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Ngure K, Browne EN, Reddy K, Friedland BA, van der Straten A, Palanee-Phillips T, Nakalega R, Gati B, Kalule HN, Siziba B, Soto-Torres L, Nair G, Garcia M, Celum C, Roberts ST. Correlates of Adherence to Oral and Vaginal Pre-exposure Prophylaxis (PrEP) Among Adolescent Girls and Young Women (AGYW) Participating in the MTN-034/REACH Trial. AIDS Behav 2024:10.1007/s10461-024-04382-3. [PMID: 38852114 DOI: 10.1007/s10461-024-04382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/10/2024]
Abstract
We evaluated correlates of adherence to PrEP, including daily oral tenofovir disoproxil fumarate in combination emtricitabine (oral FTC/TDF) and the monthly dapivirine ring (ring)among adolescent girls and young women (AGYW) in the MTN-034/REACH study. We enrolled 247 AGYW aged 16-21 years in South Africa, Uganda and Zimbabwe (ClinicalTrials.gov: NCT03074786). Participants were randomized to the order of oral FTC/TDF or ring use for 6 months each in a crossover period, followed by a 6-month choice period. We assessed potential adherence correlates-individual, interpersonal, community, study, and product-related factors-quarterly via self-report. We measured biomarkers of adherence monthly; high adherence was defined as > 4 mg dapivirine released from returned rings or intracellular tenofovir diphosphate levels ≥ 700 fmol/punch from dried blood spots (DBS). We tested associations between correlates and objective measures of high adherence using generalized estimating equations. High adherence to oral FTC/TDF was significantly associated with having an older primary partner (p = 0.04), not having exchanged sex in the past 3 months (p = 0.02), and rating oral FTC/TDF as highly acceptable (p = 0.003). High ring adherence was significantly associated with unstable housing (p = 0.01), disclosing ring use to a male family member (p = 0.01), and noting a social benefit from study participation (p = 0.03). All associations were moderate, corresponding to about 6%-10% difference in the proportion with high adherence. In our multinational study, correlates of adherence among African AGYW differed for oral FTC/TDF and the ring, highlighting the benefit of offering multiple PrEP options.
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Affiliation(s)
- Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Box 19704-00202, Nairobi, Kenya.
- Department of Global Health, University of Washington, Seattle, USA.
| | - Erica N Browne
- Women's Global Health Imperative (WGHI), RTI International, Berkeley, CA, USA
| | - Krishnaveni Reddy
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ariane van der Straten
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA
- ASTRA Consulting, Kensington, CA, USA
| | - Thesla Palanee-Phillips
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rita Nakalega
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Brenda Gati
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Hadijah N Kalule
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Bekezela Siziba
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | | | | | - Connie Celum
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Sarah T Roberts
- Women's Global Health Imperative (WGHI), RTI International, Berkeley, CA, USA
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Becker M, Mishra S, Bhattacharjee P, Musyoki H, Tennakoon A, Leung S, Cheuk E, Lorway R, Isac S, Ma H, Cholette F, Sandstrom P, Gichangi P, Mwatelah R, Mckinnon L, Blanchard J, Pickles M. Differential Burden of HIV Among Adolescent Girls and Young Women by Places Associated With Sex Work: An Observational Study in Mombasa, Kenya. J Acquir Immune Defic Syndr 2024; 96:121-129. [PMID: 38771751 DOI: 10.1097/qai.0000000000003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/02/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The design of HIV prevention programs for adolescent girls and young women (AGYW) are informed by data on who is at highest risk and where they can be reached. Places (hotspots) associated with selling sex are an established outreach strategy for sex work (SW) programs but could be used to reach other AGYW at high risk. SETTING This study took place in Mombasa, Kenya. METHODS We conducted a cross-sectional, bio-behavioural survey among (N = 1193) sexually active AGYW aged 14-24 years recruited at hotspots. We compared HIV prevalence by subgroup (SW; transactional sex, TS; and non-transactional sex), stratified by hotspot type (venues and nonvenues). We examined whether associations between HIV prevalence and hotspot/subgroup remained after adjustment for individual-level risk factors, and estimated HIV prevalence ratio with and without adjustment for these individual-level factors. RESULTS Overall HIV prevalence was 5.6%, 5.3% in venues and 7.3% in nonvenues. Overall SW HIV prevalence was 2-fold higher than among participants engaged in nontransactional sex. After adjusting for age and individual-level risk factors, HIV prevalence was 2.72 times higher among venue-based SWs (95% confidence interval: 1.56 to 4.85) and 2.11 times higher among nonvenue AGYW not engaged in SW (95% confidence interval: 0.97 to 4.30) compared with venue-based AGYW not engaged in SW. CONCLUSION AGYW who sell sex remain at high risk of HIV across types of hotspots. The residual pattern of elevated HIV burden by AGWY subgroup and hotspot type suggests that unmeasured, network-level factors underscore differential risks. As such, hotspots constitute a "place" to reach AGYW at high risk of HIV.
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Affiliation(s)
- Marissa Becker
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Aruni Tennakoon
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stella Leung
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Eve Cheuk
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rob Lorway
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- India Health Action Trust, New Delhi, India
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- National HIV and Retrovirology Laboratories, J.C. Wilt Infectious Diseases Research Centre at the National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, J.C. Wilt Infectious Diseases Research Centre at the National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | | | - Ruth Mwatelah
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Lyle Mckinnon
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya; and
| | - James Blanchard
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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Ibitoye M, Sandfort TGM, Bingenheimer JB, Sommer M. The sexual and reproductive health covariates of early menarche among adolescent girls. J Adolesc 2024; 96:789-802. [PMID: 38297495 DOI: 10.1002/jad.12298] [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: 04/07/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Research suggests that girls who reach menarche at an early age are at greater risk for negative sexual and reproductive health (SRH) outcomes than their later-maturing counterparts, but very little research has examined this issue in sub-Saharan Africa, especially in West Africa. The goal of the current study was to determine whether early menarche was associated with any SRH outcomes in a sample of Ghanaian girls. METHODS The study data were drawn from the baseline assessment of a longitudinal study involving two age cohorts (13-14 and 18-19 years) of 700 adolescent girls from Ghana. Logistic regressions were used to assess the association between early menarche (before age 13) and seven SRH outcomes (adolescent sexual activity, early sexual initiation, inconsistent condom use, transactional sex, sexual violence, multiple sexual partners, and adolescent pregnancy). RESULTS Early menarche was significantly associated with adolescent sexual activity (odds ratio [OR] = 6.4; 95% confidence interval [CI] 2.1-19.7), and sexual violence (OR = 3.2; 95% CI 1.6-6.2) in the younger cohort and early sexual initiation (OR = 3.2; 95% CI 1.19-8.61) and multiple sexual partners (OR = 3.7; 95% CI 1.39-9.87) in the older cohort. Early menarche was also associated with transactional sex and teen pregnancy in the full sample. CONCLUSIONS These findings suggest the need for special attention to the needs of early-maturing girls in SRH programming. Interventions are needed to delay adolescent sexual activity in girls with early menarche. Efforts to prevent sexual violence among adolescent girls in Ghana may benefit from targeting and addressing the specific needs of early-maturing girls.
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Affiliation(s)
- Mobolaji Ibitoye
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Theo G M Sandfort
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Jeffrey B Bingenheimer
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
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Gabster A, Mayaud P, Jhangimal M, Pascale JM, Francis SC, Cislaghi B. Social norms that sustain transactional sex and associations with sexual health outcomes: A mixed-methods study in the Comarca Ngäbe-Buglé, a rural-Indigenous region of Panama. PLoS One 2024; 19:e0304805. [PMID: 38820484 PMCID: PMC11142491 DOI: 10.1371/journal.pone.0304805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/17/2024] [Indexed: 06/02/2024] Open
Abstract
The Comarca Ngäbe-Buglé (CNB), home to >200,000 Indigenous people, is one of the poorest regions in Panama. We describe transactional sex (TS) behaviours, normative beliefs and factors associated with TS among Indigenous adolescents(14-19years) in the CNB. We conducted a mixed-methods study in the CNB between January and November 2018, which included a qualitative study with participant observation and semi-structured interviews that focused on descriptive norms related to TS; and a cross-sectional study among public-school-going adolescents using self-administered questionnaire to report sexual behaviour and injunctive norms related to TS. Participants in the epidemiological study were also asked to submit samples for HIV, syphilis, chlamydia, and gonorrhoea testing. Qualitative thematic analysis was used to organise and analyse field notes and semi-structured interviews. Quantitative analysis included four models: TS experience and acceptance of a TS offer and the associations of these outcome variables with demographic and behavioural variables and HIV/STI infections. In the qualitative study among 20 adolescents, we found that people offering TS were reported to be from within and outside of the community, and included older men and women, and disturbingly, teachers. Participants reported feeling individual and collective agency in the decision to engage in TS and described little social sanctions for participation. In the quantitative study among 700 adolescents(309 girls[45.1%],379 boys[54.9%]), we found that girls(18.8%;58/309) and boys(15.5%;58/379) reported similar levels of having been offered TS, and of acceptance among those offered(girls 81.4% [35/43]; boys 77.8% [35/45]). TS was found to be associated with the reported forced sex and HIV/syphilis seropositivity. Due to widespread acceptance and feelings of agency, interventions would not be effective if they focused on eliminating the transactional component of sexual encounters. Instead, interventions should focus on individual and household economic stability, increasing violence reporting, bringing perpetrators to justice, and adopting condom use during all sexual encounters.
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Affiliation(s)
- Amanda Gabster
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Panamá
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sistema Nacional de Investigación, SENACYT, Panamá City, Panamá, Panamá
- Center of Population Sciences for Health Equity, Florida State University, Tallahassee, FL, United States of America
| | - Philippe Mayaud
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mónica Jhangimal
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Panamá
| | - Juan Miguel Pascale
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Panamá
- Facultad de Medicina, Universidad de Panamá, Panamá City, Panamá, Panamá
| | | | - Ben Cislaghi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Thiaw Y, Nyothach E, Zulaika G, van Eijk AM, Fwaya E, Obor D, Phillips-Howard P, Mason L. "He'll come with some sugar." A qualitative study exploring the drivers and consequences of schoolgirls transactional sex behaviours. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1325038. [PMID: 38800526 PMCID: PMC11119281 DOI: 10.3389/frph.2024.1325038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
Intoduction Transactional sex (TS) is common in areas of sub-Saharan Africa, motivated by reasons beyond financial support. Through this qualitative study we sought to understand the motivation driving TS among adolescent schoolgirls in rural western Kenya where rates are reportedly high. Identifying and understanding drivers within the local context is necessary for implementation of successful public health policy and programming to reduce the associated harms impacting health and wellbeing. Methods To understand the drivers of sexual behaviors, individual views, and socio-cultural norms, we spoke with schoolgirls, male peers, parents and teachers. The three latter groups may influence, encourage, and shape girls' views and behaviors and thus contribute to the perpetuation of cultural and societal norms. Results One hundred and ninety-nine participants took part across 20 FGDs; 8 comprised of schoolgirl groups, and 4 each of schoolboy, parent or teacher groups. Through thematic analysis, poverty emerged as the key driver of TS and a normative behaviour amongst secondary school girls. Subthemes including parental influence, need for menstrual pads, pressure from boda boda drivers, peer pressure, and blame were part of a complex relationship linking poverty with TS. Discussion We conclude that whilst TS is perceived as inevitable, normal and acceptable it is not really a choice for many girls. Exploring ways to encourage communication between families, including around menstruation, may help enable girls to ask for help in acquiring essential items. In addition, education at a community level may shift social norms over time and decrease the prevalence of age-disparate TS among schoolgirls and older, wealthier men in the community.
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Affiliation(s)
- Yandé Thiaw
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisian, Kenya
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Eunice Fwaya
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisian, Kenya
| | - David Obor
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisian, Kenya
| | - Penelope Phillips-Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Rogers K, Kajula L, Kilonzo MN, Palermo T, Ranganathan M, Collins RL, Livingston JA, Yamanis T. 'You are looked upon as a luxury tool': Young Tanzanian women's perception of community norms supporting partner violence during transactional sex ( kudanga). CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38669268 DOI: 10.1080/13691058.2024.2339280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
This paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls' and young women's vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga.
