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Kanagasabai U, Thorsen V, Zhu L, Annor FB, Chiang L, McOwen J, Augusto A, Manuel P, Kambona C, Coomer R, Kamagate F, Ramphalla P, Denhard L, Cain M, Hegle J, de Barros RB, Saenz S, Kamami M, Patel P. Adverse childhood experiences, HIV and sexual risk behaviors - Five sub-Saharan countries, 2018-2020. CHILD ABUSE & NEGLECT 2024; 150:106541. [PMID: 38114359 DOI: 10.1016/j.chiabu.2023.106541] [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: 07/18/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been shown to have negative, lasting effects on health including increasing the likelihood of engaging in sexual risk behaviors. OBJECTIVE This study aimed to identify associations between exposures to ACEs and sexual risk behaviors and HIV service utilization among young people. PARTICIPANTS AND SETTING A sample of 8023 sexually active young people (19-24 year olds) from five sub-Saharan African countries participated Violence Against Children and Youth Surveys (VACS). METHODS Descriptive analysis of demographic variables, individual ACEs, cumulative ACEs, sexual risk behaviors, HIV testing, antiretroviral treatment (ART) and Antenatal Care (ANC) attendance were completed. Bivariate and multivariable logistic regression analyses were conducted to assess the associations between both individual and cumulative ACEs, sexual HIV risk behaviors, and service utilization while controlling for important covariates such as demographic, having ever been pregnant, had an STI, and used contraception. RESULTS Exposure to three or more ACEs was higher among males (26.1 %) compared to females (21.3 %); p = 0.003. The most prominent sexual risk behavior for females was having sexual partners who were at least 5 years older (45.7 % compared to males 3.7 %; p < 0.0001) whereas in males it was no or infrequent condom use (45.3 % compared to females 30.1 %; p < 0.0001). Males and females exposed to childhood sexual violence had seven and four times the odds of engaging in transactional sex (aOR = 7.34, 95 % CI: [3.5-15.0]) and (aOR =3.75, 95 % CI: [2.3-6.2], respectively. Females exposed to three or more ACEs were four times more likely to engage in transactional sex (aOR = 4.85, 95 %, CI: [1.6-14.4]) compared to those who did not experience any ACEs. Males exposed to three or more ACEs were two times more likely to engage in early sexual debut (aOR = 2.2, 95 % CI: [1.3-3.4]),]) compared to those who did not experience any ACEs. Females who had witnessed IPV or violence in the community had significantly higher odds of getting tested for HIV (aOR = 2.16, 95 % CI: [1.63-2.87]) and (aOR = 1.36, 95 % CI: [1.03-1.81]), respectively. CONCLUSIONS This study demonstrated that experiencing ACEs during childhood is associated with higher HIV risk behaviors in sub-Saharan Africa (SSA) with unique differences between males and females.
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Affiliation(s)
| | - Viva Thorsen
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Liping Zhu
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Francis B Annor
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Laura Chiang
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jordan McOwen
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Mozambique
| | | | - Pedro Manuel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Mozambique
| | - Caroline Kambona
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Kenya
| | - Rachel Coomer
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Namibia
| | - Fathim Kamagate
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Cote d'Ivoire
| | - Puleng Ramphalla
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lesotho
| | - Langan Denhard
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Meagan Cain
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jennifer Hegle
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Shantal Saenz
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Mwikali Kamami
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Pragna Patel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
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Logie CH, Okumu M, Admassu Z, Perez-Brumer A, Ahmed R, Luna ML, MacKenzie F, Kortenaar JL, Berry I, Hakiza R, Katisi B, Musoke DK, Nakitende A, Batte S, Kyambadde P, Taing L, Giordana G, Mbuagbaw L. HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings. AIDS Behav 2024; 28:507-523. [PMID: 38048017 DOI: 10.1007/s10461-023-04240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16-24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19-3.08; FI: aOR: 2.31. 95%CI: 1.36-3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24-6.17; FI: aOR: 2.62, 95%CI: 1.03-6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22-7.89; FI: aOR: 3.51, 95%CI: 1.15-10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.
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Affiliation(s)
- Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada.
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rushdia Ahmed
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Marianne Lahai Luna
- Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Brenda Katisi
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | | | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy (OGERA) Uganda, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
| | - Lina Taing
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
| | - Gio Giordana
- World Food Programme East Africa, Nairobi, Kenya
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Howard AL, Chiang L, Picchetti V, Zhu L, Hegle J, Patel P, Saul J, Wasula L, Nantume S, Coomer R, Kamuingona R, Oluoch RP, Mharadze T, Duffy M, Kambona CA, Ramphalla P, Fathim KM, Massetti GM. Population Estimates of HIV Risk Factors to Inform HIV Prevention Programming for Adolescent Girls and Young Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:20-38. [PMID: 37406147 DOI: 10.1521/aeap.2023.35.suppa.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Violence Against Children and Youth Survey (VACS) data from seven countries were analyzed to estimate population-level eligibility for the President's Emergency Plan for AIDS Relief (PEPFAR) Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) HIV prevention program for adolescent girls and young women (AGYW). The prevalence of overall eligibility and individual risk factors, including experiences of violence, social, and behavioral risks differ across countries and age groups. A large proportion of AGYW across all countries and age groups examined have at least one risk factor making them eligible for DREAMS. Experiencing multiple risks is also common, suggesting that researchers and programs could work together to identify combinations of risk factors that put AGYW at greatest risk of HIV acquisition, or that explain most new HIV infections, to more precisely target the most vulnerable AGYW. The VACS provides important data for such analyses to refine DREAMS and other youth programming.
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Affiliation(s)
- Ashleigh L Howard
- U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health, Atlanta, Georgia
| | - Laura Chiang
- CDC, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Viani Picchetti
- CDC, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Liping Zhu
- CDC, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Jennifer Hegle
- U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health, Atlanta, Georgia
| | - Pragna Patel
- U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health, Atlanta, Georgia
| | - Janet Saul
- U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health, Atlanta, Georgia
| | - Lydia Wasula
- Uganda Ministry of Gender, Labor and Social Development, Kampala, Uganda
| | | | | | - Rahimisa Kamuingona
- Namibia Ministry of Gender Equality, Poverty Eradication and Social Services, Windhoek, Namibia
| | | | | | | | | | - Puleng Ramphalla
- CDC, Lesotho Country Office, Maseru, Lesotho. Puleng Ramphalla, MS, is affiliated with the CDC, Côte d'Ivoire Country Office, Abidjan, Côte d'Ivoire
| | | | - Greta M Massetti
- CDC, National Center for Injury Prevention and Control, Atlanta, Georgia
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Kanagasabai U, Aholou T, Chevalier MS, Tobias JL, Okuku J, Shiraishi RW, Sheneberger R, Pande YC, Chifuwe C, Mamane LE, Njika G, Obongo C, Thorsen VC. Reaching Youth Through Faith Leaders: Evaluation of the Faith Matters! Initiative. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:82-99. [PMID: 37406142 PMCID: PMC11075127 DOI: 10.1521/aeap.2023.35.suppa.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Faith leaders can be uniquely positioned to guide and support young people on health issues, particularly HIV/AIDS and sexual violence. Faith Matters!, a 2-day training workshop for faith leaders, was delivered in September 2021 in Zambia. Sixty-six faith leaders completed a questionnaire at baseline, 64 at posttraining, and 59 at 3-month follow-up. Participants' knowledge, beliefs, and comfort communicating about HIV/AIDS and sexual violence were assessed. More faith leaders accurately identified common places where sexual violence occurs at the 3-month point compared to baseline: at church (2 vs. 22, p = .000), the fields (16 vs. 29, p = .004), parties (22 vs. 36, p = .001), and clubs (24 vs. 35, p = .034). More faith leaders stated that they engaged in conversations that supported people living with HIV (48 at baseline vs. 53, p = .049 at 3-month follow-up). These findings can inform future HIV/AIDS initiatives focusing on increasing the capacity among communities of faith.
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Affiliation(s)
- Udhayashankar Kanagasabai
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Tiffiany Aholou
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Michelle S Chevalier
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - James L Tobias
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jackson Okuku
- Division of Global HIV & TB, CGH, CDC, Lusaka, Zambia
| | - Ray W Shiraishi
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | | | - Clifton Chifuwe
- Executive Director and Global Master Trainer at the Centre for Peace Research and Advocacy, Zambia
| | - Lauren Erickson Mamane
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- Office of the Director, CGH, CDC, Atlanta, Georgia
| | | | - Chris Obongo
- Regional Measurement Specialist and Global Master Trainer at PATH, Kenya
| | - Viva C Thorsen
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Hlongwa M, Mutambo C, Hlongwana K. 'In fact, that's when I stopped using contraception': a qualitative study exploring women's experiences of using contraceptive methods in KwaZulu-Natal, South Africa. BMJ Open 2023; 13:e063034. [PMID: 37080630 PMCID: PMC10124203 DOI: 10.1136/bmjopen-2022-063034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES This study explored women's experiences of using contraceptive methods in KwaZulu-Natal, South Africa. SETTING In October 2021, we conducted a qualitative study at Umlazi Township in KwaZulu-Natal province, South Africa, through face-to-face in-depth interviews. PARTICIPANTS Women from four primary healthcare facilities were recruited through a criterion-based sampling strategy. Using NVivo V.11, two skilled researchers independently conducted thematic data analysis, as a mechanism for quality assurance, before the results were collated and reconciled. RESULTS The study included 15 female participants, aged between 18 and 35 years, of whom two-thirds were aged 18-24 years. We found that women were concerned about unpleasant contraceptive methods side effects such as prolonged or irregular menstrual periods, bleeding, weight gain and/or severe pains, resulting in discontinuation of their use. In addition to contraceptive stockouts, women indicated that healthcare providers did not appropriately counsel or inform them about the available contraceptive methods, including how to use them. Key themes included the following: negative effects of contraceptive methods; stockouts of preferred contraceptive methods; inconsistent or incorrect use of contraceptive methods; lack of counselling regarding contracepive methods; and misconceptions about contraception. CONCLUSIONS Interventions aimed at reducing contraceptive stockouts are required to ensure that women are empowered to choose contraception based on their own preference, convenience and/or experience. It is imperative that counselling on contraceptive methods' side effects be improved, to ensure that women have freedom to make informed decisions about their preferred method, proper management of side effects and to assist them with method switching as needed, instead of discontinuation.
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Affiliation(s)
- Mbuzeleni Hlongwa
- School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Public Health, Societies and Belonging programme, Human Sciences Research Council, Pretoria, South Africa
| | - Chipo Mutambo
- School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani Hlongwana
- School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit, University of KwaZulu-Natal, Durban, South Africa
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Who is Exposed to HIV Prevention Interventions? An Assessment of Associated Factors Among Adolescent Girls and Young Women in South Africa. AIDS Behav 2023:10.1007/s10461-023-04023-1. [PMID: 36856934 PMCID: PMC10387118 DOI: 10.1007/s10461-023-04023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/02/2023]
Abstract
This study examined the prevalence of HIV risk factors and their association with intervention exposure among adolescent girls and young women (AGYW) living in six South African districts in which a combination HIV-prevention intervention was being implemented. A cross-sectional household survey was conducted from 2017 to 2018 among a representative sample of AGYW aged 15-24 years living in the six districts. We used an electronic questionnaire for self-reported demographic and behavioural questions and blood samples were taken to confirm HIV status in the laboratory. Chi-Squared tests and multivariate binary logistic regression were used to examine associations between demographic characteristics, HIV acquisition and transmission risk factors and the likelihood of participating in any of the key components of the combination HIV-prevention intervention. Among the 4399 participants, 45.3% reported inconsistent condom use with casual partner and 46.6% with a main partner. Almost half of participants (47.8%) had participated in one or more components of the HIV-prevention intervention, and in a multivariate logistic regression, those reporting a higher number of HIV risk behaviours were no more (or less) likely to participate. Participants who were not in high school were significantly less likely to have participated in the intervention compared to those still in high school, when adjusting for age and HIV risk factors. The barriers to access and uptake of combination HIV prevention interventions among AGYW who are out of the education system need to be explored and combination HIV prevention interventions and implementation strategies need to be tailored to reach this population.
