Correlates of Sexual Risky Behaviours, HIV Testing, and HIV Testing Intention among Sexually Active Youths in Northern Tanzania

A community-based study of intention to use HIV self-testing among young people in urban areas of southern Ethiopia

In sub-Saharan Africa, young people are at high risk of HIV infection, representing nearly 4 out of 5 new infections. HIV self-testing (HIVST), a new and proactive testing scheme that involves self-collection of a specimen and interpretation of results, is deemed potentially helpful for increasing testing amongst population groups like young people who do not frequently use routine testing services. This study assessed young people's intention to use HIVST in urban areas of southern Ethiopia drawing on the Theory of Planned Behaviour. A community-based cross-sectional study was conducted with 634 participants aged 15-24 years from six town administrations of two zones in January to February 2023. The participation rate was 634/636 yielding 99.7%. The OraQuick HIVST kit was demonstrated to young people recruited in a door-to-door survey with a face-to-face interview using an electronic questionnaire in a mobile phone-based application. Intention to use HIVST was measured from a 6-point Likert scale with scores of agreements ranging from 1 to 6. Descriptive statistics and ordinal logistic regression analysis were done using STATA version 18. Most of the participants agreed that they would use HIVST if it was available (86.3% agreeing or strongly agreeing). Interestingly, young people who perceived themselves at some to high risk were 0.51 times less likely to be in the higher order of intention to use when HIVST is available to them than those who perceived themselves at no to low risk. Intention to use HIVST increased by a factor of 1.29, 1.84 and 2.35 for every one-unit increase on the mean favourable attitude, perceived behavioural control, and acceptability scores, respectively. The majority of young people intended to use HIVST. Young people's perceived behavioural control, and acceptability of HIVST affected their intention to use. Intention and subsequent use of HIVST can be enhanced through an understanding of the role of risk perception and positive attitude, confidence to perform and acceptance of the test. Implementation studies are required to examine the actual uptake of HIVST among young people.

Factors associated with perceived social support among adolescents in Gamo Zone, Southern Ethiopia: a community-based cross-sectional study

Introduction

Perceived social support plays a crucial role in adolescent development, health, well-being, and resilience. Understanding the factors associated with perceived social support among adolescents is essential for designing effective interventions. However, research in this area, particularly within specific contexts, remains limited. Therefore, this study aims to identify the factors associated with perceived social support among adolescents in the Gamo Zone, South Ethiopia Regional State.

Method

A community-based cross-sectional study was conducted, involving 1172 adolescents selected through a stratified multi-stage sampling method. Structured face-to-face interviews were employed for data collection. Summary statistics were utilized for data presentation. Multiple linear regressions were then performed to identify factors associated with perceived social support. The strength and direction of associations were presented using β coefficients and 95% confidence intervals (CIs). The level of statistical significance was set at alpha 5%.

Result

The total mean for perceived social support among adolescents was 57.02 ± 12.68. Adolescents living with their biological parents reported significantly higher levels of perceived social support (β = 4.17, 95% CI: 2.00 to 6.34) compared to their counterparts. Similarly, adolescents engaged in paid work within the last 12 months reported higher perceived social support (β = 3.43, 95% CI: 1.39 to 5.46). Higher levels of parental monitoring were also associated with increased perceived social support (β = 3.03, 95% CI: 1.23 to 4.82). Additionally, adolescents who perceived risks for sexual and reproductive health (SRH) problems reported higher levels of perceived social support (β = 2.76, 95% CI: 0.84 to 4.69). Moreover, adolescents with good knowledge about SRH rights exhibited increased perceived social support (β = 2.46, 95% CI: 0.89 to 4.02). Furthermore, adolescents residing in rural areas reported higher levels of perceived social support compared to those in urban areas (β = 1.56, 95% CI: 0.16 to 3.11).

Conclusion

The findings of this study reveal that factors such as living arrangements, employment status, parental monitoring, perceived risks for SRH problems, knowledge about SRH rights, and geographical context emerged as important predictors of perceived social support. Therefore, implementing interventions and initiatives to address these identified factors holds promise for nurturing resilient adolescent social support networks.