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Affiliation(s)
- Kate Rogers
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Lusajo Kajula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
| | - Mrema Noel Kilonzo
- UNICEF Office of Research, Innocenti, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | | | - R Lorraine Collins
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Thespina Yamanis
- School of International Service, American University, WA, DC, USA
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Pichon M, Buller AM, Gimunta V, Rutenge O, Thiaw Y, Sono R, Howard-Merrill L. Qualitative evaluation of an edutainment intervention to prevent age-disparate transactional sex in Tanzania: Changes in educational aspirations and gender equitable attitudes towards work. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002527. [PMID: 38568918 PMCID: PMC10990206 DOI: 10.1371/journal.pgph.0002527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
Age-disparate transactional sex is a major contributor to the disproportionate rates of HIV experienced by adolescent girls in sub-Saharan Africa, and a key driver of unintended adolescent pregnancy. This paper comprises one element of the impact evaluation of the Learning Initiative on Norms, Exploitation and Abuse (LINEA) radio drama intervention to prevent age-disparate transactional sex. It provides new insights into the radio drama's influence on distal drivers of age-disparate transactional sex identified in formative research: girls' own educational aspirations, and gendered attitudes towards work. The intervention, which targeted adolescent girls and their caregivers in the Shinyanga Region of Tanzania, uses an edutainment approach to prevent transactional sex between girls aged 12-16 years and men at least 5-10 years older. We distributed the 39-episode radio drama on USB flash drives to 331 households and conducted longitudinal in-depth interviews with 59 participants. We conducted a thematic analysis of endline (December 2021) transcripts from 23 girls, 18 women caregivers, and 18 men caregivers of girls (n = 59), and midline (November 2021) transcripts from a sub-sample of these participants: 16 girls, 16 women and 13 men (n = 45). Findings suggest the radio drama created an enabling environment for preventing age-disparate transactional sex by increasing girls' motivation to focus on their studies and remain in school. There was also strong evidence of increased gender-equitable attitudes about work among girls and women and men caregivers. These supported women joining the workforce in positions traditionally reserved for men and challenging the male provider role. Our findings suggest that the LINEA radio drama can supplement interventions that address structural drivers of age-disparate transactional sex. The radio drama may also have impacts beyond preventing age-disparate transactional sex, such as reducing girls' HIV morbidity and mortality, and challenging attitudes that promote sexual and gender-based violence to foster more gender-equitable communities across Tanzania.
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Affiliation(s)
- Marjorie Pichon
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ana Maria Buller
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Oscar Rutenge
- Tanganyika Christian Refugee Service, Dar es Salaam, United Republic of Tanzania
| | - Yandé Thiaw
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Revocatus Sono
- Amani Girls Organization, Mwanza, United Republic of Tanzania
| | - Lottie Howard-Merrill
- Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom
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Puffer H, Hodson G, Prusaczyk E. Attitudes Toward Cisgender Women's Participation in Sex Work: Opportunity for Agency or Harmful Exchange? ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1169-1185. [PMID: 38285296 DOI: 10.1007/s10508-023-02797-y] [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] [Received: 11/24/2022] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
Despite the stigmatization of sex work in society, little empirical research has examined attitudes toward sex work, especially its modern incarnations (e.g., sugar relationships, webcamming). Here, a sample of 298 US residents (Mage = 40.06 years; 59.1% male, 40.9% female) was recruited through Amazon Mechanical Turk. Various theoretical predictors (e.g., right-wing authoritarianism [RWA]), sociosexuality) were set to predict the degree to which four sex work domains (prostitution, pornography, sugar relationships, webcamming) provide cisgender women agency (beneficial) or harm them (detrimental). We found that the domains of sex work were organized hierarchically, as theorized by the so-called "whorearchy," whereby the more "unfavorable" domains (e.g., prostitution) fall at the bottom, and the more "favorable" ones (e.g., webcamming) sit at the top. Additionally, multiple regression analyses revealed that RWA (negatively) and sociosexuality (positively) were the strongest predictors of sex work agency across various domains. In predicting harm, RWA, feminism, religiosity, and age were unique positive predictors, whereas sociosexuality and male (vs. female) self-identified sex were unique negative predictors, across the four domains of sex work. Moreover, individual differences (e.g., RWA) were often significantly stronger predictors of agency or harm among female than male participants. The results suggest that although sex work domains vary in agency and harm ratings, individual differences (most notably, RWA and sociosexuality) are important predictors across domains, especially for cisgender women. Given the growing prevalence of such online forms of sex work, along with growing evidence of sugar relationships, it will become increasingly important to track reactions as these forms of sex work evolve.
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Affiliation(s)
- Hanna Puffer
- Department of Psychology, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada.
| | - Gordon Hodson
- Department of Psychology, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Elvira Prusaczyk
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
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Massetti GM, Stamatakis C, Charania S, Annor FB, Rice CE, Hegle J, Ramphalla P, Sechache M, Motheo M. Prevalence of Functional Disabilities and Associations Among Disabilities, Violence, and HIV Among Adolescents and Young Adults in Lesotho. J Epidemiol Glob Health 2024; 14:223-233. [PMID: 38498114 PMCID: PMC11043310 DOI: 10.1007/s44197-023-00184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/22/2023] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Lesotho has the second-highest prevalence of HIV. Despite progress in achieving HIV epidemic control targets, inequities persist among certain groups, particularly associations between disability, HIV, and violence. We assessed the prevalence of disability and examined associations between disability and HIV and violence using data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS). METHODS Lesotho VACS was a nationally representative survey of females and males ages 13-24. We assessed the associations between disability status and HIV, sexual risk behaviours, and violence using logistic regression, incorporating survey weights. RESULTS Weighted functional disability prevalence was 14.1% for females (95% confidence interval [CI] 12.7-15.4) and 7.3% for males (5.3-9.2). Compared with females with no disabilities, females with disabilities had higher odds of being HIV positive (adjusted odds ratio [aOR] 1.92, 1.34-2.76), having transactional sex (aOR 1.79, 1.09-2.95), and experiencing any lifetime violence (aOR 2.20, 1.82-2.65), sexual violence (aOR 1.77, 1.36-2.31), emotional violence (2.02. 1.61-2.53), physical violence (aOR 1.85, 1.54-2.24), witnessing interparental violence (aOR 1.71, 1.46-2.01), and witnessing community violence (aOR 1.52, 1.26-1.84). Males with disabilities had higher odds of having transactional sex (aOR 4.30, 1.35-13.73), having recent multiple sex partners (aOR 2.31, 1.13-4.75), experiencing emotional violence (aOR 2.85, 1.39-5.82), and witnessing interparental violence (aOR 1.78, 1.12-2.84). HIV models for males did not converge due to low numbers. CONCLUSION Findings emphasize the importance of inclusion and accessibility for adolescents and young adults with disabilities in prevention and services for violence and HIV. Ending HIV in Lesotho depends on addressing the vulnerabilities that lead to potential infection including violence and ensuring equitable services for all.
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Affiliation(s)
- Greta M Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Caroline Stamatakis
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Sana Charania
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Catherine E Rice
- Divison of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Atlanta, USA
| | - Jennifer Hegle
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, USA
| | - Puleng Ramphalla
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Maseru, Lesotho
| | | | - Mookho Motheo
- Ministry of Social Development, Government of Lesotho, Maseru, Lesotho
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10
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Oswald G. Baiting the hook: Fish scarcity, gendered division of labour, and the fish-for-sex trade. Soc Sci Med 2024; 345:116594. [PMID: 38382334 DOI: 10.1016/j.socscimed.2024.116594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/27/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024]
Abstract
Transactional sex in sub-Saharan Africa's fishing communities, driven by the highly gendered organisation of production, is widely recognised as a key driver of HIV transmission in lakeshore areas. This longitudinal study investigates the economic drivers of the trade and its impact on sexual health outcomes. Specifically, the impact of regional and district fish market shocks and comparable maize shocks on facility-level sexual health outcomes are examined in Tanzania's shoreline communities. Following unfavourable shocks to the fish market, such as high prices or low amounts of fish captured, this paper finds that new HIV cases, newly pregnant women attending antenatal clinic, and the number of people treated for syphilis increases with proximity to the shoreline, supporting the hypothesis that the fish-for-sex trade intensifies when fish supply is relatively scarce. Further, the observed increase in new HIV cases is driven by new cases in women. Contrasting effects are observed following maize price shocks, where facilities see an increase in both male and female new HIV cases following a favourable price shock. These findings highlight the role that gender-based organisation of production plays in shaping sexual health inequalities following shocks to a good.
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Affiliation(s)
- Grace Oswald
- London School of Economics and Political Science (LSE), UK; LSE Department of Economics, 32 Lincoln's Inn Fields, London, WC2A 3PH, UK.
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11
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Zuilkowski SS, Quinones S, Kihanzah H, Marwerwe G, Prencipe L, Kajula L, Palermo T. Economic vulnerabilities, mental health, and coping strategies among Tanzanian youth during COVID-19. BMC Public Health 2024; 24:577. [PMID: 38388862 PMCID: PMC10885560 DOI: 10.1186/s12889-024-18074-z] [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: 09/19/2022] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated struggles for youth living in poor households. Youth in rural Tanzania are particularly vulnerable given widespread poverty, lack of formal sector employment opportunities, and health risks. We examine influences of the pandemic on economic insecurity and mental health and explore the coping strategies employed by youth and their households. METHODS We conducted mixed-method data collection with youth (N = 760 quantitative and N = 44 qualitative interviews) and households (n = 542) via mobile phone among a sub-set of a cohort from an on-going longitudinal sample in two rural regions in Tanzania. In addition to phone interviews, we collected data bi-weekly via SMS messaging. We present mixed-methods, descriptive analysis of the outcomes and longitudinally compare quantitative outcomes pre- and post-COVID-19, within the same individuals. RESULTS Adverse economic impacts were most salient, and to cope, youth engaged in more labor and domestic chores. Compared to prior the COVID-19 pandemic, youth reported spending more time caring for elderly or sick household members and gathering firewood or nuts. CONCLUSIONS These findings underscore the potential opportunity to promote policies and programs which address risks youth face. Recommended measures include expansion and adaptation of social protection policies, strengthened food and nutrition surveillance and referral systems, and scaling up community-based mental health programming.
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Affiliation(s)
- Stephanie Simmons Zuilkowski
- Educational Leadership and Policy Studies Learning Systems Institute University Center C4600, Florida State University, Tallahassee, FL, USA.
| | - Sarah Quinones
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, University at Buffalo (State University of New York) , Buffalo, NY, USA
| | - Hassan Kihanzah
- Independent Researcher , and University at Buffalo (State University of New York) , Dar es Salaam, Tanzania
| | - Graca Marwerwe
- Independent Researcher , and University at Buffalo (State University of New York) , Dar es Salaam, Tanzania
| | - Leah Prencipe
- Department of Social Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - Lusajo Kajula
- Independent Researcher , and Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, University at Buffalo (State University of New York) , Buffalo, NY, USA
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12
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Magni S, Hatcher A, Gibbs A, Wamoyi J, Dunkle K, Christofides N. Pathways to transactional sex among peri-urban South African women: the role of relationship control, food insecurity and alcohol misuse. AIDS Care 2024:1-8. [PMID: 38334776 DOI: 10.1080/09540121.2024.2307385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
Transactional sex increases sub-Saharan African women's risk of HIV acquisition. We quantitatively explored the pathways contributing towards women's future engagement in transactional sex with casual partners and khwapheni (secret concurrent sex partners). We conducted secondary data analysis from a cluster randomised controlled trial in urban informal settlements in eThekwini Municipality., South Africa. Data were collected at enrolment (t0) and 24 months' later (t2) using self-completed questionnaires. Structural equation modelling (SEM) assessed pathways leading to transactional sex over two years. 677 women 18-35 years were enrolled and 80.5% (n = 545) were followed up. At t2, 44.6% of respondents reported transactional sex with a casual partner or khwapheni. The SEM demonstrated a small effect (d = 0.23) between transactional sex at t0 and at t2. Controlling for past transactional sex, main partner relationship control had a large effect size on future transactional sex (d = 0.60). Hazardous drinking had a medium effect size (d = 0.45) and food insecurity a small effect (d = 0.24), (RMSEA 0.03, 90%CI 0.02-0.04; CFI 0.97; TLI 0.96). HIV prevention programming should highlight current transactional sex but also address structural issues predicting future transactional sex, including food insecurity and alcohol misuse. Gender transformative interventions to reduce controlling behaviours in main relationships are worth investigating.