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Steventon Roberts KJ, Smith C, Cluver L, Toska E, Jochim J, Wittesaele C, Marlow M, Sherr L. Adolescent mothers and their children affected by HIV-An exploration of maternal mental health, and child cognitive development. PLoS One 2022; 17:e0275805. [PMID: 36264898 PMCID: PMC9584392 DOI: 10.1371/journal.pone.0275805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 09/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Some children born to adolescent mothers may have developmental challenges, while others do not. Research focusing on which children of adolescent mothers are at the highest risk for cognitive delay is still required. Both maternal HIV status and maternal mental health may affect child development. An examination of maternal mental health, especially in the presence of maternal HIV infection may be timely. This study explores the relationship between the mental health of adolescent mothers (comparing those living with and not living with HIV) and the cognitive development performance scores of their children. Additional possible risk and protective factors for poor child development are explored to identify those children born to adolescent mothers who may be at the greatest risk of poor cognitive development. METHODS Cross-sectional data utilised within the analyses was drawn from a large cohort of adolescent mothers and their children residing in South Africa. Detailed study questionnaires were completed by adolescent mothers relating to their self and their child and, standardised cognitive assessments were completed by trained researchers for all children using in the Mullen Scales of Early Learning. Chi-square, t-tests (Kruskal Wallis tests, where appropriate), and ANOVA were used to explore sample characteristics and child cognitive development scores by maternal mental health status (operationalised as likely common mental disorder) and combined maternal mental health and HIV status. Multivariable linear regression models were used to explore the relationship between possible risk factors (including poor maternal mental health and HIV) and, child cognitive development scores. RESULTS The study included 954 adolescent mothers; 24.1% (230/954) were living with HIV, 12.6% (120/954) were classified as experiencing likely common mental disorder. After adjusting for covariates, maternal HIV was found to be associated with reduced child gross motor scores (B = -2.90 [95%CI: -5.35, -0.44], p = 0.02), however, no other associations were identified between maternal likely common mental disorder, or maternal HIV status (including interaction terms), and child cognitive development scores. Sensitivity analyses exploring individual maternal mental health scales identified higher posttraumatic stress symptomology scores as being associated with lower child cognitive development scores. Sensitivity analyses exploring potential risk and protective factors for child cognitive development also identified increased maternal educational attainment as being protective of child development scores, and increased child age as a risk factor for lower development scores. CONCLUSIONS This study addresses a critical evidence gap relating to the understanding of possible risk factors for the cognitive development of children born to adolescent mothers affected by HIV. This group of mothers experience a complex combination of risk factors, including HIV, likely common mental disorder, and structural challenges such as educational interruption. Targeting interventions to support the cognitive development of children of adolescent mothers most at risk may be of benefit. Clearly a basket of interventions needs to be considered, such as the integration of mental health provision within existing services, identifying multiple syndemics of risk, and addressing educational and structural challenges, all of which may boost positive outcomes for both the mother and the child.
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Affiliation(s)
- Kathryn J. Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Colette Smith
- Institute for Global Health, University College London, London, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | | | | | - Lorraine Sherr
- Institute for Global Health, University College London, London, United Kingdom
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Bhushan NL, Musara P, Hartmann M, Stoner MCD, Shah SR, Nabukeera J, Rukundo I, Mutero P, Lewis MA, Piper J, Shapley‐Quinn MK, Etima J, Minnis AM. Making the Case for Joint Decision-Making in Future Multipurpose Prevention Technology (MPT) Choice: Qualitative Findings on MPT Attribute Preferences from the CUPID Study (MTN-045). J Int AIDS Soc 2022; 25:e26024. [PMID: 36254362 PMCID: PMC9577116 DOI: 10.1002/jia2.26024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Young women in sub‐Saharan Africa account for two‐thirds of all new HIV infections and face high rates of unintended pregnancy. Multipurpose prevention technologies (MPTs) are promising products under development that are designed to simultaneously prevent HIV and unintended pregnancy. Since MPTs will be used in the context of sexual relationships, ensuring acceptability and use requires understanding the role of male partners in MPT use decision‐making. Methods This paper draws on qualitative data from 39 couples enrolled in the Microbicide Trials Network (MTN) 045 study, conducted in 2019–2020. Partners completed a discrete choice experiment (DCE), first separately and then jointly, to measure preferences for future MPT attributes and then completed a qualitative interview. We also draw on quantitative data from interviewer observation about who dominated the decision‐making process during the joint DCE. Content analysis was used to examine (1) how couples made decisions on existing non‐MPT HIV and pregnancy prevention products; (2) how couples made decisions on future ideal‐MPT product during the DCE; and (3) how these decision‐making processes varied by decision‐making dominance (10 male, 10 female and 19 equal) and interview type (19 joint and 20 separate). Results Existing non‐MPT product decisions focused on trust between partners and product attributes, while future ideal‐MPT product decisions exclusively focused on product attributes. Across existing and future products, preferences for product attributes varied by gender. Male partners were most concerned with limiting side effects impacting sexual pleasure, female partners were most concerned with limiting side effects causing physical symptoms and both were concerned with the return to fertility. Across all dominance and interview types, couples reported making decisions together and female partners were often able to negotiate with male partners for their preferred product or set of product attributes. Conclusions Research activities in this study provided an opportunity for couples to openly present their product attribute preferences to their partner, learn about their partner's attribute preferences, negotiate for their ideal set of attributes and ultimately choose attributes that benefited the couple without disempowering the female partner. Future research should focus on the utility of couple‐based decision‐making aids or similar tools for facilitating joint MPT decision‐making.
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Affiliation(s)
| | - Petina Musara
- Clinical Trials Research CentreUniversity of ZimbabweHarareZimbabwe
| | | | | | - Shweta R. Shah
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Josephine Nabukeera
- Makerere University ‐ Johns Hopkins University Research Collaboration (MU‐JHU)KampalaUganda
| | - Ivan Rukundo
- Makerere University ‐ Johns Hopkins University Research Collaboration (MU‐JHU)KampalaUganda
| | - Prisca Mutero
- Clinical Trials Research CentreUniversity of ZimbabweHarareZimbabwe
| | - Megan A. Lewis
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Jeanna Piper
- National Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | | | - Juliane Etima
- Makerere University ‐ Johns Hopkins University Research Collaboration (MU‐JHU)KampalaUganda
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9
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Factors influencing healthcare-seeking behaviour of South African adolescents. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Kasonde ME, Bwalya BB, Nyirenda ET, Mapoma CC, Sikaluzwe M, Chimpinde K, Songolo GI. Association between sexual violence and unintended pregnancy among married women in Zambia. BMC Public Health 2022; 22:1491. [PMID: 35927643 PMCID: PMC9354302 DOI: 10.1186/s12889-022-13881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background One of the outcomes of sexual violence is unintended pregnancy. In Zambia, 15% of married women age 15—49 years had experienced sexual violence from their husband or partner. The prevalence of unintended pregnancies among women age 15—49 years has risen from 33% in 1992 to 38% in 2018. The link between sexual violence and unintended pregnancy in Zambia was investigated in this study. Methods This study used the women's dataset from the 2018 Zambia Demographic and Health Survey, a cross-sectional survey. The study looked at a weighted sample size of 4,465 women age 15 – 49 years. Unintended pregnancy was measured by combining response categories of mistimed and unwanted pregnancy. Multivariate binary logistic regression was performed to establish the net effects of sexual violence and each explanatory variable on unintended pregnancy. Results The findings suggest that sexual violence does have a role in unintended pregnancies (AOR 1.74; CI 1.38—2.19). Ever use of contraception is also a significant predictor of unintended pregnancy (AOR 1.48; CI 1.16—1.88), even when other characteristics are taken into account. Results have shown that a woman who had ever used contraception and had experienced sexual violence was more likely to have an unintended pregnancy. Conclusion Spousal sexual violence is highly associated with unintended pregnancies in Zambia. Addressing intimate partner sexual violence is among the ways to prevent unintended pregnancies. It is also important to sensitize women on reporting acts of sexual violence to relevant authorities as this will not only prevent reoccurrence of sexual violence but also reduce unintended pregnancies and associated long-term effects.
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Affiliation(s)
- Mwewa E Kasonde
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
| | - Bwalya Bupe Bwalya
- Directorate of Research and Postgraduate Studies, Mulungushi University, Kabwe, Zambia
| | - Elizabeth T Nyirenda
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Chabila Christopher Mapoma
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Milika Sikaluzwe
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Kafiswe Chimpinde
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Gloria I Songolo
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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11
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Cluver L, Rudgard WE, Toska E, Orkin M, Ibrahim M, Langwenya N, Kuo C, Xaba N, Roehm K, Smith M, Bernardini S, Giordana G, Mumma M, Kingori J, Yates R, Sherr L. Food security reduces multiple HIV infection risks for high-vulnerability adolescent mothers and non-mothers in South Africa: a cross-sectional study. J Int AIDS Soc 2022; 25:e25928. [PMID: 36008916 PMCID: PMC9411725 DOI: 10.1002/jia2.25928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Adolescent girls and young women, including adolescent mothers, in Southern Africa have high HIV seroconversion and transmission. We need to know which risks drive HIV infections, and what can reduce these risks. METHODS We interviewed 1712 adolescent girls and young women (11-23 years), including 1024 adolescent mothers who had conceived before age 20 and had a living child, from two health municipalities of South Africa's Eastern Cape Province between March 2018 and July 2019. Recruitment was through multiple community, school and health facility channels. Associations between adolescent motherhood and seven HIV risk behaviours (multiple sexual partners, transactional sex, age-disparate sex, condomless sex, sex on substances, alcohol use and not in education or employment) were investigated using the generalized estimating equations method for multiple outcomes specified with a logit link and adjusting for nine covariates. Using the same model, we investigated associations between having enough food at home every day in the past week (food security) and the same seven HIV risk behaviours. When we found evidence of moderation by HIV status, we report stratum-specific odds ratios. RESULTS Mean age was 17.51 years (SD: 2.54), 46% participants were living with HIV. Compared to non-mothers, adolescent mothers had lower odds of alcohol use (AOR = 0.47, 95% CI = 0.29-0.75), but higher odds of multiple sexual partners (AOR = 1.93, 95% CI = 1.35-2.74), age-disparate sex (HIV-uninfected AOR = 1.73, 95% CI = 1.03-2.91; living with HIV AOR = 5.10, 95% CI = 2.98-8.73), condomless sex (AOR = 8.20, 95% CI = 6.03-11.13), sex on substances (AOR = 1.88, 95% CI = 1.10-3.21) and not in education/employment (HIV-uninfected AOR = 1.83, 95% CI = 1.19-2.83; living with HIV AOR = 6.30, 95% CI = 4.09-9.69). Among non-mothers, food security was associated with lower odds of multiple sexual partners (AOR = 0.45, 95% CI = 0.26-0.78), transactional sex (AOR = 0.32, 95% CI = 0.13-0.82) and not in education/employment (AOR = 0.48, 95% CI = 0.29-0.77). Among adolescent mothers, food security was associated with lower odds of transactional sex (AOR = 0.17, 95% CI = 0.10-0.28), age-disparate sex (AOR = 0.66, 95% CI = 0.47-0.92), sex on substances (AOR = 0.51, 95% CI = 0.32-0.82), alcohol use (AOR = 0.45, 95% CI = 0.25-0.79) and not in education/employment (AOR = 0.56, 95% CI = 0.40-0.78). CONCLUSIONS Adolescent motherhood is associated with multiple vulnerabilities to HIV infection and transmission. Social protection measures that increase food security are likely to reduce HIV risk pathways for adolescent girls and young women, especially adolescent mothers.
