clinical care.

Young people living with HIV(YPLWH) in low-and middle-income countries are entering adolescence and young adulthood in large numbers. The majority of the HIV-related research on these young people has focused on clinical outcomes with less emphasis on their sexual and reproductive health. It is important to understand and address their sexual and reproductive health (SRH) needs, as many are at a high risk of passing on HIV to their sexual partners and young women, in particular, are at significant risk for passing on HIV to their infants. The purpose of this scoping review is to summarize research examining the SRH needs of young people living with HIV in low- and middle-income countries. We searched online databases for studies focusing on young aged 10–24 years and 27 studies were included in the review. This review identified four themes characterizing research on SRH among young people living with HIV: knowledge of SRH, access to SRH services, sexual practices, and future family planning and childrearing. Our findings suggest a need for additional research on comprehensive sexuality education to equip YPLWH with knowledge to facilitate desirable SRH outcomes, interventions on sero-status disclosure and condom use, and health provider capacity to provide SRH services in their pre-existing HIV clinical care.

Growing up positive: adolescent HIV disclosure to sexual partners and others

Over three million youth live with HIV worldwide. Very little is known about whether youth disclose their HIV status to family, friends or sexual partners, and what risks and benefits may accrue from doing so. This study characterizes HIV disclosure among 250 youth with perinatally-acquired HIV (PHIV; age 13-24 years) living in Soweto, South Africa. A third had self-disclosed their HIV status to at least one person; similarly, only a third of sexually-active PHIV had disclosed their HIV status to their most recent partner. It is not clear whether HIV disclosure alone leads to positive impact: we found perceived social support from the family was negatively associated with disclosure (aOR 0.81, 95% 0.70-0.94). PHIV who spoke to a provider about disclosure were more likely to share their HIV status with a sexual partner (aOR 2.48; 95% CI 1.28-4.81). However, those PHIV who disclosed their status were no more likely to use a condom. The World Health Organization recommends that health providers advise adolescent patients on safe disclosure, but we still lack evidence on the consequences for young people and effective tools to help them weigh benefits and risks.