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Affiliation(s)
- Sarah Magni
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Genesis Analytics, Johannesburg, South Africa
| | - Abigail Hatcher
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Psychology, Faculty of Life and Health Sciences, University of Exeter, Exeter, UK
- Institute of Global Health, University College London, London, UK
| | - Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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13
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Sheira LA, Izudi J, Gatare E, Packel L, Kayitesi L, Sayinzoga F, Hope R, McCoy SI. Food Insecurity and Engagement in Transactional Sex Among Female Secondary Students in Rwanda. AIDS Behav 2024; 28:135-140. [PMID: 37792235 PMCID: PMC10803384 DOI: 10.1007/s10461-023-04173-2] [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: 09/09/2023] [Indexed: 10/05/2023]
Abstract
The relationship between food insecurity and transactional sex is well recognized, but less is known about this relationship among adolescents. We analyzed cross-sectional baseline data from 3,130 female secondary students aged 12-19 enrolled in a three-arm, cluster randomized controlled trial to examine the association between food insecurity and transactional sex. The explanatory variable was food security and the outcome was ever engaging in transactional sex. Over one quarter (28.7%) reported any food insecurity and 1.9% of all participants (9.6% of sexually active participants) reported ever engaging in transactional sex. In adjusted models, ever experiencing any food insecurity was associated with a higher prevalence of ever transactional sex (PR: 1.60; 95% CI: 1.02, 2.49) compared to little to no food insecurity. These results provide insight into potential predictors of higher-risk sexual behavior in Rwanda; they also provide policy-makers with populations with whom to intervene on upstream determinants of transactional sex, notably poverty and food insecurity.
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Affiliation(s)
- Lila A Sheira
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA.
| | - Jonathan Izudi
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Laura Packel
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
| | | | - Felix Sayinzoga
- Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | | | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
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14
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Browne EN, Torjesen K, Mirembe BG, Palanee-Phillips T, Jeenarain N, Chitukuta M, Stoner MCD, Mansoor LE, Reddy K, Tauya TT, Naidoo L, Siva S, Richardson B, Dadabhai S, Seyama L, Soto-Torres L, van der Straten A. Acceptability of the dapivirine vaginal ring for HIV-1 prevention among women reporting engagement in transactional sex. AIDS Care 2024; 36:80-86. [PMID: 37066990 PMCID: PMC10579446 DOI: 10.1080/09540121.2023.2198187] [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: 03/29/2022] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
We assessed if acceptability of the dapivirine vaginal ring for HIV prevention differed among the subgroup of women who reported engaging in transactional sex prior to enrollment in MTN-020/ASPIRE (phase III trial in Malawi, South Africa, Uganda, and Zimbabwe, 2012-2015; n = 2629). Transactional sex was defined as receipt of money, goods, gifts, drugs, or shelter in exchange for sex in the past year. Dimensions of acceptability included: ease of use and physical sensation in situ, impacts on sex, partner's opinion, and likelihood of future use. We used Poisson regression models with robust standard errors to compare risk of acceptability challenges by baseline history of transactional sex. At product discontinuation, women exchanging sex found the ring comfortable (90%), easy to insert (92%) and nearly all (96%) were likely to use the ring in the future. Women who had exchanged sex were more likely to report feeling the ring during sex (ARR 1.43, 95% CI: 1.09, 1.89; p = 0.01) and slightly more likely to mind wearing the ring during menses (ARR 1.22, 95% CI: 1.01, 1,46; p = 0.04) and during sex (ARR 1.22, 95% CI: 1.02, 1.45; p = 0.03). Messaging and counseling should include enhanced support for use during sex and menses to support optimal use.
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Affiliation(s)
- Erica N. Browne
- Women’s Global Health Imperative, RTI International,
Berkeley, CA, USA
| | | | - Brenda Gati Mirembe
- Makerere University-Johns Hopkins University Research
Collaboration, Kampala, Uganda
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, Faculty of
Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Miria Chitukuta
- University of Zimbabwe Clinical Trials Research Centre,
Harare, Zimbabwe
| | | | - Leila E. Mansoor
- Centre for the AIDS Programme of Research in South Africa
(CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, Faculty of
Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thelma T. Tauya
- University of Zimbabwe Clinical Trials Research Centre,
Harare, Zimbabwe
| | | | - Samantha Siva
- South African Medical Research Council, Durban, South
Africa
| | - Barbra Richardson
- Department of Biostatistics, University of Washington,
Seattle, WA, USA
| | - Sufia Dadabhai
- College of Medicine-John Hopkins University Research
Project, Blantyre, Malawi
| | - Linly Seyama
- College of Medicine-John Hopkins University Research
Project, Blantyre, Malawi
| | - Lydia Soto-Torres
- Division of AIDS, National Institute of Allergy and
Infectious Diseases, National Institutes of Mental Health, and Eunice Shriver
Kennedy, National Institute of Child Health and Human Development, National
Institutes of Health, Bethesda, MD, USA
| | - Ariane van der Straten
- University of California San Francisco, San Francisco, CA,
USA
- ASTRA Consulting, Kensington, PA, USA
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15
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Alonso D, Vallès X. A potential transition from a concentrated to a generalized HIV epidemic: the case of Madagascar. Infect Dis Poverty 2023; 12:112. [PMID: 38057918 DOI: 10.1186/s40249-023-01164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND HIV expansion is controlled by a range of interrelated factors, including the natural history of HIV infection and socio-economical and structural factors. However, how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood. We aim to explore these mechanisms, using Madagascar as a case-study. METHODS We developed a compartmental dynamic model using available data from Madagascar, a country with a contrasting concentrated epidemic, to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers. RESULTS The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022, and prevalence reaching stabilization by 2033 within 9 to 24% in the studied (10 out of 11) cities, similar to high-prevalence regions in Southern Africa. The late/slow introduction of HIV and circumcision, a widespread traditional practice in Madagascar, could have slowed down HIV propagation, but, given the key interplay between risky behaviors associated to young women and acute infections prevalence, mediated by transactional sex, the protective effect of circumcision is currently insufficient to contain the expansion of the disease in Madagascar. CONCLUSIONS These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic. This case-study model could help to understand how this HIV epidemic transition occurs.
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Affiliation(s)
- David Alonso
- Computational and Theoretical Ecology, Spanish Council for Scientific Research (CEAB-CSI)C, C/Access Cala Francesc, 14, 17300, Blanes, Spain
| | - Xavier Vallès
- International Health Program (PROSICS), North Metropolitan Health Area From Barcelona, Hospital Universitari Germans Trias i Pujol, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain.
- Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, C/Canyet s/n, 08916, Badalona, Spain.
- Fundació Lluita contra les Infeccions, C/Canyet s/n, 08916, Badalona, Spain.
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16
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Ghadirian MZ, Omer K, Cockcroft A. Determinants of Adolescent Sexual and Reproductive Health in Sub-Saharan Africa: Protocol for an Umbrella Review. JMIR Res Protoc 2023; 12:e51278. [PMID: 37976499 PMCID: PMC10692888 DOI: 10.2196/51278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Adolescents are a large proportion of the population in sub-Saharan Africa and face multiple risks to their health and well-being. Prior systematic reviews have focused on specific adolescent sexual and reproductive health outcomes such as teen pregnancies, HIV/AIDS, and sexually transmitted diseases. A comprehensive synthesis of the influential factors that shape different aspects of adolescent sexual and reproductive health can inform health policy and program development for this important segment of the population. OBJECTIVE This paper presents the protocol for an umbrella review that aims to synthesize the existing knowledge in the literature on the associations among individual, family, and societal factors and sexual and reproductive health outcomes among adolescents in sub-Saharan Africa. METHODS We will include systematic reviews that identify factors associated with sexual and reproductive health outcomes among adolescents, 10-19 years of age, in sub-Saharan Africa. Reviews can include quantitative and qualitative primary studies with or without meta-analysis. Academic and gray literature searches will identify reviews from PubMed, Scopus, CINAHL, Cochrane Database of Systematic Reviews, ProQuest, Google, and Google Scholar. Two reviewers (MZG and KO) will independently carry out title, abstract, and full text screening, assess methodological quality, and extract data. We will assess the methodological quality of the included studies using the Joanna Briggs Institute standard forms. The review will present findings in narrative form and in tables and will follow PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. RESULTS A preliminary search in April 2023 found 1351 articles to be screened. CONCLUSIONS This umbrella review will permit a comprehensive and high-level understanding of the various factors that influence adolescent sexual and reproductive health in sub-Saharan Africa. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42023394512; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394512. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51278.
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Affiliation(s)
| | - Khalid Omer
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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17
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Doyisa N, Maharaj P, Dunn S. Older men, younger women: blesser-blessee relationships among university students in Durban, South Africa. CULTURE, HEALTH & SEXUALITY 2023; 25:1530-1542. [PMID: 36633499 DOI: 10.1080/13691058.2022.2164065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
In sub-Saharan Africa, sexual relationships between younger women and older men have been shown to pose a risk of HIV transmission. In South Africa, there has been growing interest in blesser-blessee relationships. This study explores perceptions of these relationships among university students in Durban, South Africa. The study draws on 15 in-depth interviews with students. Participants suggest that older men engage in these relationships for sexual gratification and younger women do so for monetary or material gain. Interviews revealed that participants believed that these relationships are common with both men and women engaging in them and putting themselves at risk of HIV infection. It is imperative to explore the context and motivation for these relationships because of their broader social and health implications. In addition, greater effort should be geared towards addressing the underlying factors that facilitate blesser-blessee relationships.
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Affiliation(s)
- Nompumelelo Doyisa
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Shanaaz Dunn
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
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18
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Lipira LE, Glick JL, German D, Glick SN, Moreno C, Elimam D, Brantley ML, Pichon LC, Barak N, Booth MM, Flynn C, Menza T. Type of Exchange Sex and Associated Behaviors and Outcomes Among Cisgender Men and Women at Increased Risk for HIV via Heterosexual Transmission in Six U.S. Metropolitan Areas. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3313-3327. [PMID: 37612535 DOI: 10.1007/s10508-023-02663-x] [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] [Received: 01/06/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023]
Abstract
Exchange sex is associated with sexual risk behaviors and poor outcomes and different types may incur different levels of risk. We assessed risk profiles of different types of exchange sex among non-injecting cisgender men and women who participated in the 2019 National HIV Behavioral Surveillance project at six sites. Six percent of men and 19% of women reported exchange sex in the past year; most engaged in non-commercial exchange sex for drugs/money with smaller percentages reporting formal sex work or non-commercial exchange sex for goods or services other than drugs/money. Exchange sex was associated with sexual risk and prevention behaviors and psychosocial and sexual health outcomes and associations varied by type of exchange sex. Efforts to improve access to STI/HIV testing and PrEP may benefit from tailoring based on type of exchange sex. Findings indicate value in a broader definition of exchange sex with follow-up assessment of exchange sex typology.
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Affiliation(s)
- Lauren E Lipira
- Regional Research Institute, Portland State University, Portland, OR, USA.