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Affiliation(s)
- Lucie Cluver
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - William E. Rudgard
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Elona Toska
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
| | - Mark Orkin
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
- Medical Research Council Development Pathways to Health Research Unit, School of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Mona Ibrahim
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | | | - Caroline Kuo
- Department of Behavioral and Social Sciences, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Nonhlanhla Xaba
- UN World Food Programme, Regional Bureau for Southern AfricaJohannesburgSouth Africa
| | - Kai Roehm
- UN World Food Programme, Regional Bureau for Southern AfricaJohannesburgSouth Africa
| | | | | | - Giovanni Giordana
- UN World Food ProgrammeRegional Bureau for Eastern AfricaNairobiKenya
| | - Manaan Mumma
- UN World Food ProgrammeRegional Bureau for Eastern AfricaNairobiKenya
| | - James Kingori
- UN World Food Programme, Regional Bureau for Southern AfricaJohannesburgSouth Africa
| | - Rachel Yates
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Lorraine Sherr
- Health Psychology Unit, Institute of Global HealthUniversity College LondonLondonUK
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12
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Bhushan NL, Stoner MCD, Groves AK, Kahn K, Pettifor AE. Partnership Dynamics and HIV-Related Sexual Behaviors Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data. J Adolesc Health 2022; 71:63-69. [PMID: 35370076 PMCID: PMC9232891 DOI: 10.1016/j.jadohealth.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE In South Africa, adolescent mothers have a three times higher risk of HIV acquisition than nonadolescent mothers. Yet, limited evidence exists regarding how early childbearing may affect HIV risk. A better understanding of adolescent mothers' partnership dynamics and sexual behaviors is critical to tailoring interventions to prevent new infections. METHODS Data are from HIV Prevention Trials Network 068, a longitudinal study of adolescent girls and young women (AGYW) aged 13-20 in South Africa who were followed annually for up to 6 years. Log-binomial regression models were used to assess whether adolescent motherhood was associated with partnership dynamics (intimate partner violence, gender inequitable norms, low relationship power, no HIV prevention communication) and if the association between partnership dynamics and sexual behaviors (unprotected sex and transactional sex) varied by adolescent motherhood. Generalized estimating equations, with an exchangeable correlation structure, were used to account for nonindependence. RESULTS Adolescent mothers were more likely than nonadolescent mothers to be in partnerships characterized by intimate partner violence, low relationship power, gender inequitable norms, and no HIV prevention communication. A higher proportion were also more likely to experience these dynamics, as well as engage in transactional sex, after giving birth. Poor partnership dynamics put AGYW at a higher risk for unprotected sex and transactional sex, regardless of adolescent motherhood status. DISCUSSION Engaging adolescent mothers in interventions post birth and developing interventions that address power imbalances in AGYW's sexual partnerships have the potential to reduce engagement in HIV-related sexual behaviors and HIV risk in the long term.
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Affiliation(s)
- Nivedita L Bhushan
- Center for Communication Science, RTI International, Research Triangle Park, North Carolina.
| | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, San Francisco, California
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Audrey E Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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13
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Closson K, Ndungu J, Beksinska M, Ogilvie G, Dietrich JJ, Gadermann A, Gibbs A, Nduna M, Smit J, Gray G, Kaida A. Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:920-937. [PMID: 33353490 DOI: 10.1177/1524838020979676] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004-2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Ndungu
- School of Behavioural & Lifestyle Sciences, 56723Nelson Mandela University, Port Elizabeth, South Africa
- Office of Engagement and Transformation, 56723Nelson Mandela University, Port Elizabeth, South Africa
| | - Mags Beksinska
- MatCH Research Unit (MRU), 37708Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Gina Ogilvie
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute (WHRI), BC Women's Health Centre, Vancouver, British Columbia, Canada
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa
| | - Anne Gadermann
- School of Population and Public Health, 8166The University of British Columbia, Vancouver, British Columbia, Canada
- The Human Learning Project, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Gibbs
- 59097South African Medical Research Council, Cape Town, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mzikazi Nduna
- Department of Psychology, 37707University of the Witwatersrand, Johannesburg, South Africa
| | - Jenni Smit
- MatCH Research Unit (MRU), 37708Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
- 59097South African Medical Research Council, Cape Town, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada
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Yator O, Khasakhala L, Stewart GJ, Kumar M. Acceptability and impact of group interpersonal therapy (IPT-G) on Kenyan adolescent mothers living with human immunodeficiency virus (HIV): a qualitative analysis. BMC Womens Health 2022; 22:240. [PMID: 35717156 PMCID: PMC9206094 DOI: 10.1186/s12905-022-01807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Task shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV). Method The study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6–12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services. Results The CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities. Conclusion Our study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01807-w.
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Affiliation(s)
- Obadia Yator
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P. O. Box 799-00517, Nairobi, Kenya.
| | - Lincoln Khasakhala
- Department of Psychiatry, University of Nairobi, P. O. Box 30197-00100, Nairobi, Kenya
| | - Grace-John Stewart
- University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 47074-00100, Nairobi, Kenya.,Department of Psychology, University College London, London, UK
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15
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Groves AK, Gebrekristos LT, Smith PD, Stoebenau K, Stoner MC, Ameyan W, Ezeh AC. Adolescent Mothers in Eastern and Southern Africa: An Overlooked and Uniquely Vulnerable Subpopulation in the Fight Against HIV. J Adolesc Health 2022; 70:895-901. [PMID: 35172930 PMCID: PMC9113251 DOI: 10.1016/j.jadohealth.2021.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE Adolescent girls (10-19 years) in Eastern and Southern Africa face a high risk of pregnancy and HIV infection. However, few studies have examined whether the profound developmental, social, and economic changes that accompany adolescent motherhood contribute to HIV risk. This study examines the intersection between adolescent motherhood and HIV infection across 10 Eastern and Southern African countries, where over half of all HIV infections occur among adolescent girls. METHODS To evaluate whether adolescent motherhood is associated with HIV infection, we used Demographic and Health Survey data on girls (15-19 years) with HIV test results (N = 19,932) from Eswatini, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. We examined unweighted bivariate and multivariable associations between adolescent motherhood and HIV using mixed effects logistic regression models that included a country-level random intercept. We examined heterogeneity in the association by testing country-level random slopes using a likelihood ratio test and used intraclass correlation to measure the proportion of total variance explained at the country level. RESULTS Nearly one fifth of adolescent girls were mothers (range: 9.80%-38.90%), and the HIV prevalence among all adolescent girls was 3.3% (range: 1.03%-10.07%). Relative to nonmothers, adolescent mothers were, on average, older, poorer, and more likely to be married, rural dwellers, and household heads. Adolescent motherhood was positively associated with HIV infection in bivariate and multivariable analyses (odds ratio: 1.87; 95% confidence interval: 1.57-2.23; adjusted odds ratio: 1.53; 95% CI: 1.24-1.89). DISCUSSION Among adolescents with HIV test results, we observed a robust association between adolescent motherhood and HIV infection across 10 high-burden countries.
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Affiliation(s)
- Allison K. Groves
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania,Address correspondence to: Allison K. Groves, Ph.D., M.H.S., 3215 Market Street, Philadelphia, 19104, USA.
| | | | - Patrick D. Smith
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland
| | - Marie C. Stoner
- Women's Global Health Imperative, RTI International, Berkeley, California
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Alex C. Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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van Staden Q, Laurenzi CA, Toska E. Two years after lockdown: reviewing the effects of COVID-19 on health services and support for adolescents living with HIV in South Africa. J Int AIDS Soc 2022; 25:e25904. [PMID: 35475319 PMCID: PMC9042673 DOI: 10.1002/jia2.25904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION South Africa's progress towards the 95-95-95 goals has been significantly slower among adolescents living with HIV (ALHIV), among whom antiretroviral therapy (ART) adherence, retention in care and viral suppression remain a concern. After 2 years of living with COVID-19, it is important to examine the direct and indirect effects of the pandemic on healthcare resources, access to HIV services and availability of support structures, to assess their impact on HIV care for ALHIV. DISCUSSION The COVID-19 response in South Africa has shifted healthcare resources towards combatting COVID-19, affecting the quality and availability of HIV services-especially for vulnerable populations, such as ALHIV. The healthcare system's response to COVID-19 has threatened to diminish fragile gains in engaging ALHIV with HIV services, especially as this group relies on overburdened public health facilities for their HIV care. Reallocation of limited health resources utilized by ALHIV disrupted healthcare workers' capacity to form and maintain therapeutic relationships with ALHIV and monitor ALHIV for ART-related side effects, treatment difficulties and mental health conditions, affecting their ability to retain ALHIV in HIV care. Prevailing declines in HIV surveillance meant missed opportunities to identify and manage opportunistic infections and HIV disease progression in adolescents. "Lockdown" restrictions have limited access to healthcare facilities and healthcare workers for ALHIV by reducing clinic appointments and limiting individual movement. ALHIV have had restricted access to social, psychological and educational support structures, including national feeding schemes. This limited access, coupled with reduced opportunities for routine maternal and sexual and reproductive health services, may place adolescent girls at greater risk of transactional sex, child marriages, unintended pregnancy and mother-to-child HIV transmission. CONCLUSIONS Adolescent HIV care in South Africa is often overlooked; however, ART adherence among ALHIV in South Africa is particularly susceptible to the consequences of a world transformed by COVID-19. The current structures in place to support HIV testing, ART initiation and adherence have been reshaped by disruptions to health structures, new barriers to access health services and the limited available education and psychosocial support systems. Reflecting on these limitations can drive considerations for minimizing these barriers and retaining ALHIV in HIV care.
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Affiliation(s)
- Quintin van Staden
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
- Universitas HospitalBloemfonteinSouth Africa
| | - Christina A. Laurenzi
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Elona Toska
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
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Huda MM, O'Flaherty M, Finlay JE, Edmed S, Mamun AA. Partner's characteristics and adolescent motherhood among married adolescent girls in 48 low-income and middle-income countries: a population-based study. BMJ Open 2022; 12:e055021. [PMID: 35264355 PMCID: PMC8915377 DOI: 10.1136/bmjopen-2021-055021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The objective of this study was to examine the prevalence of adolescent motherhood among married adolescent girls and its associations with their partners' characteristics in low-income and middle-income countries (LMICs). DESIGN Population-based study. PARTICIPANTS 54 285 ever married (or lived with a partner) adolescent girls (15-19 years old) were including in prevalence analysis. However, partner characteristics were assessed in a subsample of 24 433 adolescent girls who were married (or living with a partner) at the time of interview. SETTINGS Data from the latest available Demographic and Health Survey round during 2010-2018 in 48 LMICs across different geographic regions. RESULTS The overall prevalence of adolescent motherhood was 73.98% (95% CI 70.96 to 78.10) among married adolescent girls in this study. In the pooled analysis, statistically significant and positive associations were observed between adolescent motherhood and partners' desire for more children (adjusted marginal effect (AME): 2.34, 95% CI 1.21 to 3.47) and spousal age gap (AME: 1.67, 95% CI 0.30 to 3.04 for three plus age gap). However, no statistically significant association was observed between adolescent motherhood and partners' education (AME: -0.36, 95% CI -1.77 to 1.05 for primary education) and partners' agricultural occupation (AME: 1.07, 95% CI -0.17 to 2.32). Overall, there was significant variation in the associations across countries; however, the positive associations persisted between adolescent motherhood and partners' desire for more children and spousal age gap in most of the studied countries. CONCLUSIONS Our findings may inform policymakers about the importance of incorporating partners of married adolescent girls into the existing birth control programmes to delay age at first birth among married adolescents in LMICs. More attention should be given to the married adolescent girls who have older partners, and efforts to discourage marriages with much older partners may have a secondary benefit of reducing adolescent motherhood in LMICs.
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Affiliation(s)
- M Mamun Huda
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- The ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Martin O'Flaherty
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Jocelyn Edwina Finlay
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Shannon Edmed
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
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Groves AK, Bhushan NL, Stoner MCD, Gómez-Olivé FX, Kahn K, Pettifor AE. HIV and Herpes Simplex Virus Type 2 Incidence Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data. J Acquir Immune Defic Syndr 2022; 89:e23-e29. [PMID: 34855627 PMCID: PMC8837695 DOI: 10.1097/qai.0000000000002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent motherhood is common in South Africa and occurs against a backdrop of high HIV risk. While childbearing during adolescence may result in social and economic strain that may negatively impact health, there has been limited study of whether adolescent motherhood increases the risk of HIV or herpes simplex virus type 2 (HSV-2) acquisition or engagement in high-risk sexual partnerships. SETTING Data are from HIV Prevention Trials Network 068, a longitudinal conditional cash transfer study of adolescent girls and young women (age, 13-23) in rural South Africa. METHODS We used survival analysis to estimate hazard ratios to determine if adolescent motherhood (live birth before 20 years) predicted incident HIV and incident HSV-2 and generalized estimating equations for behavioral risk ratios to determine if adolescent motherhood was associated with transactional sex and age-disparate partnerships. RESULTS Of 2452 adolescent girls and young women who were HIV negative at baseline, 5% were adolescent mothers; 16% were adolescent mothers by the end of the study period. After controlling for covariates, adolescent motherhood predicted incident HSV-2 acquisition [ adjusted hazard ratios, 1.30; 95% confidence interval (CI): 1.01 to 1.95] but not HIV acquisition ( adjusted hazard ratios, 1.19; 95% CI, 0.76 to 1.86). Adolescent motherhood was also associated with being in an age-disparate partnership (adjusted risk ratio, 1.30; 95% CI: 1.07 to 1.58) but not transactional sex. CONCLUSION Adolescent motherhood increased the risk of HSV-2 and engagement in age-disparate partnerships, both known risk factors for HIV infection. Sexually transmitted infection screening and/or tailored combination HIV prevention interventions that account for the context of adolescent motherhood are critical to maximize adolescent mothers' long-term health and to meet UNAIDS 95-95-95 targets by 2030.
