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Martin K, Dauya E, Simms V, Bandason T, Azizi S, Machiha A, Shamu T, Musiyandaka P, Mwaturura T, Francis SC, Mackworth-Young CRS, Busza J, Mavodza C, Tembo M, Hayes RJ, Kranzer K, Ferrand RA, Dziva Chikwari C. Risk factors for curable sexually transmitted infections among youth: findings from the STICH population survey in Zimbabwe. Sex Transm Infect 2024:sextrans-2024-056146. [PMID: 38871454 DOI: 10.1136/sextrans-2024-056146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES Youth are at high risk of sexually transmitted infections (STIs) in Africa. We aimed to determine the risk factors for curable STIs in youth in Zimbabwe. METHODS A population-based survey was conducted among randomly selected 18-24 year-olds in 16 communities across two provinces in Zimbabwe to ascertain outcomes for a cluster randomised trial investigating the impact of community-based STI screening for youth on population prevalence of STIs. Participants underwent an interviewer-administered questionnaire, HIV testing and screening for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV). Risk factors for curable STIs were explored through multivariable logistic regression. RESULTS Of the 5601 participants, 62.5% (n=3500) were female, and the median age was 20 (IQR 19-22) years. HIV prevalence was 6.3% (351/5556), and 55.4% (1939/3501) reported condomless sex at last intercourse. Only 7.2% (401/5599) reported STI symptoms, but CT/NG/TV prevalence was 19.8% (1107/5601). On multivariable analysis, factors associated with STI diagnosis included being aged 21-24 years (adjusted OR (aOR) 1.37, 95% CI 1.17 to 1.61); female sex (aOR 2.11, 95% CI 1.76 to 2.53); being unemployed/informally employed (compared with in education/formal employment) (aOR 1.35, 95% CI 1.13 to 1.61); increasing number of sexual partners in the preceding 12 months (one partner: aOR 2.23, 95% CI 1.73 to 2.88; two partners: aOR 2.39, 95% CI 1.69 to 3.39); living with HIV (aOR 1.44, 95% CI 1.07 to 1.94); and previous attempted suicide (aOR 1.58, 95% CI 1.08 to 2.32). CONCLUSIONS The prevalence of STIs among youth in Zimbabwe is high, particularly among those with HIV. In addition to moving away from syndromic STI management and strengthening implementation of existing prevention tools, there is a need for a more holistic focus on broader risk factors such as mental health and employment opportunities, and of integration of HIV and STI programming. TRIAL REGISTRATION NUMBER ISRCTN15013425, NCT03719521.
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Affiliation(s)
- Kevin Martin
- Clinical Research Department, The London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Steven Azizi
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Machiha
- AIDS and TB Unit, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Primrose Musiyandaka
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tinashe Mwaturura
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Constance R S Mackworth-Young
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environments and Society, The London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, The London School of Hygiene & Tropical Medicine, London, UK
| | - Mandi Tembo
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Kranzer
- Clinical Research Department, The London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rashida A Ferrand
- Clinical Research Department, The London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
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Doyisa N, Maharaj P, Dunn S. Older men, younger women: blesser-blessee relationships among university students in Durban, South Africa. CULTURE, HEALTH & SEXUALITY 2023; 25:1530-1542. [PMID: 36633499 DOI: 10.1080/13691058.2022.2164065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
In sub-Saharan Africa, sexual relationships between younger women and older men have been shown to pose a risk of HIV transmission. In South Africa, there has been growing interest in blesser-blessee relationships. This study explores perceptions of these relationships among university students in Durban, South Africa. The study draws on 15 in-depth interviews with students. Participants suggest that older men engage in these relationships for sexual gratification and younger women do so for monetary or material gain. Interviews revealed that participants believed that these relationships are common with both men and women engaging in them and putting themselves at risk of HIV infection. It is imperative to explore the context and motivation for these relationships because of their broader social and health implications. In addition, greater effort should be geared towards addressing the underlying factors that facilitate blesser-blessee relationships.
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Affiliation(s)
- Nompumelelo Doyisa
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Shanaaz Dunn
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
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Kyegombe N, Zuma T, Hlongwane S, Nhlenyama M, Chimbindi N, Birdthistle I, Floyd S, Seeley J, Shahmanesh M. A qualitative exploration of the salience of MTV-Shuga, an edutainment programme, and adolescents' engagement with sexual and reproductive health information in rural KwaZulu-Natal, South Africa. Sex Reprod Health Matters 2022; 30:2083809. [PMID: 35929964 PMCID: PMC9448405 DOI: 10.1080/26410397.2022.2083809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Young people, particularly adolescent girls and young women, represent a growing proportion of those living with HIV. Edutainment programmes have been widely used throughout the world to "educate" and "entertain" audiences and tackle serious social issues in bold and engaging ways. This paper examines the extent to which an edutainment programme, MTV-Shuga, was reported to influence young people's engagement with sexual and reproductive health (SRH) information in rural KwaZulu-Natal, South Africa. In 2019 we conducted eight community-based screenings of MTV-Shuga episodes followed by 25 individual in-depth interviews and 13 focus group discussions with young people aged between 15 and 30. Interviews were audio recorded and transcribed verbatim. Data analysis was thematic and complemented by constant comparison and deviant case analysis techniques. In this rural and poor setting with a high burden of HIV, young people exhibited high levels of awareness of SRH and HIV but had constrained access to services, and limited ability to engage with parents or guardians on SRH matters. MTV Shuga provided an entertaining guide of ways to navigate the risks that they faced in a way that resonated with them. The findings highlight the importance of enabling young people in rural areas to watch MTV Shuga with peers in a safe space in which discussion of the content is facilitated. There is also value in encouraging parents to watch MTV Shuga as a means of enabling discussions between children and adults in their lives about SRH matters.
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Affiliation(s)
- Nambusi Kyegombe
- Associate Professor, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Correspondence:
| | - Thembelihle Zuma
- Senior Research Associate, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Siphesihle Hlongwane
- Research Professional, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Mxolisi Nhlenyama
- Research Assistant, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Natsayi Chimbindi
- Junior Faculty, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Isolde Birdthistle
- Associate Professor, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sian Floyd
- Associate Professor, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Professor, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.,Senior Faculty, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Maryam Shahmanesh
- Professor, Institute of Global Health, University College London.,Senior Faculty and Study PI, Africa Health Research Institute, KwaZulu-Natal, South Africa
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