- Public Health Division, Oregon Health Authority, 800 NE Oregon St, Portland, OR, 97232, USA.
| | - Jennifer L Glick
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Courtney Moreno
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Dena Elimam
- Epidemiology Section, Georgia Department of Public Health, Division of Health Protection, Atlanta, GA, USA
| | - Meredith L Brantley
- HIV/STI/Viral Hepatitis Section, Tennessee Department of Health, Nashville, TN, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | | | | | - Colin Flynn
- Maryland Department of Health, Baltimore, MD, USA
| | - Timothy Menza
- Public Health Division, Oregon Health Authority, 800 NE Oregon St, Portland, OR, 97232, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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19
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Omanga E, Inwani I, Agot K, Buttolph J, Nduati R, Macharia P, Onyango J, Kurth A. Understanding sexual behaviors of youth from the lens of caregivers, teachers, local leaders and youth in Homabay County, Kenya. Reprod Health 2023; 20:141. [PMID: 37723500 PMCID: PMC10507942 DOI: 10.1186/s12978-023-01680-2] [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: 11/25/2022] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
In Kenya similar to other countries in Eastern and Southern Africa There is a disproportionately high burden of the global HIV incidence among youth ages 15-24 years, and where adolescent girls and young women account for up to a third of all incident HIV infections and more than double the burden of HIV compared to their male peers. Previous work has shown early sexual debut as entry point into risks to sexual and reproductive health among young people including STI/HIV acquisition. This was a formative assessment of the local context of three sexual risk behaviors among youth ages of 15-24 years: early sexual debut, multiple sexual partnerships, and age-mixing /intergenerational sex for purposes of informing comprehensive combination HIV intervention program design. We conducted a cross-sectional formative qualitative study in four sub-counties within Homabay county a high HIV prevalence region of Kenya. Participants were recruited through youth groups, schools, government offices and, community gatekeepers using approved fliers, referred to a designated venue for focus group discussion (FGD). After oral informed consent, twelve FGDs of 8-10 participants were carried out. Transcripts and field notes were uploaded to Atlas.ti qualitative data analysis and research software (version 8.0, 2017, ATLAS.ti GmbH). Open coding followed by grouping, categorization of code groups, and thematic abstraction was used to draw meaning for the data. A total of 111 youth participated in the FGD, 65 males and 46 females. The main findings were that youth engaged in early sex for fear of being labeled 'odd' by their peers, belief (among both male and female) that 'practice makes perfect', curiosity about sex, media influence, need to prove if one can father a child (among male), the notion that sex equals love with some of the youth using this excuse to coerce their partners into premature sex, and the belief that sex is a human right and parents/guardians should not intervene. Male youth experienced more peer-pressure to have sex earlier. Female youths cited many reasons to delay coitarche that included fear of pregnancy, burden of taking care of a baby, and religious doctrines. Having multiple sexual partners and intergenerational sexual relationships were common among the youth driven by perceived financial gain and increased sexual prowess. HIV prevention strategies need to address gender vulnerabilities, as well as promoting a protective environment, hence application of combination prevention methods is a viable solution to the HIV pandemic.Trial registration number: The study was approved by the KNH/UoN Ethics review committee (KNH/UoN ERC-P73/03/2011) and New York University (NYU Reg no.-00000310).
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Affiliation(s)
| | - Irene Inwani
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jasmine Buttolph
- Yale University, New Haven, CT, USA
- United States Agency for International Development (USAID), Washington, DC, USA
| | - Ruth Nduati
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Paul Macharia
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Jacob Onyango
- Impact Research and Development Organization, Kisumu, Kenya
| | - Ann Kurth
- The New York Academy of Medicin (NYAM), New York, USA
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20
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Qiu P, He H, Zhao Y, Yang Z, Li S, Ni P, Guo Y, Ji C, Zhang C, Zhang H, Zhou C, Wang B. Global disease burden attributed to unsafe sex in 204 countries and territories from 1990 to 2019: results from the Global Burden of Disease Study 2019. Sci Rep 2023; 13:12900. [PMID: 37558737 PMCID: PMC10412620 DOI: 10.1038/s41598-023-40001-2] [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: 04/06/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
Unsafe sex has become a public safety problem that endangers society, and research on deaths and disability-adjusted life years (DALYs) related to unsafe sex is valuable for global policy-making. We aimed to estimate the deaths and DALYs attributable to unsafe sex by country, gender, age group, and sociodemographic status from 1990 to 2019. We extracted data on disease burden from the Global Disease Burden 2019 (GBD 2019) database for unsafe sex, including deaths, DALYs and age-standardized rates (ASRs). Comparative analyses were performed on data about deaths, DALYs and the responding ASRs attributable to unsafe sex in different countries and regions using the Social Demographic Index (SDI). The global age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) attributable to unsafe sex were 11.98 (95% uncertainty intervals (UI): 10.97-13.52) per 100,000 people and 570.78 (95% UI: 510.24-658.10) per 100,000 people, respectively. Both the ASMRs and ASDRs were the highest in southern sub-Saharan Africa and lowest in Australasia and decreased with increasing SDI levels. About unsafe-sex-related disease, HIV/AIDS has the highest ASMR [8.48 (95% UI: 7.62-9.95)/100,000 people] and ASDR [447.44 (95% UI: 394.82-533.10)/100,000 people], followed by Cervical cancer [ASMR: 3.40 (95% UI: 2.90-3.81)/100,000 people and ASDR: 107.2 (95% UI: 90.52-119.43)/100,000 people] and sexually transmitted infections excluding HIV [ASMR: 0.10 (95% UI: 0.08-0.11)/100,000 people and ASDR: 16.14 (95% UI: 10.51-25.83)/100,000 people]. The death and DALY burden caused by these three diseases were more serious in the over 75 years old age group. The 40-44 age group for men and the 35-39 age group for women had the highest population of unsafe sex-related deaths and DALYs, respectively. In addition, the burden of unsafe sex in women was more serious than those in men. Unsafe sex is an important risk factor for global disease burden and a leading cause of substantial health loss. We found that the risk of ASMRs and ASDRs attributable to unsafe sex had negative correlation with SDI levels. These results demonstrate that the need for revised policies that focus on efforts to reduce overall unsafe sex worldwide.
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Affiliation(s)
- Pei Qiu
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuting Zhao
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zejian Yang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shouyu Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Peng Ni
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yujie Guo
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Ji
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chenchen Zhang
- Department of Clinical Laboratory, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
| | - Can Zhou
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China.
| | - Bo Wang
- Center for Translational Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China.
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an, China.
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21
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Stoebenau K, Bingenheimer JB, Kyegombe N, Datar R, Ddumba-Nyanzi I. Development of the Gender Roles and Male Provision Expectations Scale. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2403-2419. [PMID: 36525226 PMCID: PMC10804394 DOI: 10.1007/s10508-022-02479-1] [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] [Received: 10/22/2021] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
Existing composite measures assess the extent to which women and men support masculinity ideals concerning the expectation that men should provide for their partners and families. In many contexts across sub-Saharan Africa, the male provider role is taken as given. This core masculinity tenet may be associated with related gender role expectations that result in increasing young women's risk of HIV, especially within the context of transactional sex relationships. Extant literature points to five domains potentially associated with male provider role expectations: male authority, men's sexual decision-making control, women's sexual agency, women's economic dependence, and love. The goal of this study was to develop the Gender Roles and Male Provision Expectations (GRMPE) scale toward understanding whether beliefs attached to male provider role expectations increase HIV risk. We developed the GRMPE across three research phases with young women (ages 15-24) in Central Uganda that (1) used qualitative data to refine domains and develop scale items; (2) cognitively tested the refined items; and (3) pilot tested a 26-item scale across five domains with 108 young women. Using confirmatory factor analyses, we retained 15 items across four factors, corresponding to the domains of male authority, sexual decision-making, women's sexual agency, and love; which we then modeled as indicators in a single second-order factor model. The GRMPE demonstrated initial reliability and validity, and tests of criterion validity found significant associations with known HIV risk behaviors. The GRMPE scale shows promise for better examining the determinants of HIV risk and assessing gender norm change interventions.
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Affiliation(s)
- Kirsten Stoebenau
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD, 20742, USA.
| | - Jeffrey Bart Bingenheimer
- Department of Prevention and Community Health, Milken School of Public Health, George Washington University, Washington, D.C, USA
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Reva Datar
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD, 20742, USA
| | - Ismael Ddumba-Nyanzi
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
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22
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Rudgard WE, Saminathen MG, Orkin M, Banougnin BH, Shenderovich Y, Toska E. Protective factors for adolescent sexual risk behaviours and experiences linked to HIV infection in South Africa: a three-wave longitudinal analysis of caregiving, education, food security, and social protection. BMC Public Health 2023; 23:1452. [PMID: 37516833 PMCID: PMC10386676 DOI: 10.1186/s12889-023-16373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Structural interventions are endorsed to enhance biomedical and behavioural HIV prevention programmes for adolescents. Aiming to inform future interventions, we evaluated longitudinal associations between six protective factors that link closely to existing structural HIV prevention interventions, and five sexual risk behaviours for HIV transmission in a cohort of adolescents in South Africa. METHODS We used three rounds of data between 2014-2018 on 1046 adolescents living with HIV and 473 age-matched community peers in South Africa's Eastern Cape (Observations = 4402). We estimated sex-specific associations between six time-varying protective factors - number of social grants, education enrolment, days with enough food, caregiver supervision, positive caregiving, and adolescent-caregiver communication; and five HIV risk behaviours - multiple sexual partners, transactional sex, age-disparate sex, condomless sex, and sex on substances. HIV risk behaviours were analysed separately in multivariable random effects within-between logistic regression models that accounted for correlation of repeated observations on the same individual. We calculated prevalence ratios (PR), contrasting adjusted probabilities of HIV risk behaviours at 'No' and 'Yes' for education enrolment, and average and maximum values for the other five protective factors. RESULTS The sample mean age was 15.29 (SD: 3.23) years and 58% were girls. Among girls, within-individuals, increases from mean to maximum scores in positive caregiving were associated with lower probability of transactional sex (PR = 0.79; 95%CI = 0.67-0.91); in caregiver supervision were associated with lower probability of transactional sex (PR = 0.75; 95%CI = 0.66-0.84), and age-disparate sex (PR = 0.84; 95%CI = 0.73-0.95); in adolescent-caregiver communication were associated with higher probability of transactional sex (PR = 1.70; 95%CI = 1.08-2.32); and in days with enough food at home were associated with lower probability of multiple sexual partners (PR = 0.89; 95%CI = 0.81-0.97), and transactional sex (PR = 0.82; 95%CI = 0.72-0.92). Change from non-enrolment in education to enrolment was associated with lower probability of age-disparate sex (PR = 0.49; 95%CI = 0.26-0.73). Between-individuals, relative to mean caregiver supervision scores, maximum scores were associated with lower probability of multiple sexual partners (PR = 0.59; 95%CI = 0.46-0.72), condomless sex (PR = 0.80; 95%CI = 0.69-0.91), and sex on substances (PR = 0.42; 95%CI = 0.26-0.59); and relative to non-enrolment, education enrolment was associated with lower probability of condomless sex (PR = 0.59; 95%CI = 0.39-0.78). Among boys, within-individuals, increases from mean to maximum scores in positive caregiving were associated with lower probability of transactional sex (PR = 0.77; 95%CI = 0.59-0.96), and higher probability of condomless sex (PR = 1.26; 95%CI = 1.08-1.43); in caregiver supervision were associated with lower probability of multiple sexual partners (PR = 0.73; 95%CI = 0.64-0.82), transactional sex (PR = 0.63; 95%CI = 0.50-0.76), age-disparate sex (PR = 0.67; 95%CI = 0.49-0.85), and sex on substances (PR = 0.61; 95%CI = 0.45-0.78), and in days with enough food at home were associated with lower probability of transactional sex (PR = 0.91; 95%CI = 0.84-0.98). CONCLUSION Effective structural interventions to improve food security and education enrolment among adolescent girls, and positive and supervisory caregiving among adolescent girls and boys are likely to translate into crucial reductions in sexual risk behaviours linked to HIV transmission in this population.
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Affiliation(s)
- William E Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, OX1 2ER, UK.
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
| | | | - Mark Orkin
- MRC/Wits Development Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Yulia Shenderovich
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, OX1 2ER, 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
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23
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Agathis NT, Annor FB, Xu L, Swedo E, Chiang L, Coomer R, Hegle J, Patel P, Forster N, O’Malley G, Ensminger AL, Kamuingona R, Andjamba H, Nshimyimana B, Manyando M, Massetti GM. Strong Father-Child Relationships and Other Positive Childhood Experiences, Adverse Childhood Experiences, and Sexual Risk Factors for HIV among Young Adults Aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6376. [PMID: 37510608 PMCID: PMC10378761 DOI: 10.3390/ijerph20146376] [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] [Received: 03/31/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey and sex-stratified multivariable models, we assessed the associations between four different positive childhood experiences (PCEs) and having ≥3 adverse childhood experiences (ACEs), including ≥3 ACE-PCE interaction terms, and seven sexual risk factors for HIV acquisition among young adults aged 19-24 years. One PCE, having a strong father-child relationship, was inversely associated with two risk factors among women (lifetime transactional sex (OR, 0.4; 95% CI, 0.2-0.7) and recent age-disparate sexual relationships (OR, 0.3; 95% CI, 0.2-0.5)), and significantly interacted with having ≥3 ACEs for three risk factors among women (not knowing a partner's HIV status, infrequently using condoms, and ever having an STI) and one among men (having multiple sexual partners in the past year). The other PCEs were significantly associated with ≤1 HIV risk factor and had no significant interaction terms. Strong father-child relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on HIV risk among young adults in Namibia.