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Affiliation(s)
- Allison K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA
| | | | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Francesc X Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
- INDEPTH Network, Accra, Ghana
| | - Audrey E Pettifor
- University of North Carolina at Chapel Hill, Chapel Hill, NC
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
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19
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Heck CJ, Mathur S, Alwang’a H, Daniel OM, Obanda R, Owiti M, Okal J. Oral PrEP Consultations Among Adolescent Girls and Young Women in Kisumu County, Kenya: Insights from the DREAMS Program. AIDS Behav 2022; 26:2516-2530. [PMID: 35099640 PMCID: PMC9252953 DOI: 10.1007/s10461-022-03590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/29/2022]
Abstract
Although Kenya nationally scaled up oral pre-exposure prophylaxis (PrEP) in May 2017, adolescent girls' (AG, aged 15-19 years) and young women's (YW, aged 20-24 years) PrEP use remains suboptimal. Thus, we analyzed PrEP consultations-interactions with a healthcare provider about PrEP-among Kenyan AGYW. In April-June 2018, AGYW enrolled in DREAMS in Kisumu County, Kenya self-reported their HIV-related knowledge, behaviors, and service use. Among HIV negative, sexually active AG (n = 154) and YW (n = 289), we examined associations between PrEP eligibility and PrEP consultations using prevalence ratios (PR, adjusted: aPR). Most AG (90.26%) and YW (94.12%) were PrEP-eligible due to inconsistent/no condom use, violence survivorship, or recent sexually transmitted infection symptoms. Between PrEP-eligible AG and YW, more YW were ever-orphaned (58.09%), ever-married (54.41%), ever-pregnant (80.88%), and out of school (78.31%); more PrEP-eligible YW reported PrEP consultations (41.18% vs. 24.46%, aPR = 1.51 [1.01-2.27]). AG who used PEP (post-exposure prophylaxis) reported more consultations (aPR = 5.63 [3.53-8.97]). Among YW, transactional sex engagers reported more consultations (58.62% vs. 39.09%, PR = 1.50 [1.06-2.12]), but only PEP use (aPR = 2.81 [2.30-3.43]) and multiple partnerships (aPR = 1.39 [1.06-1.82]) were independently associated with consultations. Consultations were lowest among those with 1 eligibility criterion (AG = 11.11%/YW = 27.18%). Comparatively, consultations were higher among AG and YW with 2 (aPR = 3.71 [1.64-8.39], PR = 1.60 [1.07-2.38], respectively) or ≥ 3 (aPR = 2.51 [1.09-5.78], PR = 2.05 [1.42-2.97], respectively) eligibility criteria. Though most AGYW were PrEP-eligible, PrEP consultations were rare and differed by age and vulnerability. In high-incidence settings, PrEP consultations should be conducted with all AGYW. PrEP provision guidelines must be re-assessed to accelerate AGYW's PrEP access.
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Affiliation(s)
- Craig J. Heck
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
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20
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Ogunwale OI, Rangiah S. Profile and obstetric outcome of teenage pregnancies compared with pregnant adults at a district hospital in KwaZulu-Natal. S Afr Fam Pract (2004) 2021; 63:5290. [PMID: 34677079 PMCID: PMC8517738 DOI: 10.4102/safp.v63i1.5290] [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] [Received: 02/19/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022] Open
Abstract
Background Teenage pregnancy remains a major public health concern and a challenge for developing countries. Young maternal age can lead to serious physical, social and psychological consequences as teenage mothers are less likely to gain full educational potential and are at higher risk of poverty and complications of pregnancy. The objective of the study was to describe the profile and obstetric outcome of teenage pregnancy compared with that of pregnant adults at a district hospital in KwaZulu-Natal. Methods A retrospective descriptive study utilising data obtained from randomly selected hospital records of 216 teenage mothers compared the socio-demographic profile, foetal and maternal outcomes to that of pregnant adults. Results The mean age of the teenage group was 17.6 and 26.0 years for the adults (control group). Both groups had a remarkable booking status (97.2% vs. 100%) and antenatal attendance (62.5% vs. 66.2% with ≥ 5 visits). No significant difference in anaemia, caesarean delivery and obstetric complications were found in both groups. There was, however, a significant risk of hypertensive disorder of pregnancy (39.8% vs. 26.4%, p = 0.030) and higher risk of episiotomy being carried out during delivery (31.5% vs. 13.0%). On the other hand, the control group had a significant higher risk of HIV infection (12.5% vs. 38.4% p = 0.000). Conclusion The study showed that teenage pregnancy has a similar obstetric risk to adult pregnant patients except for hypertension disorder of pregnancy. Although this study demonstrated improved antenatal attendance by pregnant teenagers, the psychosocial impact on young mothers requires further research.
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Affiliation(s)
- Olaolu I Ogunwale
- Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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21
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Roberts KJ, Smith C, Cluver L, Toska E, Sherr L. Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap. AIDS Behav 2021; 25:2094-2107. [PMID: 33452658 PMCID: PMC7810185 DOI: 10.1007/s10461-020-03138-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/28/2022]
Abstract
Adolescent (10-19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic search of electronic databases using pre-defined search terms, supplemented by hand-searching, was undertaken in September 2020. One author and an independent researcher completed a title and abstract screening of results from the search. A full-text search of all seemingly relevant manuscripts (both quantitative and qualitative) was undertaken and data extracted using pre-determined criteria. A narrative synthesis of included studies is provided. Quality and risk of bias within included studies was assessed using the Newcastle-Ottawa scale. A systematic keyword search of databases and follow-up hand searching identified 2287 unique records. Of these, thirty-eight full-text quantitative records and seven full-text qualitative records were assessed for eligibility. No qualitative records met the eligibility criteria for inclusion within the review. One quantitative record was identified for inclusion. This study reported on depressive symptomology amongst 14 pregnant adolescents living with HIV in Kenya, identifying a prevalence of 92.9%. This included study did not meet the high methodological quality of this review. No studies were identified reporting on risk and protective factors for common mental disorder, and no studies were found identifying any specific interventions for common mental disorder for this group, either for prevention or for treatment. The limited data identified within this review provides no good quality evidence relating to the prevalence of common mental disorder among adolescents living with HIV who have experienced pregnancy in sub-Saharan Africa. No data was available relating to risk and protective factors or interventions for psychological distress amongst this group. This systematic review identifies a need for rigorous evidence regarding the mental health of pregnant and parenting adolescents living with HIV, and calls for granular interrogation of existing data to further our understanding of the needs of this group. The absence of research on this topic (both quantitative and qualitative) is a critical evidence gap, limiting evidence-based policy and programming responses, as well as regional development opportunities.
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Affiliation(s)
| | - Colette Smith
- Institute for Global Health, University College London, London, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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22
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Woldesenbet S, Kufa-Chakezha T, Lombard C, Manda S, Cheyip M, Ayalew K, Chirombo B, Barron P, Diallo K, Parekh B, Puren A. Recent HIV infection among pregnant women in the 2017 antenatal sentinel cross-sectional survey, South Africa: Assay-based incidence measurement. PLoS One 2021; 16:e0249953. [PMID: 33852629 PMCID: PMC8046194 DOI: 10.1371/journal.pone.0249953] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction New HIV infection during pre-conception and pregnancy is a significant contributor of mother–to–child transmission of HIV in South Africa. This study estimated HIV incidence (defined as new infection within the last one year from the time of the survey which included both new infections occurred during pregnancy or just before pregnancy) among pregnant women and described the characteristics of recently infected pregnant women at national level. Methods Between 1 October and 15 November 2017, we conducted a national cross–sectional survey among pregnant women aged 15–49 years old attending antenatal care at 1,595 public facilities. Blood specimens were collected from pregnant women and tested for HIV in a centralised laboratory. Plasma viral load and Limiting Antigen Avidity Enzyme Immunosorbent Assay (LAg) tests were further performed on HIV positive specimens to differentiate between recent and long–term infections. Recent infection was defined as infection that occurred within one year from the date of collection of blood specimen for the survey. Data on age, age of partner, and marital status were collected through interviews. Women whose specimens were classified as recent by LAg assay and with viral loads >1,000 copies/mL were considered as recently infected. The calculated proportion of HIV positive women with recent infection was adjusted for assay–specific parameters to estimate annual incidence. Survey multinomial logistic regression was used to examine factors associated with being recently infected using HIV negative women as a reference group. Age–disparate relationship was defined as having a partner 5 or more years older. Results Of 10,049 HIV positive participants with LAg and viral load data, 1.4% (136) were identified as recently infected. The annual HIV incidence was 1.5% (95% confidence interval (CI): 1.2–1.7). In multivariable analyses, being single (adjusted odds ratio, aOR: 3.4, 95% CI: 1.8–6.2) or cohabiting (aOR: 3.8, 95% CI: 1.8–7.7), compared to being married as well as being in an age–disparate relationship among young women (aOR: 3.1, 95% CI: 2.0–4.7; reference group: young women (15–24years) whose partners were not 5 years or more older) were associated with higher odds of recent infection. Conclusions Compared to previous studies among pregnant women, the incidence estimated in this study was substantially lower. However, the UNAIDS target to reduce incidence by 75% by 2020 (which is equivalent to reducing incidence to <1%) has not been met. The implementation of HIV prevention and treatment interventions should be intensified, targeting young women engaged in age–disparate relationship and unmarried women to fast track progress towards the UNAIDS target.
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Affiliation(s)
- Selamawit Woldesenbet
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Tendesayi Kufa-Chakezha
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Samuel Manda
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Mireille Cheyip
- Strategic Information Unit, Center for Disease Control and Prevention, Pretoria, South Africa
| | - Kassahun Ayalew
- Strategic Information Unit, Center for Disease Control and Prevention, Pretoria, South Africa
| | - Brian Chirombo
- HIV and Hepatitis Program, World Health Organization, Pretoria, South Africa
| | - Peter Barron
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Karidia Diallo
- Laboratory Branch, Centers for Disease Control and Prevention South Africa, Pretoria, South Africa
| | - Bharat Parekh
- Division of Global HIV/AIDS, International Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adrian Puren
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- Division of Virology, School of Pathology University of the Witwatersrand, Johannesburg, South Africa
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Medina‐Marino A, Daniels J, Bezuidenhout D, Peters R, Farirai T, Slabbert J, Guloba G, Johnson S, Bekker L, Nkhwashu N. Outcomes from a multimodal, at-scale community-based HIV counselling and testing programme in twelve high HIV burden districts in South Africa. J Int AIDS Soc 2021; 24:e25678. [PMID: 33709542 PMCID: PMC7952633 DOI: 10.1002/jia2.25678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/23/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Facility-based HIV testing services (HTS) have been less acceptable and accessible by adolescents, men and key populations in South Africa. Community-based HIV counselling and testing (CBCT) modalities, including mobile unit and home-based testing, have been proposed to decrease barriers to HIV testing uptake. CBCT modalities and approaches may be differentially acceptable to men and women based on age. Implementation of multimodal CBCT services may improve HIV testing rates among adolescents and men, and support the roll-out of prevention services. METHODS A cross-sectional analysis was conducted using aggregate, routine programmatic data collected from 1 October 2015 through 31 March 2017 from a multimodal, at-scale CBCT programme implemented in 12 high-burden districts throughout South Africa. Data collection tools were aligned to reporting standards for the National Department of Health and donor requirements. HIV testing rates (i.e. number of tests performed per 100,000 population using South African census data) and testing proportions by modality were stratified by sex, age groups and heath districts. Descriptive statistics were performed using STATA 13.0. RESULTS Overall, 944,487 tests were performed during the 1.5-year testing period reported. More tests were conducted among females than males (53.6% vs. 46.4%). Overall, 8206 tests per 100,000 population (95% CI: 8190.2 to 8221.9) were performed; female-to-male (F:M) testing ratio was 1.11. Testing rates were highest among young women age 20 to 24 years (16,328.4; 95% CI: 16,237.9 to 16,419.1) and adolescent girls aged 15 to 19 years (12,817.0; 95% CI: 12,727.9 to 12,906.6). Home-based testing accounted for 61.3% of HIV tests, followed by near-home mobile unit testing (30.2%) and workplace mobile unit testing (4.7%). More women received HTS via home-based testing (F:M ratio = 1.29), whereas more men accessed work-place mobile testing (M:F ratio = 1.35). No sex differential was observed among those accessing near-home mobile testing (F:M ratio = 0.98). CONCLUSIONS Concurrent implementation of multiple, targeted CBCT modalities can reduce sex disparities in HIV testing in South Africa. Given the acceptability and accessibility of these CBCT services to adolescent girls and young women, evident from their high testing rates, leveraging community-based services delivery platforms to increase access to HIV prevention services, including pre-exposure prophylaxis (PrEP), should be considered.