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

INTRODUCTION

Adolescents and young adults (AYA) face multiple barriers to accessing healthcare services, which can interact, creating complex needs that often impact health behaviours, leading to increased vulnerability to HIV. We aimed to identify distinct AYA subgroups based on patterns of barriers to HIV testing services and assess the association between these barrier patterns and sexual behaviour, socio-demographics, and HIV status.

METHODS

Data were from Nigeria's AIDS Indicator and Impact Survey (NAIIS, 2018) and included 18,612 sexually active AYA aged 15-24 years who had never been tested for HIV and reported barriers to accessing HIV testing services. A Latent class analysis (LCA) model was built from 12 self-reported barrier types to identify distinct subgroups of AYA based on barrier patterns. Latent class regressions (LCR) were conducted to compare the socio-demographics, sexual behaviour, and HIV status across identified AYA subgroups. Sex behaviour characteristics include intergenerational sex, transactional sex, multiple sex partners, condom use, and knowledge of partner's HIV status.

RESULTS

Our LCA model identified four distinct AYA subgroups termed 'low-risk perception' (n = 7,361; 39.5%), 'consent and proximity' (n = 5,163; 27.74%), 'testing site' (n = 4,996; 26.84%), and 'cost and logistics' (n = 1,092; 5.87%). Compared to adolescents and young adults (AYA) in the low-risk perception class, those in the consent and proximity class were more likely to report engaging in intergenerational sex (aOR 1.17, 95% CI 1.02-1.35), transactional sex (aOR 1.50, 95% CI 1.23-1.84), and have multiple sex partners (aOR 1.75, 95% CI 1.39-2.20), while being less likely to report condom use (aOR 0.79, 95% CI 0.63-0.99). AYA in the testing site class were more likely to report intergenerational sex (aOR 1.21, 95% CI 1.04-1.39) and transactional sex (aOR 1.53, 95% CI 1.26-1.85). AYA in the cost and logistics class were more likely to engage in transactional sex (aOR 2.12, 95% CI 1.58-2.84) and less likely to report condom use (aOR 0.58, 95% CI 0.34-0.98). There was no significant relationship between barrier subgroup membership and HIV status. However, being female, aged 15-24 years, married or cohabiting, residing in the Southsouth zone, and of Christian religion increased the likelihood of being HIV infected.

CONCLUSIONS

Patterns of barriers to HIV testing are linked with differences in sexual behaviour and sociodemographic profiles among AYA, with the latter driving differences in HIV status. Findings can improve combination healthcare packages aimed at simultaneously addressing multiple barriers and determinants of vulnerability to HIV among AYA.

Examining differentials in HIV transmission risk behaviour and its associated factors among men in Southern African countries

Sub-Saharan Africa (SSA), particularly Southern and East Africa, has the highest AIDS deaths and HIV-infected people in the world. Even though considerable effort has been made over the years to study HIV transmission risk behaviours of different population groups in SSA, there is little evidence of studies that have looked at pooled effects of associated HIV risk factors among men, particularly in Southern Africa. Thus, this study sought to fill this gap in knowledge by investigating the variations in HIV risk behaviours among men in the region. The study analysed cross-sectional data based on the most recent country Demographic and Health Survey (DHS) for six countries, namely Lesotho, Mozambique, Namibia, South Africa, Zambia and Zimbabwe. The study employed multivariate logistic regression models on a pooled dataset and individual country data to examine the relative risk of education and other factors on HIV risk behaviour indicators. It considered: (i) condom use during high risk-sex, (ii) multiple sexual partnerships, and (iii) HIV testing among men aged 15-59 years. Findings show that the proportion of men who engaged in HIV transmission risk behaviour was high in Southern Africa. Two-thirds of men reported non-use of a condom during last sex with most recent partners while 22% engaged in multiple sexual partnerships. The percentage of men who used condoms during sex with most recent partners ranged from 18% in Mozambique to 58% in Namibia. Age, residence, marital status and household wealth status were associated with HIV risk factors in the region. The study has established country variations in terms of how individual factors influence HIV transmission risk behaviour among men. Results show that the level of education was associated with increased use of condoms, only in Zambia and Mozambique. Delay in starting a sexual debut was associated with reduced odds of having multiple sexual partnerships in the region. Suggesting the need to strengthen comprehensive sexuality education among young men in school, to promote social behaviour change during adolescence age. The study presents important results to inform direct health policy, programme and government action to address HIV prevalence in the Southern region of Africa.