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Affiliation(s)
- Nickolas T. Agathis
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Francis B. Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Likang Xu
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Elizabeth Swedo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Laura Chiang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Rachel Coomer
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Private Bag, Windhoek 12029, Namibia
| | - Jennifer Hegle
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Pragna Patel
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Alison L. Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rahimisa Kamuingona
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Helena Andjamba
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Brigitte Nshimyimana
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Molisa Manyando
- US Agency for International Development, Washington, DC 20004, USA
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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24
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LoVette A, Sullivan A, Operario D, Kuo C, Harrison A, Mathews C. Social resources, resilience, and sexual health among South African adolescent girls and young women: findings from the HERStory study. CULTURE, HEALTH & SEXUALITY 2023; 25:929-943. [PMID: 35960862 PMCID: PMC9922337 DOI: 10.1080/13691058.2022.2108501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/28/2022] [Indexed: 05/30/2023]
Abstract
Socioecological factors, including social resources, influence South African adolescent girls' and young women's sexual health. Few studies have explored how these multi-level social factors relate to both resilience and sexual health in this community. This study examines if social resources mediate associations between resilience and two sexual health outcomes. A weighted-sample of 7,237 South African girls and young women (aged 15-24 years) completed a cross-sectional survey conducted from 2017 to 2018 which included a validated measure of resilience, along with measures of sexual health and social resources. Using multivariable logistic regression models and bootstrapping methods, two types of social resources were assessed as potential mediators. Increased resilience was negatively associated with early sexual debut and engagement in transactional sex. Social support mediated associations between resilience and engagement in transactional sex but did not mediate associations between resilience and early sexual debut. Of all the types of social support measured, social support from a special person mediated the largest proportion of the association between resilience and transactional sex. Examining underlying social and community dynamics related to resilience and sexual health can guide the development of future contextually-relevant programming and policies.
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Affiliation(s)
| | - Adam Sullivan
- School of Public Health, Brown University, Providence, RI, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
| | - Caroline Kuo
- School of Public Health, Brown University, Providence, RI, USA
| | | | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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25
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Joshi S, Namuddu C, Kasujja FX, Mirembe M, Homsy J, Seeley J, King R. PrEP uptake and persistence amongst HIV-negative women who exchange sex for money or commodities in Kampala, Uganda: A qualitative inquiry assessing the influence of pregnancy. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000434. [PMID: 37368866 PMCID: PMC10298783 DOI: 10.1371/journal.pgph.0000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/10/2023] [Indexed: 06/29/2023]
Abstract
Pregnant young women who exchange sex for money or commodities are at elevated biological and social risk for HIV acquisition. PrEP serves as an effective means of HIV prevention, including during pregnancy. This study aimed to explore attitudes, experiences and challenges with PrEP to understand what motivates or limits PrEP uptake and adherence specifically during pregnancy among this population of young women. Semi-structured interviews were conducted with 23 participants, recruited from the Prevention on PrEP (POPPi) study in the Good Health for Women Project clinic in Kampala, Uganda. POPPi's inclusion criteria comprised of HIV-uninfected women, aged 15-24, who exchange sex for money or commodities. Interviews focused on experience with PrEP and pregnancy. Data were analyzed utilizing a framework analysis approach. Key themes were comprised of participant barriers to and facilitators of PrEP uptake and adherence. Reasons for PrEP initiation included desire for autonomy and agency, mistrust of partners, and social support. Participants expressed challenges with initiating or sustaining their use of PrEP, including pregnancy, PrEP access and perceived or felt stigma. During pregnancy, participants' primary motivators for altering PrEP use were either understanding of PrEP safety for their baby or changes in perceptions of their HIV risk. Many of these factors were similar across participants who had experience with pregnancy and those who did not. This study highlights the importance of addressing barriers to and facilitators of PrEP uptake and persistence, especially during pregnancy where risk is elevated, with a multi-level approach. Community-oriented education, stigma reduction activities alongside access to PrEP, can serve as means for adherence. The development of robust PrEP support services and guidelines regarding PrEP use during pregnancy among high-risk women, and strategies for their implementation, are of utmost importance for the control of HIV in key populations and the elimination of mother-to-child transmission of HIV.
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Affiliation(s)
- Shivali Joshi
- Institute for Global Health Sciences, University of California, San Francisco, (UCSF), San Francisco, California, United States of America
| | - Catherine Namuddu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Francis Xavier Kasujja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Miriam Mirembe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, (UCSF), San Francisco, California, United States of America
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, (UCSF), San Francisco, California, United States of America
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26
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Sprague C, Maqsood L, George G. When Social and Personal Norms Collide: Narratives of South African Women Navigating Transactional Sexual Relationships with Blessers. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:444-458. [PMID: 38601723 PMCID: PMC10903689 DOI: 10.1080/19317611.2023.2219260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 04/12/2024]
Abstract
Due to the negative implications of transactional sexual relationships (TSRs) for women's sexual and reproductive health, studies of social norms in sub-Saharan and South Africa have sought to inform HIV-related risk and interventions in this key population. To date, however, little research has investigated the normative conflicts facing women in African settings when initiating, continuing or abstaining from participation in TSRs. In 2017-2018, we investigated conflicts black South African women in KwaZulu-Natal expressed between adhering to social versus personal norms in TSRs with "blessers"-wealthy men who gift women financially or materially-typically in exchange for sex. Participants expressed conflicts between social norms of blesser engagement to satisfy aspirations for money/material items vs. personal norms of retaining virginity and fidelity to partners. Women largely ignored adverse sexual health risks of HIV and unintended pregnancy. Participants highlighted internal conflicts, prompting reflection on their desires, choices and normative behaviors, also informing women's self-concept, self-efficacy and desires for relationship satisfaction. Greater reflection from women about personal norms and values-and attention to their self-efficacy in relationships-may assist in understanding and advancing women's holistic health and wellbeing in research and interventions among this population and potentially women in other settings.
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Affiliation(s)
- Courtenay Sprague
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leena Maqsood
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
- Division of Social Medicine and Global Health, Lund University, Lund, Sweden
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27
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Truong HHM, Guzé MA, Kadede K, Amboka S, Otieno B, Odhiambo H, Odeny D, Hewa M, Opiyo M, Opondo F, Fatch R, Ogolla D, Miller LE, Bushman D, Auerswald C, Bukusi EA, Cohen CR. HIV Infection Among Adolescents Residing in Urban Informal Settlements of Kenya. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:225-234. [PMID: 37410374 PMCID: PMC10624479 DOI: 10.1521/aeap.2023.35.3.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Adolescents comprise approximately 15% of new HIV infections in Kenya. Impoverished living conditions in informal settlements place residents at high risk for HIV infection. We assessed factors associated with HIV infection among adolescents residing in urban informal settlements in Kisumu. We recruited 3,061 adolescent boys and girls aged 15-19. HIV prevalence was 2.5% overall, all newly identified cases were among girls and infection was positively associated with not completing a secondary education (p < .001). Girls who had ever been pregnant (p < .001) or out-of-school without completing a secondary education (p < .001) were more likely to be HIV-positive. Our findings of higher HIV prevalence among adolescent girls who had been pregnant or did not complete secondary school highlight the need to facilitate access to HIV testing, HIV pre-exposure prophylaxis, and sexual and reproductive health services as components of a comprehensive prevention strategy to decrease HIV infections in this priority population.
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Affiliation(s)
| | | | | | - Sayo Amboka
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | | | - Marion Hewa
- Kenya Medical Research Institute, Kisumu, Kenya
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28
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Bhushan NL, Shangase N, Kimaru LJ, Gomez-Olive FX, Kahn K, Pettifor AE. HIV Related Behaviors Among Male Partners of Adolescent Girls and Young Women in Rural South Africa. AIDS Behav 2023; 27:1469-1477. [PMID: 36318420 PMCID: PMC10485811 DOI: 10.1007/s10461-022-03882-4] [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: 09/27/2022] [Indexed: 05/16/2023]
Abstract
Improving men's engagement in HIV prevention is not only essential for reducing their own HIV risk but also the risk of transmitting HIV to their female partners. We conducted a cross-sectional survey using a population-based sample of men (age 18-30) who reported being a partner of an adolescent girls and young women (AGYW) in South Africa (N = 2827). We used logit-binomial regression models to examine associations among men's partnership characteristics, HIV risk perceptions, and HIV-related behaviors and examine differences by male partner age (younger men (18-24) vs. older men (25-30)) and age difference between partners (age-concordant (< 5 years) vs. age-disparate (≥ 5 years)). Most men reported inconsistent condom use (85%) and nearly half reported engaging in transactional sex (48%). Older men were just as likely as younger men, and men with age-disparate and age-concordant partners, to inconsistently use condoms, engage in transactional sex, and perpetrate intimate partner violence. Most men also reported a very high interest in pre-exposure prophylaxis (PrEP) (77%) and half reported having an HIV test in the past year (50%). There were no differences by male partner age or age difference between partners in PrEP interest but older men and men in age-discordant relationships were more likely than younger men and men in age-concordant relationships to have an HIV test in the past year. Male partners of AGYW in South Africa are engaging in HIV-related behaviors and need HIV prevention interventions to reduce risk for themselves and their female partners.
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Affiliation(s)
- Nivedita L Bhushan
- RTI International, 3040 Cornwallis Road, 27709, Research Triangle Park, NC, USA.
| | - Nosipho Shangase
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Jepkoech Kimaru
- University of Arizona, Tucson, AZ, USA
- 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
| | - F Xavier Gomez-Olive
- 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
| | - 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
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 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
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Gangcuangco LMA, Eustaquio PC. The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023. Trop Med Infect Dis 2023; 8:tropicalmed8050258. [PMID: 37235306 DOI: 10.3390/tropicalmed8050258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15-17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine-tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.
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Affiliation(s)
- Louie Mar A Gangcuangco
- Hawaii Center for AIDS, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
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Sodeinde K, Sholeye O, Adebisi O, Omotosho A, Sodeinde A, Abiodun O. Sex for food: a transactional sex reaction to the COVID-19-induced rise in the prevalence of hunger among in-school female adolescents in Ogun State, Nigeria. Pan Afr Med J 2023; 44:177. [PMID: 37455879 PMCID: PMC10349629 DOI: 10.11604/pamj.2023.44.177.35687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 03/23/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction COVID-19 has doubled the proportion of people with acute hunger globally and Nigeria is categorized as having a "severe" form of hunger. Vulnerable groups responding more to hunger stressors include the female adolescents who transact sex for both survival and luxury purposes. This study assessed the engagement in transactional sex to obtain food among female adolescents in Ogun State, Nigeria. Methods this descriptive cross-sectional research was conducted among 668 in-school female adolescents that were selected through a multistage sampling method. Data were collected with a structured interviewer-administered questionnaire. Food security was assessed using a standard tool while engagement in transactional sex was elicited through self-report. Data analysis was done using Statistical package for the social sciences (SPSS) version 25. Logistic regression was used to find factors associated with transactional sex. P< 0.05 was taken as statistically significant. Results the mean age of the respondents was 15.18±1.35 years. More than two-fifths (41.5%) were staying in households without food security. Less than one-fifth (15.3%) were engaging in transactional sex. Having emotional stress (OR = 4.33; 95 CI: 1.37-13.63), mother´s education (OR =0.163; 95% CI: 0.057- 0.461), having sexual partner (OR = 0.132; 95% CI: 0.047-0.370 and missing classes (OR 3.35, 95% CI: 1.084-10.331) were significant predictors of engaging in transactional sex among female adolescents. Conclusion transactional sex is commoner among female adolescents who were missing classes, had sexual partners, and were emotionally stressed. There is a need for intervention programs to protect the female adolescent, delay sexual debut and improve academic performance among them.