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Affiliation(s)
- Andrew Medina‐Marino
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
| | - Joseph Daniels
- Department of Psychiatry and Human BehaviorsCharles R. Drew University of Medicine and ScienceLos AngelesCAUSA
| | - Dana Bezuidenhout
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
| | - Remco Peters
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
| | - Thato Farirai
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Jean Slabbert
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Geoffrey Guloba
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Suzanne Johnson
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Linda‐Gail Bekker
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
| | - Nkhensani Nkhwashu
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
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Oppong FB, Logo DD, Agbedra SY, Adomah AA, Amenyaglo S, Arhin-Wiredu K, Afari-Asiedu S, Ae-Ngibise KA. Determinants of contraceptive use among sexually active unmarried adolescent girls and young women aged 15-24 years in Ghana: a nationally representative cross-sectional study. BMJ Open 2021; 11:e043890. [PMID: 33550261 PMCID: PMC7925931 DOI: 10.1136/bmjopen-2020-043890] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE There is a decline in contraceptive use among sexually active unmarried young women in Ghana. This study assessed the prevalence of contraceptive knowledge and use, and the determinant of contraceptive use among sexually active unmarried young women in Ghana. DESIGN This was a nationally representative cross-sectional survey, using data from the 2017 Ghana Maternal Health Survey. Weighted logistic regression was used to assess the association between background and obstetric characteristics of young women and contraceptive use. SETTING Ghana. PARTICIPANTS A total of 809 sexually active unmarried adolescent girls (15-19 years) and young women (20-24 years). PRIMARY AND SECONDARY OUTCOME MEASURES Knowledge and use of both modern and traditional contraceptive methods. RESULTS Knowledge of at least one modern and traditional contractive method was 99.8% and 95.0%, respectively. The prevalence of contraceptive use was 43%-with 34% modern and 9% traditional methods. From the unadjusted analyses, age (p=0.002), past pregnancy (p<0.001), abortion in the past 5 years (p=0.007) and history of childbirth (p=0.025) were independently associated with contraceptive use, whereas education (p=0.072), place of residence (p=0.702), household wealth (p=0.836) and age at first sex (p=0.924) were not independently associated with contraceptive use. In the adjusted analysis, contraceptive use was significantly higher among respondents with secondary education compared with those with primary education (OR 2.43, 95% CI 1.31 to 4.49, p=0.017), and was higher among respondents with a history of pregnancy (OR 2.13, 95% CI 1.48 to 3.06, p<0.001). CONCLUSION There is a significant gap between knowledge and use of contraceptives among the study population. While intensifying knowledge of adolescents and young women on contraceptives, adolescent-friendly corners should be established at vantage points to increase utilisation and to prevent societal stigma on young women who access contraceptives services.
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Affiliation(s)
| | | | - Senyo Yao Agbedra
- Sunyani Municipal Health Directorate, Ghana Health Service, Sunyani, Ghana
| | | | - Seidu Amenyaglo
- Department of Global and International Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Mabunda SA, Sigovana K, Chitha W, Apalata T, Nomatshila S. Socio-demographic associations of HIV among women attending antenatal care in selected rural primary care facilities in South Africa's Eastern Cape province. BMC Infect Dis 2021; 21:61. [PMID: 33435863 PMCID: PMC7805084 DOI: 10.1186/s12879-020-05744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa. Methods A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance. Results A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2–43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42–141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value< 0.0001). Conclusion Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.
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Affiliation(s)
- Sikhumbuzo A Mabunda
- The George Institute for Global Health and Research, University of New South Wales, Level 5 - 1 King Street, Sydney, Newtown NSW, 2042, Australia. .,Department of Public Health, Walter Sisulu University, Mthatha, South Africa.
| | - Khuthala Sigovana
- Department of Public Health, Walter Sisulu University, Mthatha, South Africa
| | - Wezile Chitha
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Teke Apalata
- Department of Laboratory Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Sibusiso Nomatshila
- Department of Public Health, Walter Sisulu University, Mthatha, South Africa
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Bosire EN, Chiseri K, Comeau DL, Richter L, Stein AD, Norris SA. A qualitative study of risks and protective factors against pregnancy among sexually-active adolescents in Soweto, South Africa. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000044. [PMID: 36962127 PMCID: PMC10021750 DOI: 10.1371/journal.pgph.0000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
Risky sexual behaviors contribute to increased risk of adolescent pregnancy. This qualitative study sought to understand risks and protective factors against pregnancy amongst sexually-active adolescents in Soweto, South Africa. We used purposive sampling to recruit women at age 24 years from Soweto, who self-reported having sexual debut by age 15 years. Twenty women were recruited: (i) women who did not become pregnant before 18 years (n = 10) and (ii) women who became pregnant before 18 years (n = 10). In-depth interviews were conducted to understand their family backgrounds, conversations about sex, sexual behaviors, and initiatives taken (or not) during adolescence to prevent pregnancy. Both groups of women reported predisposing risks to early pregnancy including influence from peers to engage in early sex, unstable family relationships and limited conversations about sex. We found that the family is a key institution in supporting adolescents' decisions regarding their behaviors and choices, as are peers and exposures to information. Community Youth Centers, high schools and Youth Friendly Health Services should ensure that adolescents have access to relevant information, including sex education and contraceptives.
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Affiliation(s)
- Edna N Bosire
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Center for Innovation in Global Health, Georgetown University, Washington, DC, United States of America
| | - Katharine Chiseri
- Department of Behavioral, Social, Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Dawn L Comeau
- Department of Behavioral, Social, Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh D Stein
- Department of Paediatrics, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Shane A Norris
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Onono MA, Rutherford GW, Bukusi EA, White JS, Goosby E, Brindis CD. Political prioritization and the competing definitions of adolescent pregnancy in Kenya: An application of the Public Arenas Model. PLoS One 2020; 15:e0238136. [PMID: 32925926 PMCID: PMC7489501 DOI: 10.1371/journal.pone.0238136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/09/2020] [Indexed: 11/19/2022] Open
Abstract
Background Approximately one in every five adolescent girls in Kenya has either had a live birth or is pregnant with her first child. There is an urgent need to understand the language and symbols used to represent adolescent pregnancy, if the current trend in adolescent pregnancy is to be reversed. Agreement on the definition of a societal problem is an important precursor to a social issue’s political prioritization and priority setting. Methods We apply the Public Arenas Model to appraise the environments, definitions, competition dynamics, principles of selection and current actors involved in problem-solving and prioritizing adolescent pregnancy as a policy issue. Using a focused ethnographic approach, we undertook semi-structured interviews with 14 members of adolescent sexual reproductive health networks at the national level and conducted thematic analysis of the interviews. Findings We found that existing definitions center around adolescent pregnancy as a “disease” that needs prevention and treatment, socially deviant behaviour that requires individual agency, and a national social concern that drains public resources and therefore needs to be regulated. These competing definitions contribute to the rarity of the topic achieving traction within the political agenda and contribute to conflicting solutions, such as lowering the legal age of consenting to sex, while limiting access to contraceptive information and services to minors. Conclusion This paper provides a timely theoretical approach to draw attention to the different competing definitions and subsequent divergent interpretations of the problem of adolescent pregnancy in Kenya. Adolescent reproductive health stakeholders need to be familiar with the existing definitions and deliberately reframe this important social problem for better political prioritization and resource allocation. We recommend a definition of adolescent pregnancy that cuts across different arenas, and leverages already existing dominant and concurrent social and economic issues that are already on the agenda table.
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Affiliation(s)
- Maricianah A. Onono
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- * E-mail:
| | - George W. Rutherford
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Justin S. White
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Eric Goosby
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Claire D. Brindis
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- Adolescent and Young Adult Health National Resource Centre, San Francisco, California, United States of America
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Ajayi AI, Ezegbe HC. Association between sexual violence and unintended pregnancy among adolescent girls and young women in South Africa. BMC Public Health 2020; 20:1370. [PMID: 32894130 PMCID: PMC7487533 DOI: 10.1186/s12889-020-09488-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unintended pregnancy has dire consequences on the health and socioeconomic wellbeing of adolescent girls and young women (AGYW) (aged 15-24 years). While most studies tend to focus on lack of access to contraceptive information and services, and poverty as the main contributing factor to early-unintended pregnancies, the influence of sexual violence has received limited attention. Understanding the link between sexual violence and unintended pregnancy is critical towards developing a multifaceted intervention to reduce unintended pregnancies among AGYW in South Africa, a country with high teenage pregnancy rate. Thus, we estimated the magnitude of unintended pregnancy among AGYW and also examined the effect of sexual violence on unintended pregnancy. METHODS Our study adopted a cross-sectional design, and data were obtained from AGYW in a South African university between June and November 2018. A final sample of 451 girls aged 17-24 years, selected using stratified sampling, were included in the analysis. We used adjusted and unadjusted logistic regression analysis to examine the effect of sexual violence on unintended pregnancy. RESULTS The analysis shows that 41.9% of all respondents had experienced an unintended pregnancy, and 26.3% of those unintended pregnancies ended in abortions. Unintended pregnancy was higher among survivors of sexual violence (54.4%) compared to those who never experienced sexual abuse (34.3%). In the multivariable analysis, sexual violence was consistently and robustly associated with increased odds of having an unintended pregnancy (AOR:1.70; 95% CI: 1.08-2.68). CONCLUSION Our study found a huge magnitude of unintended pregnancy among AGYW. Sexual violence is an important predictor of unintended pregnancy in this age cohort. Thus, addressing unintended pregnancies among AGYW in South Africa requires interventions that not only increase access to contraceptive information and services but also reduce sexual violence and cater for survivors.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, Africa Population and Health Research Center, Off Kirawa Road, Manga Close, Nairobi, Kenya
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Toska E, Cluver L, Laurenzi CA, Wittesaele C, Sherr L, Zhou S, Langwenya N. Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status. J Int AIDS Soc 2020; 23 Suppl 5:e25558. [PMID: 32869543 PMCID: PMC7459160 DOI: 10.1002/jia2.25558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION There is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in this high-risk group, including the effect of motherhood and HIV status. We report data from a large survey of adolescent girls and young women conducted in a mixed rural-urban district in South Africa. METHODS Quantitative interviews were conducted with 1712 adolescent girls and young women (ages 10 to 24): 336 adolescent mothers living with HIV (AMLHIV), 454 nulliparous adolescent girls living with HIV (ALHIV), 744 HIV-negative adolescent mothers (control adolescent mothers) and 178 HIV-negative nulliparous adolescent girls (nulliparous controls) in 2018 to 2019. Standardized questionnaires included socio-demographic measures, reproductive health and contraception experiences. Reproductive aspirations were measured as the number of children participants wanted to have. Dual protection was computed as use of both hormonal and barrier contraception or abstinence. Multivariate logistic regression and marginal effects models in STATA 15 were used to test associations between HIV status, adolescent motherhood and outcomes of reproductive aspirations, contraception use and dual protection, controlling for covariates. RESULTS AND DISCUSSION Nearly 95% of first pregnancies were unintended. Over two-thirds of all participants wanted two or more children. Hormonal contraception, condom use and dual protection were low across all groups. In multivariate regression modelling, ALHIV were less likely to report hormonal contraception use (aOR 0.55 95% CI 0.43 to 0.70 p ≤ 0.001). In marginal effects modelling, adolescent mothers - independent of HIV status - were least likely to report condom use at last sex. Despite higher probabilities of using hormonal contraception, rates of dual protection were low: 17.1% among control adolescent mothers and 12.4% among AMLHIV. Adolescent mothers had the highest probabilities of not using any contraceptive method: 29.0% among control mothers and 23.5% among AMLHIV. CONCLUSIONS Among adolescent girls and young women in HIV-endemic communities, reproductive aspirations and contraceptive practices affect HIV risk and infection. Tailored adolescent-responsive health services could help young women plan their pregnancies for when they are healthy and well-supported, and help interrupt the cycle of HIV transmission by supporting them to practice dual protection.