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Affiliation(s)
- Kolawole Sodeinde
- Department of Community Medicine, Babcock University, Ilishan, Ogun State, Nigeria
| | - Oluwafolahan Sholeye
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
| | - Olusegun Adebisi
- Department of Community Medicine and Primary Care, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
| | - Adebola Omotosho
- Department of Community Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | - Adedotun Sodeinde
- Department of Educational Management, Tai Solarin University of Education, Ogun State, Nigeria
| | - Olumide Abiodun
- Department of Community Medicine, Babcock University, Ilishan, Ogun State, Nigeria
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Rudgard WE, Saminathen MG, Banougnin BH, Shenderovich Y, Toska E. The role of structural factors for preventing HIV risk practices among adolescents in South Africa: A three-wave analysis of caregiving, education, food security, and social protection. RESEARCH SQUARE 2023:rs.3.rs-2164051. [PMID: 36798325 PMCID: PMC9934770 DOI: 10.21203/rs.3.rs-2164051/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Structural interventions are endorsed to enhance biomedical and behavioural HIV prevention programmes for adolescents. Aiming to inform future interventions, we evaluated longitudinal associations between six structural factors and five HIV risk practices in a cohort of adolescents in South Africa. METHODS We used three rounds of data between 2014-2018 on 1046 adolescents living with HIV and 483 age-matched community peers in South Africa's Eastern Cape (Observations = 4402). We used multivariable random effects within-between logistic regression to estimate sex-specific associations between six time-varying structural factors - number of social grants, education enrolment, days with enough food, caregiver supervision, positive caregiving, and adolescent-caregiver communication - and five HIV risk practices - multiple sexual partners, transactional sex, age-disparate sex, condomless sex, and sex on substances. We calculated probability differences, contrasting predicted probabilities at average and maximum values of structural factors associated with multiple risk practices. FINDINGS The sample mean age was 15.29 (SD: 3.23) years and 58% were female. In females, compared to average, maximum positive caregiving scores were associated with lower probability of transactional sex (-1.06 percentage points [ppts], 95%CI=-1.60; -0.52ppts), and age-disparate sex (-0.73ppts; 95%CI=-1.26; -0.19ppts); maximum caregiver supervision scores were associated with lower probability of multiple sexual partners (-3.11ppts; 95%CI=-3.87; -2.35ppts) transactional sex (-1.07ppts, 95%CI=-1.42; -0.71ppts), age-disparate sex (-0.67ppts; 95%CI=-1.08; -0.25ppts), condomless sex (-3.96ppts; 95%CI=-5.65; -2.26ppts), and sex on substances (-0.93ppts; 95%CI=-1.50; -0.37ppts); and, seven days with enough food was associated with lower probability of multiple sexual partners (-1.18ppts, 95%CI=-2.06; -0.30ppts), and transactional sex (-0.91ppts; 95%CI=-1.41; -0.42ppts). Relative to non-enrolment, education enrolment was associated with lower probability of age-disparate sex (-3.18ppts; 95%CI=-5.35; -1.01ppts), and condomless sex (-11.32ppts; 95%CI=-19.15; -3.49ppts). In males, compared to average, maximum caregiver supervision scores were associated with lower probability of multiple sexual partners (-2.83ppts; 95%CI=-3.66; -2.00ppts), transactional sex (-0.90ppts; 95%CI=-1.20; -0.60ppts), age-disparate sex (-0.46ppts; 95%CI=-0.77; -0.15ppts), and sex on substances (-1.42ppts; 95%CI=-2.06; -0.78ppts). No other structural factors were associated with multiple risk practices. INTERPRETATION Structural interventions to improve food security and education enrolment among adolescent girls, and positive and supervisory caregiving among adolescent girls and boys are likely to translate into crucial reductions in HIV risk.
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Affiliation(s)
| | | | | | | | - Elona Toska
- University of Cape Town Centre for Social Science Research
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Busza J, Matambanadzo P, Phiri L, Meki B, Cowan FM. HIV prevention in individuals engaged in sex work. Curr Opin Infect Dis 2023; 36:1-8. [PMID: 36729746 DOI: 10.1097/qco.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW People who sell sex remain at disproportionate risk of acquiring HIV and should be prioritized for evidence-based HIV prevention programmes delivered at sufficient scale and intensity for effectiveness. Although new biomedical tools are becoming available, many basic lessons learned early in the HIV pandemic remain salient today and need renewed attention. RECENT FINDINGS New preexposure prophylaxis formulations, distribution systems, and delivery mechanisms are being successfully trialled and implemented, adding to well established prevention tools such as male and female condoms and lubricants. The importance of social support networks and community ownership of programmes has been consistently reaffirmed. Serious challenges remain in optimizing HIV prevention for sex workers, including providing services at the scale and intensity necessary for population level impact, addressing culturally sensitive issues of gender identity and sexual orientation, and protecting adolescents and young people who may sell sex. Pervasive social stigma, often reinforced by criminalization and police harassment, further constrain sex workers' access to available services and prevention tools. SUMMARY Meaningful community engagement and addressing the multiple social determinants of vulnerability at individual, community, and structural levels remain at the core of preventing HIV among people involved in selling sex.
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Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Bee Meki
- Trans and Intersex Rising Zimbabwe, Zimbabwe
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe
- Department for International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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LoVette A, Sullivan A, Kuo C, Operario D, Harrison A, Mathews C. Examining Associations Between Resilience and Sexual Health Among South African Girls and Young Women Living With and Without HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:1-13. [PMID: 36735229 DOI: 10.1521/aeap.2023.35.1.1] [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: 06/18/2023]
Abstract
Resilience, or multilevel processes related to thriving, offers a strengths-based approach to reducing HIV and sexual risk behaviors among girls and young women. Processes of resilience may change based on the experience of living with HIV. However, little is known about how resilience and serologically verified HIV status influence sexual health. Using weighted cross-sectional data collected during 2017-2018 from South African girls and young women aged 15-24 (N = 7237), this article examines associations between resilience and three sexual risk behaviors among those living with and without HIV. Logistic regression models indicated greater resilience scores were associated with reduced odds of engaging in transactional sex and early sexual debut. Results also identified differing associations between resilience and sexual risk behaviors by HIV status. Findings provide implications for programming to prevent HIV and improve sexual health while underscoring the need for tailored resilience-promoting interventions for South African girls and young women living with HIV.
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Affiliation(s)
- Ashleigh LoVette
- Brown University, School of Public Health, Providence, Rhode Island
| | - Adam Sullivan
- Brown University, School of Public Health, Providence, Rhode Island
| | - Caroline Kuo
- Brown University, School of Public Health, Providence, Rhode Island
| | - Don Operario
- Brown University, School of Public Health, Providence, Rhode Island
| | - Abigail Harrison
- Brown University, School of Public Health, Providence, Rhode Island
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Stoebenau K, Dunkle K, Willan S, Shai N, Gibbs A. Assessing risk factors and health impacts across different forms of exchange sex among young women in informal settlements in South Africa: A cross-sectional study. Soc Sci Med 2023; 318:115637. [PMID: 36628880 DOI: 10.1016/j.socscimed.2022.115637] [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: 01/07/2022] [Revised: 10/28/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
For women in South Africa, engaging in exchange sex, including transactional sex (TS), or sex work (SW), is associated with several shared poor health outcomes; yet the practices themselves differ in meaningful ways. SW is a form of commodity exchange, while TS is grounded in gendered relationship expectations of male provision and aspects of emotional intimacy. Additionally, exchange sex types could be imagined on a "continuum of instrumentality" from relationships that do not include material support; to those characterized, but not driven by support; to those primarily motivated by material support. We use cross-sectional data from 644 women ages 18-30 enrolled in a trial addressing intimate partner violence in urban KwaZulu-Natal, South Africa to assess whether these conceptualizations may also map onto different types or levels of risk. Using self-reports, we developed four exchange sex relationship categories corresponding to a continuum of instrumentality: no exchange-based relationship; TS with a main partner only; TS with a casual partner; and SW. Using tests of association and adjusted logistic regression models, we compared socio-economic and behavioural risk factors, and health outcomes across reported forms of exchange sex. We find little difference between women who report no exchange sex and those who report TS only with a main partner. By contrast, as compared to women not in exchange sex, women in casual TS and SW were poorer, and significantly more likely to report problematic alcohol use, past drug use, prior non-partner sexual violence, and PTSD; with aOR higher for women in SW for many outcomes. When comparing casual TS to SW, we find women in SW held more gender equitable attitudes and were more likely to report modern contraceptive use. We discuss the implications for distinguishing between TS and SW, and use of the continuum of instrumentality conceptualization for research and programming.
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Affiliation(s)
- Kirsten Stoebenau
- University of Maryland School of Public Health, Department of Behavioral and Community Health, 4200 Valley Drive, College Park, MD, USA.
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Nwabisa Shai
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa; Department of Psychology, University of Exeter, Exeter, UK; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
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Oliveira RLESE, Silva LAVD, Duarte FM, Brasil SA, Castellanos MEP, Magno L, Dourado I. Building bridges to care: the experience of peer navigation in enabling linkage to PrEP for adolescent men who have sex with men and transgender women. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00176821. [PMID: 36995868 DOI: 10.1590/0102-311xen176821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/08/2022] [Indexed: 03/29/2023] Open
Abstract
Vulnerable populations are at increased risk for HIV/AIDS, especially adolescent men who have sex with men (AMSM) and adolescent travestis and transgender women (ATGW). Pre-exposure prophylaxis (PrEP) is one component of combination HIV prevention and is already available for these populations in Brazil. However, ensuring its uptake entails certain challenges since inequality and barriers have traditionally marked access and linkage to the related public health services. Peer navigation could be a way of mediating the linkage process because it involves peers keeping track of others’ care schedules, dynamically fostering linkage to care according to the needs of users and the actors involved in their everyday care contexts. Therefore, this study proposes analyzing peer-navigator-mediated linkage to PrEP care for 15- to 19-year-old MSM and transgender women from the PrEP1519 project in Salvador, Bahia State, Brazil. In total, 15 field notebooks/diaries, written in April-July 2019, by four peer navigators were analyzed, as were the transcripts of one focal group and 20 semi-structured interviews with adolescents (17 MSM and three trans women) between June and December 2019. Linkage via peer navigator and participant is influenced by emotional dynamics and shared personal characteristics. It is fluid and unstable and calls for care practices to be shaped to meet each participant’s needs. For peer navigation to be adopted as a care strategy for sexually transmitted infection prevention and treatment, it should envisage not only increased linkage to care but also sensitivity to service users’ specific characteristics and lived experiences.
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Wamoyi J, Ranganathan M, Mugunga S, Stöckl H. "It Gives You a Feeling of Pride when You Touch Her": The Role of Masculinity in Sexual Harassment of Adolescent Schoolgirls in Tanzania. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP108-NP127. [PMID: 35350928 DOI: 10.1177/08862605221080957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual harassment or the unwanted offensive behaviours that women and girls experience is a pervasive global challenge. Yet, there is limited evidence on the lived experiences of sexual harassment from school-based settings in sub-Saharan Africa. We explore students' perceived experiences, perpetration, and drivers of sexual harassment in schools in Mwanza, Tanzania. This study employed a qualitative research design involving 30 in-depth interviews and seven focus group discussions with 30 male and 40 female secondary school pupils aged 13-19 years. Data was analysed using a thematic approach. The findings show that experiences of sexual harassment among schoolgirls were widespread. Common forms of harassment were verbal and non-verbal gestures of a sexual nature. The desire to prove one's masculinity and peer pressure were key drivers of perpetration among schoolboys. Teachers took advantage of their positions of authority to sexually harass female pupils and employed corporal punishment to those who resisted their advances. Sexual harassment had multiple negative outcomes, including schoolgirls dropping out of school and mental health issues, such as anxiety, stress and poor academic performance. Girls rarely reported sexual harassment for fear of further victimisation and stigma from others. Sexual harassment of girls is common in secondary schools in Mwanza and is mainly driven by peer pressure and the desire to prove one's masculinity. Given its harmful effects, there is a need to implement clear policies to protect girls, support confidential disclosure and reporting and to address toxic masculinity norms among young men.