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Affiliation(s)
- Elona Toska
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
| | - Lucie Cluver
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- Department of Child and Adolescent PsychiatryUniversity of Cape TownCape TownSouth Africa
| | - Christina A Laurenzi
- Department of Global HealthInstitute for Life Course Health ResearchStellenbosch UniversityCape TownSouth Africa
| | - Camille Wittesaele
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- Department of Infectious Disease EpidemiologyFaculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Lorraine Sherr
- Institute for Global HealthUniversity College LondonLondonUnited Kingdom
| | - Siyanai Zhou
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of StatisticsUniversity of Cape TownCape TownSouth Africa
| | - Nontokozo Langwenya
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Oxford Research South AfricaEast LondonSouth Africa
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Fitzpatrick M, Pathipati MP, McCarty K, Rosenthal A, Katzenstein D, Chirenje ZM, Pinsky B. Knowledge, attitudes, and practices of cervical Cancer screening among HIV-positive and HIV-negative women participating in human papillomavirus screening in rural Zimbabwe. BMC WOMENS HEALTH 2020; 20:153. [PMID: 32711530 PMCID: PMC7382027 DOI: 10.1186/s12905-020-01017-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Women in low- and middle-income countries are at the highest risk of cervical cancer yet have limited access to and participation in cervical cancer screening programs. Integrating self-collected, community-based screening offers a potential primary screening method in areas of limited resources. In this paper, we present a study evaluating knowledge, attitudes, and practices of cervical cancer and Human Papilloma Virus (HPV) in rural Zimbabwe. METHODS We performed a community-based cross-sectional knowledge, attitudes and practices of HPV and cervical cancer study in rural Zimbabwe from January 2017-May 2017. Women were selected for the study via random number generation from complete lists of inhabitants in the study area if they satisfied the inclusion criteria (≥30-years-old, ≤65-years-old, not pregnant, intact uterus). If selected, they participated in a 19-question structured knowledge, attitudes and practices survey. The questionnaire included questions on demographics, education, knowledge of HPV, cervical cancer, and risk factors. Chi-squared tests were evaluated comparing knowledge, attitudes and practices relating to HPV and cervical cancer screening with actual infection with HPV. Women were also offered a voluntary HIV and self-collected HPV screening. RESULTS Six hundred seventy-nine women were included in the knowledge, attitudes and practices survey. Most women (81%) had heard of cervical cancer while the majority had not heard of HPV (12%). The number of women that had been screened previously for cervical cancer was low (5%). There were no significant differences between and within groups regarding knowledge of cervical cancer and actual overall infection with HR-HPV, HPV 16, and HPV 18/45 test results. CONCLUSIONS Most women in rural Zimbabwe have heard of cervical cancer, but the number that had been screened was low. Extending existing outreach services to include cervical cancer screening, potentially including HPV screening, should include cervical cancer/HPV education and screening triage. This approach would serve to bridge the gap between knowledge and screening availability to address some of the barriers to cervical cancer care still affecting women in many regions of the world.
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Affiliation(s)
- Megan Fitzpatrick
- Department of Pathology, University of Wisconsin, 600 Highlands Ave, Madison, WI, USA.
| | - Mythili P Pathipati
- Department of Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kathy McCarty
- Chidamoyo Christian Hospital, P.O. Box 330, Karoi, Zimbabwe
| | - Anat Rosenthal
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel
| | - David Katzenstein
- Biomedical Research and Training Institute of Zimbabwe, 10 Seagrave Rd, Mount Pleasant, Harare, Zimbabwe
| | - Z M Chirenje
- Department of Obstetrics and Gynecology, University of Zimbabwe College of Health Science, Harare, Zimbabwe
| | - Benjamin Pinsky
- Department of Pathology, Stanford Hospitals and Clinics, 300 Pasteur Drive, Stanford, CA, USA
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Toska E, Laurenzi CA, Roberts KJ, Cluver L, Sherr L. Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa. Glob Public Health 2020; 15:1655-1673. [PMID: 32507031 DOI: 10.1080/17441692.2020.1775867] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.,Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Christina A Laurenzi
- Institute for Life Course Health Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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Twizelimana D, Muula AS. Correlates of pregnancy among Female Sex Workers (FSWs) in semi urban Blantyre, Malawi. BMC Pregnancy Childbirth 2020; 20:337. [PMID: 32487138 PMCID: PMC7268236 DOI: 10.1186/s12884-020-03018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/15/2020] [Indexed: 11/28/2022] Open
Abstract
Background Little is known about female sex workers’ (FSWs) reproductive health apart from their being at higher than usual risk of sexually transmitted infections (STIs), including HIV. The aim of this study was therefore to investigate the correlates of pregnancy among FSWs in semi – urban Blantyre in Malawi. Methods We used systematic sampling to recruit a total of 200 FSWs in four different study sites in Blantyre. Data were collected through questionnaire interviews. We calculated the mean and standard deviation for continuous covariates and proportions for categorical variables to describe the data. Logistic regression analysis was used to examine the correlates between the outcome variable (pregnancy) and independent variables. Results Ninety one (45, 5%) FSWs were between 18 and 24 years. The prevalence of pregnancy was 61% for FSWs born in rural place as compared to 37% for those who were born in town. In multivariate analysis FSWs who reported to value being respected as mothers had 12 times the risk of pregnancy comparing to the ones who did not (AOR: 11.8, 95% CI: [4.56, 30.72] p-value < 0.001). FSWs who reported using condoms inconsistently had five times the risk of pregnancy compared to the ones who did not, (AOR: 5.26, 95% CI: [2.29, 12.08], p-value < 0.001). FSWs who had a request to bear children from steady partners had 5 times the risk of pregnancy comparing to the ones who did not (AOR: 5.07, 95% CI: [2.14, 11.99]). FSWs who reported forgetfulness of contraceptives’ use had 3 times more risk of pregnancy comparing to the ones who did not (AOR: 3.49 CI: [1.29, 9.37], p-value < 0.013). Conclusion The study documents a wide range of correlates of pregnancies among FSWs in the study sites. It is important to recognize the child bearing desires and circumstances of FSWs in order to inform health programs responsive to their needs.
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Affiliation(s)
- Donatien Twizelimana
- Mlambe Mission Hospital, P.O. Box: 45 Lunzu, Blantyre, Malawi. .,Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi. .,The Africa Center of Excellence in Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi.
| | - Adamson S Muula
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,The Africa Center of Excellence in Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi
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Erasmus MO, Knight L, Dutton J. Barriers to accessing maternal health care amongst pregnant adolescents in South Africa: a qualitative study. Int J Public Health 2020; 65:469-476. [PMID: 32388574 PMCID: PMC7275000 DOI: 10.1007/s00038-020-01374-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives This study explores the barriers to accessing antenatal care (ANC) services amongst pregnant adolescents within a particular community of South Africa. Methods An exploratory qualitative design was applied to examine the views of pregnant adolescents. In-depth interviews were conducted with pregnant adolescents at the Mitchells Plain Midwifery Obstetric Unit, as well as nursing staff working at the facility. Thematic analysis was then used and analysis was framed using the social–ecological model for health-seeking behaviour. Results This study found that barriers to adolescents seeking ANC often centered on a discourse of adolescent pregnancy being deviant, irresponsible, and shameful. Pregnant adolescents often absorbed these beliefs and were fearful of other’s reaction within their family, the community, at school, and within the ANC facilities. Conclusions Stigma regarding adolescent pregnancy participates in the perpetuation of a culture of non-disclosure and shame, which stands in the way of young pregnant people seeking the care they require. Such beliefs and attitudes need to be challenged at a community and national level. Electronic supplementary material The online version of this article (10.1007/s00038-020-01374-7) contains supplementary material, which is available to authorised users.
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Affiliation(s)
| | - Lucia Knight
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Jessica Dutton
- School of Public Health, University of Western Cape, Cape Town, South Africa
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Pillay N, Manderson L, Mkhwanazi N. Conflict and care in sexual and reproductive health services for young mothers in urban South Africa. CULTURE, HEALTH & SEXUALITY 2020; 22:459-473. [PMID: 31035891 DOI: 10.1080/13691058.2019.1606282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
In South Africa, sexual and reproductive health services aim to facilitate access to and utilisation of care to young people. We draw on narrative interviews with 45 young mothers and six health care providers delivering sexual and reproductive health services at an urban health centre, to understand how young mothers experienced services in relation to ante- and post-natal care, including termination services. Although health care providers emphasised what they considered young women's 'ignorance' and 'irresponsibility' as central to early and unintended pregnancy; they also expressed their sympathy and concern. In a resource-limited health care setting, with health system inefficiencies and lack of specialised training, there was little opportunity to deliver high-quality care to young women. We draw attention to the need to prioritise the training of health care providers to expand early pregnancy testing and termination services and to deliver patient-centred family planning services to young women.
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Affiliation(s)
- Nirvana Pillay
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nolwazi Mkhwanazi
- Wits Institute for Social and Economic Research, University of the Witwatersrand, Johannesburg, South Africa
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Gebrekristos LT, Groves AK, McNaughton Reyes L, Maman S, Moodley D. IPV victimization in pregnancy increases postpartum STI incidence among adolescent mothers in Durban, South Africa. AIDS Care 2020; 32:193-197. [PMID: 32193964 DOI: 10.1080/09540121.2020.1742871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Women, and specifically, adolescents, are at high risk of HIV and STIs during the postpartum period. Biological and behavioral factors contribute to adolescents' susceptibility. However, the influence of behavioral factors, like intimate partner violence (IPV), on postpartum STI acquisition has been understudied. The study's purpose is to determine whether IPV victimization during pregnancy predicts incident STIs in the first 6 months postpartum. Adolescent mothers (14-19 years) were recruited at a township hospital's maternity ward near Durban. Adolescent mothers who were HIV-negative and had no laboratory-diagnosed STIs at baseline (6 weeks postpartum) were included in the analysis (n = 61). We used a modified Poisson regression with robust standard errors to assess differences in postpartum STI risk by IPV victimization during pregnancy controlling for covariates. At baseline, 25 (41%) adolescent mothers reported IPV victimization during pregnancy. Adolescent mothers who reported IPV during pregnancy were at higher risk of receiving an STI diagnoses at 6 months postpartum (aRR: 4.43; 95% CI: 1.31-14.97). Our findings heighten understanding of HIV risk among a vulnerable subset of adolescent girls: adolescent mothers. Non-combined interventions that help young mothers and their partners navigate partnership dynamics to reduce IPV and STIs are needed to reduce HIV risk.
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Affiliation(s)
- Luwam T Gebrekristos
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Luz McNaughton Reyes
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal Nelson R. Mandela School of Medicine, Durban, South Africa
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Govender D, Naidoo S, Taylor M. "My partner was not fond of using condoms and I was not on contraception": understanding adolescent mothers' perspectives of sexual risk behaviour in KwaZulu-Natal, South Africa. BMC Public Health 2020; 20:366. [PMID: 32197592 PMCID: PMC7082996 DOI: 10.1186/s12889-020-08474-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Adolescent pregnancy has been a persistent area of interest and concern in the field of public health. The debate about adolescents’ sexual risk behaviour has also gained prominence due to findings that have demonstrated that adolescent girls between 15 and 19 years of age give birth to 16 million infants and account for 62% of new HIV infections in the Caribbean and African regions. Health compromising behaviours often develop in adolescence, yet the sexual and reproductive health of adolescent mothers is often marginalised in the healthcare field. The aim of this study was to explore adolescent mothers’ understanding of sexual risk behaviour. Methods The study employed a descriptive qualitative design. To collect the data, four focus group discussions were conducted with adolescent mothers aged 16–19 years. The eighteen adolescent mothers were recruited using purposive sampling technique from a hospital in the Ugu district in KwaZulu-Natal, South Africa. Data were analysed using thematic analysis. Results The study revealed that decisions to engage in risky sexual behaviour is influenced by peer pressure, drugs and alcohol, sexual experimentation, myths about contraception, the media, poor parental supervision and power gender dynamics, poverty leading to transactional sex, the vulnerability of young girls, and the fear of partner rejection. Conclusion The findings of this study will contribute to a better understanding of adolescent mothers’ perspectives of sexual risk behaviour. In the subject matter of sexual and reproductive health, adolescents’ autonomy with respect to cultural and social recommendations should not be sidelined. Due to their vulnerability, adolescent women are exposed to transactional sex, and it is particularly due to poverty that adolescent women are driven into sexual relations with older men as a means of survival. Moreover, interventions to curb postpartum sexual risk behaviour are important to protect adolescent women and mothers against HIV/AIDS. The sexual and reproductive education of adolescent women should focus on resilience, negotiating skills, and protective decision making. Collaborative efforts to curb sexual risk taking by young women should be encouraged and should involve relevant agents from the educational, social and clinical fields.