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Affiliation(s)
- Joyce Wamoyi
- Department of Sexual and Reproductive Health, 119151National Institute for Medical Research, Mwanza, Tanzania
| | - Meghna Ranganathan
- Department of Global Health and Development, 4906London School of Hygiene and Tropical Medicine, London, UK
| | - Samuel Mugunga
- Department of Sexual and Reproductive Health, 119151National Institute for Medical Research, Mwanza, Tanzania
| | - Heidi Stöckl
- Department of Global Health and Development, 4906London School of Hygiene and Tropical Medicine, London, UK
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Chingono R, Kasese C, Miles S, Busza J. 'I was in need of somewhere to release my hurt:' Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups. Glob Health Action 2022; 15:2040151. [PMID: 35322767 PMCID: PMC8956306 DOI: 10.1080/16549716.2022.2040151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Adolescents experiencing multiple vulnerabilities, including poverty, curtailed education, transactional sex and early childbearing, are at risk of poor mental health. In Zimbabwe, girls who are pregnant or new mothers and involved in selling sex struggle to cope with the combined pressures of parenthood, financial insecurity, and social stigma. A pilot intervention brought such girls together into self-help groups to increase peer support, resources and skills. Objective This study aimed to explore whether and how participation in a self-help group intervention affected vulnerable young mothers’ experiences and perceptions of mental health stressors. Methods Self-help groups received 12 participatory sessions over 6 months. Eighteen semi-structured interviews and three focus group discussions were held with participants and drop-outs. Before and after the intervention, participants completed the locally validated 14-item Shona Symptom Questionnaire tool to indicate the probable prevalence of common mental health disorders. Results Adolescent girls described mutually reinforcing stressors in their lives and reported low self-esteem and anxiety. Key themes emerging from qualitative data centred around girls’ struggles with adverse life events, the burden of new motherhood, social isolation related to sex work and self-help groups as a source of hope. Participants joined groups to obtain support and felt their mental well-being improved due to new social networks, feelings of solidarity with peers, and increased confidence for positive action, that is, seeking health services for themselves and their babies. Prior to enrolment 16% showed signs of possible common mental disorders falling to 2% at follow-up. Conclusions Participants believed involvement in interactive self-help groups improved their mental health by strengthening peer support and engendering hope for the future. Although reduced mental distress cannot be attributed to the programme, the pilot intervention offers a low-cost approach that could be rigorously tested and adapted to a wide range of community settings.
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Affiliation(s)
- Rudo Chingono
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Institute of Global Health, University College London, UK
| | - Constance Kasese
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Sam Miles
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
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A savings intervention to reduce men's engagement in HIV risk behaviors: study protocol for a randomized controlled trial. Trials 2022; 23:1018. [PMID: 36527120 PMCID: PMC9756445 DOI: 10.1186/s13063-022-06927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In much of eastern and southern Africa, the incidence of HIV and other sexually transmitted infections (STIs) remains high despite the scale-up of promising biomedical and behavioral interventions. Studies have documented the crucial role of transactional sex-the exchange of money, material support, or goods, in sexual relationships-and heavy alcohol use in contributing to men's and women's health outcomes. Existing policy responses to this challenge have largely focused on women, through the provision of pre-exposure prophylaxis (PrEP) or structural interventions such as education subsidies and cash transfers. However, the effectiveness of these interventions has been hindered by the relative lack of interventions and programs targeting men's behavior. We describe the protocol for a study that will test an economic intervention designed to reduce men's engagement in HIV/STI-related risk behaviors in Kenya. METHODS We will conduct a randomized controlled trial among income-earning men in Kenya who are aged 18-39 years and self-report alcohol use and engagement in transactional sex. The study will enroll 1500 participants and randomize them to a control group or savings group. The savings group will receive access to a savings account that includes lottery-based incentives to save money regularly, opportunities to develop savings goals/strategies, and text message reminders about their savings goals. The control group will receive basic health education. Over a period of 24 months, we will collect qualitative and quantitative data from participants and a subset of their female partners. Participants will also be tested for HIV and other STIs at baseline, 12, and 24 months. DISCUSSION The findings from this study have the potential to address a missing element of HIV/STI prevention efforts in sub-Saharan Africa by promoting upstream and forward-looking behavior and reducing the risk of acquiring HIV/STIs in a high HIV/STI burden setting. If this study is effective, it is an innovative approach that could be scaled up and could have great potential for scientific and public health impact in Kenya. TRIAL REGISTRATION ClinicalTrials.gov NCT05385484 . Registered on May 23, 2022.
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Ekwunife OI, Ejie IL, Okelu V, Mita C, Durosinmi-Eti O, Powell A, Franke MF. Interventions to increase the uptake and continuation of pre-exposure prophylaxis (PrEP) by adolescent girls and young women at high risk of HIV in low-income and middle-income countries: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2022-009474. [PMID: 36593640 PMCID: PMC9743293 DOI: 10.1136/bmjgh-2022-009474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Effective strategies to increase pre-exposure prophylaxis (PrEP) uptake and continuation among adolescent girls and young women (AGYW) who engage in sex work or transactional sex are sparsely reported. We aimed to describe the available evidence on strategies for improving the uptake and continuation of PrEP among AGYW who engage in sex work or transactional sex, or otherwise are at high risk of acquiring HIV, and report their implementation outcomes. METHOD PubMed, Embase, CINAHL and Global Health were searched for studies describing strategies to increase uptake and continuation of PrEP for HIV prevention among AGYW at high risk of acquiring HIV in low-income and middle-income countries. Two independent reviewers screened citations for inclusion and performed data abstraction. Proctor's framework was used to report the implementation outcomes of the interventions. RESULT We identified 1046 citations, and reviewed 69 full-text documents, of which we included 11 in the scoping review. A social marketing campaign was used in one study to create demand for PrEP. A decision support tool was used in one study to improve PrEP initiation. SMS reminders (two studies), drug-level feedback (two studies), peer group support (one study) and conditional economic incentives (one study) were used to improve PrEP continuation. Five studies reported adoption outcomes, two of which were high. Four studies reported sustainability outcomes; these were low or moderate. One study found private youth-friendly clinics a better fit for AGYW PrEP delivery compared with public hospitals, and prescription of PrEP by non-study staff in the hospital facility was low. CONCLUSION Multiple promising interventions have been used to deliver PrEP to AGYW at high risk of acquiring HIV; however, more information is needed to understand how these interventions would likely perform at scale outside of a research context.
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Affiliation(s)
- Obinna Ikechukwu Ekwunife
- Takemi Program in International Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA,Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Valentine Okelu
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Carol Mita
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Antonia Powell
- Center for HIV and Infectious Diseases, John Snow Inc, Boston, Massachusetts, USA
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Langwenya N, Toska E, Stöckl H, Cluver L. Which groups are most affected by sexual violence? A disaggregated analysis by sex, age, and HIV-status of adolescents living in South Africa. CHILD ABUSE & NEGLECT 2022:105981. [PMID: 36473807 DOI: 10.1016/j.chiabu.2022.105981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Estimates on sexual violence (SV) among adolescents are rarely disaggregated by key indicators. OBJECTIVE We examine the independent effects of sex, age, HIV status and mode of HIV acquisition on the exposure to SV using generalised estimating equations models and proportional hazard model. PARTICIPANT AND SETTING Data from a 4-year prospective cohort study of 1447 adolescents (ages 10-19, 57% girls, 76% living with HIV) in South Africa. METHODS We describe the lifetime prevalence of three forms of SV: non-contact (unwanted showing of private parts), contact (coerced sexual debut, attempted and completed forced penetrative or oral sex,) and exploitative (sex in exchange for goods/money). RESULTS Overall, 23.9% (95%CI = 21.7%-26.1%) reported exposure to SV at some point in their lives: non-contact = 5.7%, contact = 9.0% and exploitative = 15.8%. While girls reported higher rates of exploitative (18.4% vs 12.3%; p < 0.001) and contact SV (12.3% vs 4.6%; p < 0.001), there were no differences in levels of non-contact SV by sex (6.5% vs 4.6%; p = 0.086). Exposure to any SV doubled in late adolescence (10-14 years = 7.0% vs ≥15 years = 31.7%; aIRR = 2.07; 95%CI = 1.82-2.37). Though level of SV were comparable between those living with HIV and those HIV-uninfected (22.9% vs 26.2%; p = 0.182), adolescents who recently acquired HIV were twice as likely to experience SV compared to adolescents who perinatally acquired HIV (42.3% vs 15.7%; aIRR = 2.03; 95%CI = 1.73-2.39). This association persisted when analysis was restricted to incidence SV during follow-up (aIRR = 1.53; 95%CI = 1.23-2.10). CONCLUSION Exposure to SV was high for both sexes, increased with age and more prevalent among adolescents who recently acquired HIV. SV prevention and response services must also be offered to boys and strengthened in HIV care services.
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Affiliation(s)
- Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Nuffield College, University of Oxford, Oxford, United Kingdom.
| | - 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
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - 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
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Pichon M, Carter DJ, Howard-Merrill L, Sono R, Gimunta V, Rutenge O, Thiaw Y, Stoebenau K, Perrin N, Buller AM. A mixed-methods, exploratory, quasi-experimental evaluation of a radio drama intervention to prevent age-disparate transactional sex in Tanzania. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1000853. [PMID: 36531443 PMCID: PMC9755860 DOI: 10.3389/frph.2022.1000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Age-disparate transactional sex (ADTS) is associated with HIV, unintended pregnancy, school dropout and violence, yet few interventions have successfully prevented it, and none have set ADTS prevention as their primary outcome. This exploratory evaluation aimed to assess indications of change after exposure to the Learning Initiative on Norms, Exploitation and Abuse (LINEA) intervention, a mass-media, gender-transformative social norms intervention aimed at preventing ADTS in Tanzania. METHODS In a condensed implementation 331 participants were instructed to listen to the LINEA radio drama over seven weeks, and 60 were randomly allocated to household discussion sessions about content. In-depth interviews (n = 81) from girls aged 12-16 years, and women and men caregivers were collected at baseline (September 2021), midline (November) and endline (December 2021). Surveys were conducted (n = 120) at baseline and endline using the Norms and Attitudes on ADTS Scale (NAATSS) and the Gender Roles and Male Provision Expectations (GRMPE) scale. Interviews were thematically analyzed using a framework approach. Age-stratified linear regression models adjusted for baseline scores were used to measure association between the intervention and endline scale scores. RESULTS Longitudinal data were available from 59 qualitative (73%) and 95 quantitative participants (79%). Qualitative evidence revealed the drama facilitated family conversations about adolescent challenges, allowing caregivers to advise daughters. Some girls gained confidence to refuse men's gifts, learning that accepting them could necessitate sexual reciprocation. Some caregivers felt increased responsibility for supporting girls in the community to avoid ADTS. Blame for ADTS shifted for some from girls to men, suggesting increased understanding of inequitable power dynamics and reductions in victim blaming. Marginal quantitative evidence revealed that highly exposed girls had improved gender equitable beliefs on the GRMPE (β = -6.26; 95% CI: -12.94, 0.42). Moderately exposed men had increased gender inequitable norms on the NAATSS subscale (β = 0.42 95% CI: 0.05, 0.79), but there was no effect in highly exposed men. CONCLUSIONS Given the small sample results should be interpreted cautiously. Our initial findings indicate high engagement with the LINEA intervention shows promise in shifting knowledge, behaviors, and attitudes, beliefs and social norms driving ADTS in Shinyanga, Tanzania, supporting a robust impact evaluation.
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Affiliation(s)
- Marjorie Pichon
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniel J Carter
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lottie Howard-Merrill
- Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom
| | - Revocatus Sono
- Adolescent Girls and Young Women Department, Amani Girls Home, Mwanza, United Republic of Tanzania
| | - Veronicah Gimunta
- Adolescent Girls and Young Women Department, Amani Girls Home, Mwanza, United Republic of Tanzania
| | - Oscar Rutenge
- Tanganyika Christian Refugee Service, Shinyanga Unit, United Republic of Tanzania
| | - Yandé Thiaw
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | - Nancy Perrin
- Department of Behavioral and Community Health, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Ana Maria Buller
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Picchetti V, Stamatakis C, Annor FB, Massetti GM, Hegle J. Association between lifetime sexual violence victimization and selected health conditions and risk behaviors among 13-24-year-olds in Lesotho: Results from the Violence Against Children and Youth Survey (VACS), 2018. CHILD ABUSE & NEGLECT 2022; 134:105916. [PMID: 36215756 PMCID: PMC9691579 DOI: 10.1016/j.chiabu.2022.105916] [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] [Received: 03/02/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sexual violence is a serious public health concern worldwide. In Lesotho, one in seven women and one in twenty men aged 18 years and older experienced sexual violence during childhood. Sexual violence victimization may lead to long-term mental and physical health issues among victims, regardless of gender. OBJECTIVE To estimate the prevalence of lifetime sexual violence victimization (SV) among 13-24-year-olds in Lesotho and assess its association with selected health conditions and risk behaviors. PARTICIPANTS AND SETTING Data from 13 to 24-year-old participants (n = 8568) of the 2018 Lesotho Violence Against Children and Youth Survey were analyzed. METHODS SV was defined as reporting one or more types of sexual violence at any age. Logistic regression analyses measured associations between SV and selected health conditions (suicidal thoughts, self-harm behaviors, mental distress, STIs, and HIV), and risk behaviors (binge drinking in the past 30 days, drug use in the past 30 days, infrequent condom use in the past 12 months, multiple sex partners in the past 12 months, and transactional sex in the past 12 months). RESULTS After controlling for study covariates, SV was significantly associated with self-harm behaviors, suicidal thoughts, ever having an STI, binge drinking in the past 30 days, infrequent condom use in the past 12 months, and multiple sex partners in the past 12 months for both males and females; and mental distress and transactional sex in the past 12 months for females. CONCLUSIONS Preventing SV against children and youth in Lesotho may improve their health and wellbeing.