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Affiliation(s)
- Desiree Govender
- KwaZulu-Natal Department of Health, Durban, South Africa. .,School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa. .,Developing Research Innovation Localisation and Leadership (DRILL), Durban, South Africa.
| | - Saloshni Naidoo
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
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Makola L, Mlangeni L, Mabaso M, Chibi B, Sokhela Z, Silimfe Z, Seutlwadi L, Naidoo D, Khumalo S, Mncadi A, Zuma K. Predictors of contraceptive use among adolescent girls and young women (AGYW) aged 15 to 24 years in South Africa: results from the 2012 national population-based household survey. BMC Womens Health 2019; 19:158. [PMID: 31830982 PMCID: PMC6909538 DOI: 10.1186/s12905-019-0861-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/01/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite a variety of contraceptives being available for women in South Africa, a considerable number of adolescent girls and young women still face challenges in using them. This paper examines socio-demographic and behavioral predictors of using contraceptives among adolescent girls and young women (AGYW) aged 15 to 24 years. METHODS A secondary data analysis was conducted based on the 2012 population-based nationally representative multi-stage stratified cluster randomised household survey. Multivariate backward stepwise logistic regression model was used to examine socio-demographic and behavioural factors independently associated with contraceptive use amongst AGYW aged 15 to 24 years in South Africa. RESULTS Out of 1460 AGYW, 78% (CI: 73.9-81.7) reported using some form of contraceptives. In the model, contraceptive use was significantly associated with secondary education [OR = 1.8 (1.2-2.7), p = 0.005], having a sexual partner within 5 years of their age [OR = 1.8 (1.2-2.5), p = 0.002], and sexual debut at age 15 years and older [OR = 2.5 (1.3-4.6), p = 0.006]. The likelihood of association decreased with other race groups-White, Coloured, and Indians/Asians [OR = 0.5 (0.3-0.7), p = 0.001], being married [OR = 0.4 (0.2-0.7), p = 0.001], never given birth [OR = 0.7 (0.5-0.9), p = 0.045], coming from rural informal [OR = 0.5 (0.3-0.9), p = 0.010] and rural formal settlements [OR = 0.5 (0.3-0.9), p = 0.020]. CONCLUSIONS Evidence suggest that interventions should be tailor-made to meet the needs of AGYW in order to, promote use and access to contraceptives. The results also suggest that family planning interventions should target those who had not given birth in order to reduce unplanned and or unintended pregnancies and associated risk factors. These findings contribute to public health discourse and reproductive health planning for these age groups in the country.
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Affiliation(s)
- L. Makola
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
- Department of Psychology, University of Limpopo, Polokwane, South Africa
| | - L. Mlangeni
- Department of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - M. Mabaso
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
| | - B. Chibi
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
| | - Z. Sokhela
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
| | - Z. Silimfe
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
| | - L. Seutlwadi
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
| | - D. Naidoo
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
| | - S. Khumalo
- Human and Social Development, Human Sciences Research Council, Durban, South Africa
| | - A. Mncadi
- Human and Social Development, Human Sciences Research Council, Durban, South Africa
| | - K. Zuma
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
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Closson K, Dietrich JJ, Beksinska M, Gibbs A, Hornschuh S, Smith T, Smit J, Gray G, Ndung’u T, Brockman M, Kaida A. Measuring sexual relationship power equity among young women and young men South Africa: Implications for gender-transformative programming. PLoS One 2019; 14:e0221554. [PMID: 31553723 PMCID: PMC6760831 DOI: 10.1371/journal.pone.0221554] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/11/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Measures used to assess equitable relationship dynamics, including the sexual relationship power scale (SRPS) have previously been associated with lower HIV-risk among young women, and reduced perpetration of intimate partner violence among men. However, few studies describe how the SRPS has been adapted and validated for use within global youth sexual health studies. We examined gender-specific psychometric properties, reliability, and validity of a SRPS used within a South African youth-engaged cohort study. METHODS Young men and women (16-24 years) enrolled in community-based cohorts in Durban and Soweto (2014-2016) reporting a primary partner at 6-month follow-up completed a 13-item (strongly agree/agree/disagree/strongly disagree) South African adaptation of Pulerwitz's SRPS (range 13-52, higher scores indicating greater sexual relationship power [SRP] equity). SRPS modifications were made using gender-specific exploratory factor analyses (EFAs), removing items with factor loadings <0.3. Cronbach alphas were conducted for full and modified scales by gender. Using modified scales, unadjusted and adjusted regression models examined associations between 1. relevant socio-demographic and relationship determinants and SRP equity, and 2. SRP equity and sexual relationship related outcomes. All models adjusted for education, age, site, and current employment. RESULTS 235 sexually-active youth (66% women, median age = 20) were included. Mean scores across all 13 scale items were 2.71 (SD 0.30) for women and 2.70 (SD 0.4) for men. Scale Cronbach's alphas were 0.63 for women and 0.64 for men. EFAs resulted in two gender-specific single-factor SRPS. Modified SRPS Cronbach alphas increased to 0.67 for women (8-items) and 0.70 for men (9-items). After adjusting for age, site and current employment, higher education remained associated with SRP equity across genders. In adjusted models, correlates of SRP equity included primary partnerships that were age-similar (<5 years older) and <2 years in length for women and living in Soweto and younger age for men. Greater SRP equity among women was also independently associated with no recent partner violence. CONCLUSIONS Results highlight important gender differences in SRP equity measures and associations, highlighting the critically need for future research to examine gendered constructions of SRP equity in order to accurately develop, validate and use appropriate measures within quantitative surveys.
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Affiliation(s)
- Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Janan J. Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mags Beksinska
- Maternal Adolescent and Child Health (MatCH) Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Andrew Gibbs
- South African Medical Research Council, Cape Town, South Africa
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tricia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jenni Smit
- Maternal Adolescent and Child Health (MatCH) Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme and Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA United States of America
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - Mark Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Smith P, Tolla T, Marcus R, Bekker LG. Mobile sexual health services for adolescents: investigating the acceptability of youth-directed mobile clinic services in Cape Town, South Africa. BMC Health Serv Res 2019; 19:584. [PMID: 31426788 PMCID: PMC6701080 DOI: 10.1186/s12913-019-4423-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Human Immunodeficiency Virus (HIV) epidemic is growing rapidly among South African adolescents and young adults (AYA). Although HIV counselling and testing, HIV prevention and treatment options are widely available, many AYA delay health-seeking until illness occurs, demonstrating a need for youth responsive, integrated sexual and reproductive health services (SRHS). While feasibility and cost-effectiveness have been evaluated, acceptability of mobile clinics among AYA has yet to be established. The objective of this study was to investigate patient acceptability of mobile AYA SRHS and compare mobile clinic usage and HIV outcomes with nearby conventional clinics. METHODS Patients presenting to a mobile clinic in Cape Town were invited to participate in an acceptability study of a mobile clinic after using the service. A trained researcher administered an acceptability questionnaire. Mobile clinic medical records during the study period were compared with the records of AYA attending four clinics in the same community. RESULTS Three hundred three enrolled participants (16-24 years, 246 (81.2%) female) rated mobile AYA SRHS acceptability highly (median = 4,6 out of 5), with 90% rating their experience as better or much better than conventional clinics. The mobile clinic, compared to conventional clinics, attracted more men (26% v 13%, p < 0,000), younger patients (18 v 19 years, p < 0,000), and yielded more HIV diagnoses (4% v 2%, p < 0,000). CONCLUSIONS Given the high ratings of acceptability, and the preference for mobile clinics over conventional primary health clinics, the scalability of mobile clinics should be investigated as part of a multipronged approach to improve the uptake of SRHS diagnostic, prevention and treatment options for AYA.
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Affiliation(s)
- Philip Smith
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - Tsidiso Tolla
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Rebecca Marcus
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Govender D, Naidoo S, Taylor M. Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal. Afr J Prim Health Care Fam Med 2019; 11:e1-e11. [PMID: 31038339 PMCID: PMC6489148 DOI: 10.4102/phcfm.v11i1.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes. AIM The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children. SETTING The study was conducted in a local district hospital in Ugu, KwaZulu-Natal. METHODS An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis. RESULTS Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers. CONCLUSION In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.
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Affiliation(s)
- Desiree Govender
- KwaZulu-Natal Department of Health, Ugu District, South Africa; and, School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban.
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Saul J, Bachman G, Allen S, Toiv NF, Cooney C, Beamon T. The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women. PLoS One 2018; 13:e0208167. [PMID: 30532210 PMCID: PMC6285267 DOI: 10.1371/journal.pone.0208167] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In sub-Saharan Africa, adolescent girls and young women (AGYW) are 5 to 14 times more likely to be infected with HIV than their male peers. Every day, more than 750 AGYW are infected with HIV. Many factors make girls and young women particularly vulnerable to HIV, including gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school. The President's Emergency Plan for AIDS Relief (PEPFAR) is dedicating significant resources through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) partnership to impact the lives of women and girls based on PEPFAR's mission to help countries achieve epidemic control of HIV/AIDS. The data show that new HIV infections must be reduced in AGYW, or the global community risks losing the extensive progress made towards reaching epidemic control. With support from PEPFAR and private sector partners-the Bill & Melinda Gates Foundation, Gilead Sciences, Girl Effect, Johnson & Johnson and ViiV Healthcare, DREAMS works together with partner governments to deliver a core package of interventions that combines evidence-based approaches that go beyond the health sector, addressing the structural drivers that directly and indirectly increase girls' HIV risk. Not only is DREAMS an effort to reduce new HIV infections, but it aims to reduce other critical vulnerabilities such as gender-based violence. When girls and young women thrive, the effects are felt throughout their families, communities and countries.
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Affiliation(s)
- Janet Saul
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Gretchen Bachman
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Shannon Allen
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Nora F. Toiv
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Caroline Cooney
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Ta’Adhmeeka Beamon
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
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Davies N, Heffron R. Global and national guidance for the use of pre-exposure prophylaxis during peri-conception, pregnancy and breastfeeding. Sex Health 2018; 15:501-512. [PMID: 30447703 PMCID: PMC6790372 DOI: 10.1071/sh18067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/15/2018] [Indexed: 12/30/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a well-established biomedical HIV prevention strategy and recommended to reduce HIV risk during peri-conception, pregnancy and breastfeeding. Efforts are needed to translate global recommendations into national guidelines and implementation strategies. This article presents the current status of policy guidance for the use of PrEP during peri-conception, pregnancy and breastfeeding, with a particular focus on high prevalence countries, including those in sub-Saharan Africa. PrEP clinical guidelines released by ministries of health or other national-level health bodies, with a particular focus on recommendations for PrEP use during peri-conception, pregnancy and breastfeeding, were reviewed and summarised. Among countries with PrEP guidelines and/or policy, pregnancy is recognised as a period with increased HIV vulnerability, and some recommend PrEP use specifically during pregnancy. Only one country notes that PrEP is contraindicated during pregnancy, recognising a gap in complete safety data from women using PrEP throughout pregnancy. PrEP is not contraindicated as a peri-conception HIV prevention strategy in any country, but only three countries have specific guidance for peri-conception HIV prevention. Multiple barriers to the implementation of PrEP during pregnancy and breastfeeding are discussed, including barriers at the policy, health systems, social and personal levels. Although pregnancy is a period of heightened risk and fertility rates are high in many settings with high HIV burden, few PrEP policies have included guidance for PrEP use specific to peri-conception, pregnancy and breastfeeding periods. This gap can be overcome by the development or adoption of national clinical guidelines and implementation strategies from exemplary countries.
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The protective role of family structure for adolescent development in sub-Saharan Africa. PLoS One 2018; 13:e0206197. [PMID: 30372474 PMCID: PMC6205637 DOI: 10.1371/journal.pone.0206197] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
Several studies have focused on the risk factors associated with adolescent developmental outcomes, but the literature on the role of protective factors at the family and community level for positive adolescent development is scarce, especially in sub-Saharan Africa (SSA). We hypothesize that ensuring a supportive environment for adolescents may result in delayed sexual debut for adolescents in SSA. The relationship between family structure and positive adolescent sexual behaviour, measured as delay in sexual debut, was examined using the bioecological theory framed by a risk and resilience perspective. We used nationally representative data on female and male adolescents (aged 15–17 years) from 12 countries in SSA. We modelled logistic regressions to test for associations between family structure and delayed sexual debut while controlling for other covariates in SSA. The majority (90%) of the young adults delayed sexual debut, and this delay varied by family structure. After controlling for other covariates, adolescents living with neither parent had lower odds of delaying sexual debut although results were only significant for males. Interaction terms with community socio-economic status showed an interaction between community education and males living with neither parent. Future studies must investigate the gender differentials in the relationship between family structure and delayed sexual debut among adolescents in SSA.
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Mlotshwa L, Manderson L, Merten S. Personal support and expressions of care for pregnant women in Soweto, South Africa. Glob Health Action 2018; 10:1363454. [PMID: 28874098 PMCID: PMC5645695 DOI: 10.1080/16549716.2017.1363454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Pregnancy is life changing, making great demands on women to adapt physically, psychologically, and socially. Social relationships and the support that flow from these provide a critical role in managing health problems in pregnancy. Isolation and lack of care, in contrast, may lead women to experience increased distress during this time. Objective: This study aimed to explore South African women's perception and experience of care and support in pregnancy. Methods: A life history approach was employed to explore women’s experiences of pregnancy and sexual behaviour, with each participant encouraged to narrate important life events from her own perspective. We drew on narrative interviews with 15 pregnant women, conducted between July and October 2015, in which we explored questions regarding pregnancy planning and the provision and receipt of care. A thematic approach was employed to code and analyse the data. Results: Themes that emerged from the interviews showed that participants gained a sense of stability in their lives when they had support in their pregnancy, especially when dealing with challenging situations. This support came variously from family, friends, and social networks. Overall, those participants who mentioned the most support, and its diversity across different groups, reported a better experience of pregnancy. Conclusions: Women emphasised the importance of social and emotional support in pregnancy. Understanding women’s experiences can assist in making pregnancy less overwhelming, and can add to a woman’s ability to deal with different challenges before and after the arrival of the new baby.
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Affiliation(s)
- Langelihle Mlotshwa
- a Department of Epidemiology and Public Health , Swiss Tropical Public Health Institute , Basel , Switzerland.,b Department of Epidemiology and Public Health , University of Basel , Basel , Switzerland.,c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Lenore Manderson
- d School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Sonja Merten
- a Department of Epidemiology and Public Health , Swiss Tropical Public Health Institute , Basel , Switzerland.,b Department of Epidemiology and Public Health , University of Basel , Basel , Switzerland
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Groves AK, Maman S, Stankard PH, Gebrekristos LT, Amon JJ, Moodley D. Addressing the unique needs of adolescent mothers in the fight against HIV. J Int AIDS Soc 2018; 21:e25155. [PMID: 29956491 PMCID: PMC6024120 DOI: 10.1002/jia2.25155] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/11/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Allison K Groves
- Department of Community Health and PreventionDrexel UniversityPhiladelphiaPAUSA
| | - Suzanne Maman
- Department of Health BehaviorUniversity of North Carolina at Chapel HillsChapel HillNCUSA
| | | | | | - Joseph J Amon
- Woodrow Wilson School of Public and International AffairsPrinceton UniversityPrincetonNJUSA
| | - Dhayendre Moodley
- Department of Obstetrics and GynaecologyUniversity of KwaZulu‐NatalNelson Mandela School of MedicineDurbanSouth Africa
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Adeniyi OV, Ajayi AI, Moyaki MG, Goon DT, Avramovic G, Lambert J. High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa. BMC Health Serv Res 2018; 18:140. [PMID: 29482587 PMCID: PMC5828463 DOI: 10.1186/s12913-018-2942-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). METHODS Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. RESULTS The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. CONCLUSION Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were exposed to integrated services. The study confirms that integration of HIV care and family planning services is an important strategy to reduce unplanned pregnancy among women living with HIV. The study's findings have significant implications for the elimination of mother-to-child transmission of HIV in South Africa. Innovative interventions are needed to further consolidate and maximise the benefit of the integration of family planning services with HIV care.
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Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine and Rural Health, Walter Sisulu University, Cecilia Makiwane Hospital/East London Hospital Complex, East London, South Africa
| | - Anthony Idowu Ajayi
- Department of Sociology, University of Fort Hare, 50, Church Street, East London, South Africa
| | | | - Daniel Ter Goon
- Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Gordana Avramovic
- University College Dublin/Mater Misericordiae University Hospital, Catherine McAuley Education & Research Centre, Dublin, Ireland
| | - John Lambert
- University College Dublin/Mater Misericordiae University Hospital, Catherine McAuley Education & Research Centre, Dublin, Ireland
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47
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Sama CB, Ngasa SN, Dzekem BS, Choukem SP. Prevalence, predictors and adverse outcomes of adolescent pregnancy in sub-Saharan Africa: a protocol of a systematic review. Syst Rev 2017; 6:247. [PMID: 29208035 PMCID: PMC5718137 DOI: 10.1186/s13643-017-0650-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/28/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several studies have reported on factors influencing adolescent pregnancies and the associated outcomes, but evidence from a systematic review is limited, especially in sub-Saharan Africa where the greater burden lies. Establishment of accurate epidemiological data on the rates of adolescent pregnancy, its predictors, and adverse outcomes (maternal and neonatal) may have important implications towards attainment of the Sustainable Development Goals. METHODS This will be a systematic review of studies reporting predictors of adolescent pregnancy and adverse outcomes in sub-Saharan Africa published between January 2000 and December 2017. The following databases will be searched: PubMed/MEDLINE, Excerpta Medica Database (EMBASE), SCOPUS, Popline, Africa Wide Information, African Index Medicus, Google scholar and the Cochrane library. Three authors will independently screen all potential articles for eligibility as guided by the selection criteria. The Stata statistical software will be used in analysing the data. Appropriate meta-analytic techniques will be used to pool prevalence estimates from studies with similar features, overall and by major subgroups as warranted. Heterogeneity of studies will be evaluated by the χ 2 test on Cochrane's Q statistic. Publication bias will be sorted for using funnel plot analysis and Egger's test. Qualitative synthesis will be used where data are insufficient to produce a quantitative synthesis. This protocol is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines. DISCUSSION This systematic review and meta-analysis is expected to serve as a template for designing adolescent-friendly preventive and control programmes to help curb the ever-growing burden of adolescent pregnancies, and as a guide for future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017070773.
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Affiliation(s)
- Carlson-Babila Sama
- School of Life and Medical Sciences, Faculty of Population Health Sciences, Institute for Global Health, University College London, WC1E 6BT, London, UK. .,Galactic Corps Research Group (GCRG), Buea, Cameroon.
| | - Stewart Ndutard Ngasa
- Galactic Corps Research Group (GCRG), Buea, Cameroon.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Sporedata Research Inc, Durham, NC, USA
| | - Bonaventure Suiru Dzekem
- Galactic Corps Research Group (GCRG), Buea, Cameroon.,Health Services Partner Cameroon, Kumba, Cameroon.,Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon
| | - Simeon-Pierre Choukem
- Health and Human Development (2HD) Research Group, Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, P.O. Box 4856, Douala, Cameroon
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Odimegwu C, De Wet N, Somefun OD. Perceptions of social capital and sexual behaviour among youth in South Africa. J Child Adolesc Ment Health 2017; 29:205-217. [PMID: 29092668 DOI: 10.2989/17280583.2017.1388246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
With about one quarter of new human immunodeficiency virus (HIV) infections occuring in young people, there is an on-going debate regarding the role of social capital on youth sexual behaviour. Some studies have suggested that high levels of family and community social capital may act as protective factors that lessen the likelihood of negative consequences; while others have concluded that social capital may be a risk factor for risky sexual behaviour among youth. Using data from the Third National Communications Survey (2012) conducted in South Africa, we examined the relationship between perceptions of social capital and youth sexual behaviour measured by age at first sex and condom use among 3 399 males and females (aged between 16 and 24 years). We assessed community perceptions of social capital with questions that measured trust, social participation, and support. The Cox proportional hazards regression model was used to predict the risk for early sexual debut. Logistic regression was used to predict the odds of condom use. There was no association between perceptions of social capital and youth sexual behaviour. This work reveals that youth sexual behaviour in South Africa may be influenced by socio-economic characteristics, especially at the individual level.
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Affiliation(s)
- Clifford Odimegwu
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Nicole De Wet
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Oluwaseyi Dolapo Somefun
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa
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Said-Mohamed R, Pettifor JM, Norris SA. Life History theory hypotheses on child growth: Potential implications for short and long-term child growth, development and health. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 165:4-19. [PMID: 29072305 DOI: 10.1002/ajpa.23340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/27/2017] [Accepted: 10/01/2017] [Indexed: 12/12/2022]
Abstract
Life history theory integrates ecological, physiological, and molecular layers within an evolutionary framework to understand organisms' strategies to optimize survival and reproduction. Two life history hypotheses and their implications for child growth, development, and health (illustrated in the South African context) are reviewed here. One hypothesis suggests that there is an energy trade-off between linear growth and brain growth. Undernutrition in infancy and childhood may trigger adaptive physiological mechanisms prioritizing the brain at the expense of body growth. Another hypothesis is that the period from conception to infancy is a critical window of developmental plasticity of linear growth, the duration of which may vary between and within populations. The transition from infancy to childhood may mark the end of a critical window of opportunity for improving child growth. Both hypotheses emphasize the developmental plasticity of linear growth and the potential determinants of growth variability (including the role of parent-offspring conflict in maternal resources allocation). Implications of these hypotheses in populations with high burdens of undernutrition and infections are discussed. In South Africa, HIV/AIDS during pregnancy (associated with adverse birth outcomes, short duration of breastfeeding, and social consequences) may lead to a shortened window of developmental plasticity of growth. Furthermore, undernutrition and infectious diseases in children living in South Africa, a country undergoing a rapid nutrition transition, may have adverse consequences on individuals' cognitive abilities and risks of cardio-metabolic diseases. Studies are needed to identify physiological mechanisms underlying energy allocation between biological functions and their potential impacts on health.
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Affiliation(s)
- Rihlat Said-Mohamed
- Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng 2193, South Africa
| | - John M Pettifor
- Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng 2193, South Africa
| | - Shane A Norris
- Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng 2193, South Africa
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Chetty T, Vandormael A, Thorne C, Coutsoudis A. Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa. BMC Pregnancy Childbirth 2017; 17:248. [PMID: 28747163 PMCID: PMC5530557 DOI: 10.1186/s12884-017-1421-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/16/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The evidence on the effect of pregnancy on acquiring HIV is conflicting, with studies reporting both higher and lower HIV acquisition risk during pregnancy when prolonged antiretroviral therapy was accessible. The aim of this study was to assess the pregnancy effect on HIV acquisition where antiretroviral therapy was widely available in a high HIV prevalence setting. METHODS This is a retrospective cohort study nested within a population-based surveillance to determine HIV incidence in HIV-uninfected women from 15 to 49 years from 2010 through 2015 in rural KwaZulu-Natal. HIV incidence per 100 person-years according to pregnancy status (not pregnant, pregnant, to eight weeks postpartum) were measured in 5260 HIV-uninfected women. Hazard ratios (HR) were estimated by Cox proportional hazards regression with pregnancy included as a time varying variable. RESULTS Overall, pregnancy HIV incidence was 4.5 per 100 person-years (95% CI 3.4-5.8), higher than non-pregnancy (4.0; 95% CI 3.7-4.3) and postpartum incidences (4.2 per 100 person-years; 95% CI 2.3-7.6). However, adjusting for age, and demographic factors, pregnant women had a lower risk of acquiring HIV (HR 0.4; 95% CI 0.2-0.9, P = 0.032) than non-pregnant women; there were no differences between postpartum and non-pregnant women (HR 1.2; 95% CI 0.4-3.2; P = 0.744). In models adjusting for the interaction of age and gravidity, pregnant women under 25 years with two or more pregnancies had a 2.3 times greater risk of acquiring HIV than their older counterparts (95% CI 1.3-4.3; P = 0.008). CONCLUSIONS Pregnancy had a protective effect on HIV acquisition. Elevated HIV incidence in younger women appeared to be driven by those with higher gravidity. The sexual and biological factors in younger women should be explored further in order to design appropriate HIV prevention interventions.
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Affiliation(s)
- Terusha Chetty
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
| | - Alain Vandormael
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
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