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Affiliation(s)
- Viani Picchetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
| | - Caroline Stamatakis
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Greta M Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jennifer Hegle
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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HIV and adolescent girls and young women in sub‐Saharan Africa: A call for expedited action to reduce new infections. IJID REGIONS 2022; 5:30-32. [PMID: 36147901 PMCID: PMC9485902 DOI: 10.1016/j.ijregi.2022.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
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Ranganathan M, Quinones S, Palermo T, Gilbert U, Kajula L, Quinones S, Kajula L, de Hoop J, Prencipe L, Groppo V, Tirivayi N, Waidler J, Nkolo JC, Mitti R, Mallet M, Munanka B, Luchemba P, Lukongo TM, Mulokozi A, Gilbert U, van Ufford PQ, Le Kirkegaard R, Eetaama F, Matafu J, Angemi D, Natali L. Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed-methods study. J Int AIDS Soc 2022; 25:e26038. [PMID: 36451279 PMCID: PMC9712808 DOI: 10.1002/jia2.26038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/31/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Transactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub-Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Transactional sex is also associated with HIV risk behaviours, such as multiple sexual partners and other determinants of HIV risk, including partner violence and abuse, alcohol consumption and inconsistent condom use. METHODS We use data from a mixed-method, cluster randomised controlled trial of the Ujana Salama cash "plus" intervention in rural Tanzania. The data are from the first and third rounds of data collection (2017-2019). The impact evaluation consisted of a parallel mixed-methods design where the quantitative and qualitative data collection occurred simultaneously, and integration of the findings was done during the discussion. We first examine contextual factors associated with transactional sex using multivariable logistic regression models and then estimate whether the "plus" intervention reduced transactional sex among adolescent girls and young women using analysis of covariance. We used thematic content analysis for analysing qualitative transcripts. RESULTS The prevalence of transactional sex among unmarried adolescent girls and young women at round 3 was 26%. Findings show that increasing age is a risk factor for transactional sex (OR = 1.80; 95% CI: [1.50, 2.17]), staying in school was negatively associated with engagement in transactional sex (OR = 0.24; 95% CI: [0.14, 0.40]). The cash plus intervention showed no impacts on reducing transactional sex (β = 0.003, p = 0.905). CONCLUSIONS The mechanisms of impact for a cash plus intervention on transactional sex are complex; economic insecurity is an important driver of transactional sex and HIV infection, but psychosocial factors and gendered social norms need consideration in intervention development. Our findings suggest that combination prevention interventions to address the structural drivers of HIV infection should focus on efforts to increase school enrolment and completion.
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Affiliation(s)
| | - Sarah Quinones
- Department of Epidemiology and Environmental HealthUniversity at BuffaloBuffaloNew YorkUSA
| | - Tia Palermo
- Department of Epidemiology and Environmental HealthUniversity at BuffaloBuffaloNew YorkUSA
| | | | - Lusajo Kajula
- UNICEF Office of Research—InnocentiDar es SalaamTanzania
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Dvalishvili D, Ssewamala FM, Nabunya P, Sensoy Bahar O, Kizito S, Namuwonge F, Namatovu P. Impact of Family-Based Economic Empowerment Intervention, Suubi+Adherence (2012-2018) on Multidimensional Poverty for Adolescents Living with HIV (ALWHIV) in Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14326. [PMID: 36361203 PMCID: PMC9657112 DOI: 10.3390/ijerph192114326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 06/15/2023]
Abstract
Children growing up in poverty are disproportionately affected by diseases, including HIV. In this study, we use data from Suubi+Adherence, a longitudinal randomized control trial (2012-2018) with 702 adolescents living with HIV (ALWHIV), to examine the effectiveness of a family-based multifaceted economic empowerment (EE) intervention in addressing economic instability and multidimensional poverty among ALWHIV in Southern Uganda. We constructed a Multidimensional Poverty Index of individual and household indicators, including health, assets, housing and family dynamics. We computed the proportion of multidimensionally poor children (H), estimated poverty intensity (A) and adjusted headcount ratio (M0). Using repeated measures at five-time points (baseline, years 1, 2, 3 and 4-post baseline) across two study arms: treatment (receiving the EE intervention) vs. control arm (not receiving EE), we find that both the incidence and proportion of multidimensional poverty decreased in the treatment arm vs. the control arm. Given that there is a direct link between economic instability and poor health outcomes, these findings are informative. They point to the potential for family EE interventions to decrease multidimensional poverty among vulnerable children, including ALWHIV, impacting their overall wellbeing and ability to meet their treatment needs and improve HIV care continuum outcomes.
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Affiliation(s)
| | - Fred. M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Samuel Kizito
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Flavia Namuwonge
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Phionah Namatovu
- International Center for Child Health and Development (ICHAD), Uganda Office, Masaka 961105, Uganda
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Mhungu A, Sixsmith J, Burnett E. Adolescent Girls and Young Women's Experiences of Living with HIV in the Context of Patriarchal Culture in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2022; 27:1365-1379. [PMID: 36318422 PMCID: PMC10129999 DOI: 10.1007/s10461-022-03872-6] [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: 09/17/2022] [Indexed: 04/28/2023]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the human immunodeficiency virus (HIV) due to socio-cultural gender, power, and economic disparities. This scoping review examined the literature to explore what is known about AGYW's everyday personal, relational, and social experiences of HIV to help shape future protective HIV policy and practice. Six databases were searched: Medline, CINAHL, Scopus, ASSIA, Google Scholar, and ProQuest, resulting in a total of 12,581 articles. Of these, 40 articles were included in the review. Key themes generated from the thematic analysis were relational and psychosocial challenges, inhibiting sexual expression, poverty, stigma, and discrimination; managing health in everyday life; agency and resilience; and personal space and social support. In conclusion, the review found a lack of understanding of AGYW's everyday experiences of living with HIV from their own perspectives. There was also little consideration of the role of patriarchal culture and how this constrains AGYW's ability to negotiate their relationships. Further research is needed to reveal AGYW's perspectives on living with HIV in sub-Saharan Africa.
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Affiliation(s)
- Alington Mhungu
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland.
| | - Judith Sixsmith
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
| | - Emma Burnett
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
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Rosen JG, Schneider KE, Allen ST, Morris M, Urquhart GJ, Rouhani S, Sherman SG. Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland. Harm Reduct J 2022; 19:115. [PMID: 36242081 PMCID: PMC9569095 DOI: 10.1186/s12954-022-00697-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men's selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. METHODS Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. RESULTS Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97-0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81-7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05-3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02-3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. CONCLUSIONS Synergistic sources of social and structural marginalization-from sexuality to hunger, homelessness, and injection drug use-are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Glenna J Urquhart
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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Stoner MCD, Rucinski KB, Lyons C, Napierala S. Differentiating the incidence and burden of HIV by age among women who sell sex: a systematic review and meta-analysis. J Int AIDS Soc 2022; 25:e26028. [PMID: 36302078 PMCID: PMC9612831 DOI: 10.1002/jia2.26028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Young women who sell sex (YWSS) are at heightened risk of HIV acquisition and transmission and are among the least engaged in HIV services. There is insufficient epidemiologic evidence characterizing the burden of HIV among YWSS, particularly as compared to older WSS. These data are needed to design and tailor effective HIV prevention and treatment programmes for this population. METHODS We conducted two parallel systematic reviews and meta-analyses to define both the immediate and long-term HIV risks for YWSS, including among women engaged in sex work, survival sex and transactional sex. In the first review, we identified and synthesized published studies of HIV incidence comparing estimates for cisgender women ≤24 years of age versus >24. In the second review, we identified and synthesized studies of HIV prevalence, comparing estimates for cisgender women who initiated selling sex <18 versus ≥18 years. In both reviews, we completed a search of four databases for articles in any language and any geographic area published from 1 January 1980 until 12 February 2021. Included articles were assessed for quality and a random effects model was used to calculate pooled effect estimates for each review. RESULTS AND DISCUSSION We identified 12 studies for the HIV incidence review and 18 studies for the HIV prevalence review. In a meta-analysis, HIV incidence was elevated in younger (5.3 per 100 person-years [PY]; 95% confidence interval [CI]: 3.5, 7.1) compared to older women (2.8 per 100 PY; 95% CI: 1.7, 3.9), although CIs overlapped. HIV prevalence among those who initiated selling sex <18 years of age (28.8; 95% CI: 18.9, 38.7) was higher than those who initiated later (20.5; 95% CI: 12.4, 28.6). CONCLUSIONS These companion reviews offer an important perspective on the relative HIV risk of engaging in selling sex at a younger age. Our findings highlight the unique and intersectional challenges YWSS face, and the importance of ensuring that health services are tailored to meet their specific needs. Research and programming should routinely stratify data into meaningful age bands to differentiate and intervene within this population.
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Affiliation(s)
| | - Katherine B. Rucinski
- Social and Behavioral Interventions Program, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Carrie Lyons
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Sue Napierala
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
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Sanchez T, Mavragani A, Materu J, Drake M, Majani E, Casalini C, Mjungu D, Mbita G, Kalage E, Komba A, Nyato D, Nnko S, Shao A, Changalucha J, Wambura M. Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e30372. [PMID: 36121686 PMCID: PMC9531008 DOI: 10.2196/30372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/19/2022] [Accepted: 08/02/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. OBJECTIVE This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. METHODS A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. RESULTS Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders. CONCLUSIONS Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. TRIAL REGISTRATION ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243.
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Affiliation(s)
| | | | - Jacqueline Materu
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Mary Drake
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Esther Majani
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Caterina Casalini
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Deusdedit Mjungu
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Gaspar Mbita
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Esther Kalage
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Albert Komba
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Soori Nnko
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Amani Shao
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Mwita Wambura
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
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Kamire V, Magut F, Khagayi S, Kambona C, Muttai H, Nganga L, Kwaro D, Joseph RH. HIV Risk Factors and Risk Perception Among Adolescent Girls and Young Women: Results From a Population-Based Survey in Western Kenya, 2018. J Acquir Immune Defic Syndr 2022; 91:17-25. [PMID: 35972852 PMCID: PMC9387564 DOI: 10.1097/qai.0000000000003021] [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: 01/06/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In sub-Saharan Africa, HIV prevalence in adolescent girls and young women (AGYW) is 2-fold to 3-fold higher than that in adolescent boys and young men. Understanding AGYW's perception of HIV risk is essential for HIV prevention efforts. METHODS We analyzed data from a HIV biobehavioral survey conducted in western Kenya in 2018. Data from AGYW aged 15-24 years who had a documented HIV status were included. We calculated weighted prevalence and evaluated factors associated with outcomes of interest (HIV infection and high risk perception) using generalized linear models to calculate prevalence ratios. RESULTS A total of 3828 AGYW were included; 63% were aged 15-19 years. HIV prevalence was 4.5% and 14.5% of sexually active AGYW had high risk perception. Over 70% of participants had accessed HIV testing and counseling in the past 12 months. Factors associated with both HIV infection and high risk perception included having an HIV-positive partner or partner with unknown status and having a sexually transmitted infection in the past 12 months. Having an older (by ≥10 years) partner was associated with HIV infection, but not high risk perception. Less than 30% of sexually active AGYW with 3 or more HIV risk factors had high perception of HIV risk. CONCLUSION Gaps in perceived HIV risk persist among AGYW in Kenya. High access to HIV testing and prevention services in this population highlights platforms through which AGYW may be reached with improved risk counseling, and to increase uptake of HIV prevention strategies.
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Affiliation(s)
- Vivienne Kamire
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Faith Magut
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Sammy Khagayi
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Caroline Kambona
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Hellen Muttai
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Lucy Nganga
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Daniel Kwaro
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Rachael H. Joseph
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
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