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Kanagasabai U, Thorsen V, Zhu L, Annor FB, Chiang L, McOwen J, Augusto A, Manuel P, Kambona C, Coomer R, Kamagate F, Ramphalla P, Denhard L, Cain M, Hegle J, de Barros RB, Saenz S, Kamami M, Patel P. Adverse childhood experiences, HIV and sexual risk behaviors - Five sub-Saharan countries, 2018-2020. Child Abuse Negl 2024; 150:106541. [PMID: 38114359 DOI: 10.1016/j.chiabu.2023.106541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been shown to have negative, lasting effects on health including increasing the likelihood of engaging in sexual risk behaviors. OBJECTIVE This study aimed to identify associations between exposures to ACEs and sexual risk behaviors and HIV service utilization among young people. PARTICIPANTS AND SETTING A sample of 8023 sexually active young people (19-24 year olds) from five sub-Saharan African countries participated Violence Against Children and Youth Surveys (VACS). METHODS Descriptive analysis of demographic variables, individual ACEs, cumulative ACEs, sexual risk behaviors, HIV testing, antiretroviral treatment (ART) and Antenatal Care (ANC) attendance were completed. Bivariate and multivariable logistic regression analyses were conducted to assess the associations between both individual and cumulative ACEs, sexual HIV risk behaviors, and service utilization while controlling for important covariates such as demographic, having ever been pregnant, had an STI, and used contraception. RESULTS Exposure to three or more ACEs was higher among males (26.1 %) compared to females (21.3 %); p = 0.003. The most prominent sexual risk behavior for females was having sexual partners who were at least 5 years older (45.7 % compared to males 3.7 %; p < 0.0001) whereas in males it was no or infrequent condom use (45.3 % compared to females 30.1 %; p < 0.0001). Males and females exposed to childhood sexual violence had seven and four times the odds of engaging in transactional sex (aOR = 7.34, 95 % CI: [3.5-15.0]) and (aOR =3.75, 95 % CI: [2.3-6.2], respectively. Females exposed to three or more ACEs were four times more likely to engage in transactional sex (aOR = 4.85, 95 %, CI: [1.6-14.4]) compared to those who did not experience any ACEs. Males exposed to three or more ACEs were two times more likely to engage in early sexual debut (aOR = 2.2, 95 % CI: [1.3-3.4]),]) compared to those who did not experience any ACEs. Females who had witnessed IPV or violence in the community had significantly higher odds of getting tested for HIV (aOR = 2.16, 95 % CI: [1.63-2.87]) and (aOR = 1.36, 95 % CI: [1.03-1.81]), respectively. CONCLUSIONS This study demonstrated that experiencing ACEs during childhood is associated with higher HIV risk behaviors in sub-Saharan Africa (SSA) with unique differences between males and females.
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Affiliation(s)
| | - Viva Thorsen
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Liping Zhu
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Francis B Annor
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Laura Chiang
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jordan McOwen
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Mozambique
| | | | - Pedro Manuel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Mozambique
| | - Caroline Kambona
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Kenya
| | - Rachel Coomer
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Namibia
| | - Fathim Kamagate
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Cote d'Ivoire
| | - Puleng Ramphalla
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lesotho
| | - Langan Denhard
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Meagan Cain
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jennifer Hegle
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Shantal Saenz
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Mwikali Kamami
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Pragna Patel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
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Miedema SS, Stamatakis C, Tracy A, Hegle J, Kamagate MF, McOwen J, Augusto A, Manuel P, Coomer R, Kambona C, Ramphalla P, Niolon P, Patel P, Annor FB. Patterns of adverse childhood experiences and their associations with mental distress, substance use and sexual risk behaviors in Sub-Saharan Africa. Child Abuse Negl 2024; 150:106494. [PMID: 37806930 DOI: 10.1016/j.chiabu.2023.106494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/02/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Multiple adverse childhood experiences (ACEs) are associated with poor sexual and mental health outcomes in low- and middle-income countries (LMICs). Less well understood is how discrete and gendered clustering of ACEs may influence health. OBJECTIVE To assess how multiple ACEs co-occur and how dominant patterns of co-occurrence are associated with mental distress, substance use, and sexual risk behaviors among young women and men in Sub-Saharan Africa. PARTICIPANTS AND SETTING We used pooled data of young men and women aged 19-24 from comparable, nationally representative Violence Against Children and Youth Surveys (VACS) conducted in Cote d'Ivoire, Kenya, Lesotho, Mozambique, and Namibia (nf = 7183; nm = 2207). METHODS We estimated sex-disaggregated latent classes of six ACEs among young women and men. We ran Bolck-Croon-Hagenaars (BCH) distal outcome analysis to test the sex-stratified relationships between ACEs latent classes and health outcomes. RESULTS A six class solution best fit the female data. Classes included witnessing violence and experiencing physical violence (PV); experiencing PV; high ACEs; witnessing community violence; orphanhood; and low ACEs exposure. Among males, the best-fitting three-class solution included experiencing PV and witnessing community violence; high ACEs; and low ACEs exposure. Membership in the high ACEs class was associated with mental distress among females and males, and substance use among males. No differences in sexual risk behavior were identified by class membership among either females or males. CONCLUSIONS Discrete clusters of co-occurring ACEs are associated with elevated odds of mental distress among females, and mental distress and substance use among males. Preventing ACEs may improve mental health among young women and men in LMICs in Sub-Saharan Africa.
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Affiliation(s)
- Stephanie Spaid Miedema
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Caroline Stamatakis
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Rwanda
| | | | - Jennifer Hegle
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jordan McOwen
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | - Pedro Manuel
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | | | - Phyllis Niolon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pragna Patel
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Chiang L, Miedema S, Saul J, Mercy J, Brooks A, Butchart A, Bachman G, Hegle J, Ligiero D, Logan J, Massetti G. Successful child sexual violence prevention efforts start with data: how the Violence Against Children and Youth Survey helped curb the tide of child sexual violence in 20 countries. BMJ Paediatr Open 2024; 8:e002497. [PMID: 38479727 PMCID: PMC10936510 DOI: 10.1136/bmjpo-2024-002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Affiliation(s)
- Laura Chiang
- Division of Violence Prevention, CDC, Atlanta, Georgia, USA
| | | | - Janet Saul
- Bureau of Global Health Security and Diplomacy, US Department of State, Washington, District of Columbia, USA
| | - James Mercy
- Division of Violence Prevention, CDC, Atlanta, Georgia, USA
| | - Andrew Brooks
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Alexander Butchart
- Prevention of Violence Unit, World Health Organization, Geneva, Switzerland
| | | | - Jennifer Hegle
- Division of Global HIV and TB, CDC, Atlanta, Georgia, USA
| | | | - Joseph Logan
- Division of Global HIV and TB, CDC, Atlanta, Georgia, USA
| | - Greta Massetti
- National Center for Injury Prevention and Control, CDC, Atlanta, Georgia, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Lee N, Self-Brown SR, Bachman G, Howard AL, Gilbert LK, Hegle J, Perry EW, Saul J, Behl I, Massetti GM. Orphanhood vulnerabilities for violence and HIV by education, sex, and orphan type among 18-24-year-old youth: findings from the 2018 Lesotho violence against children and youth survey. PSYCHOL HEALTH MED 2024; 29:655-669. [PMID: 37434351 PMCID: PMC10782587 DOI: 10.1080/13548506.2023.2235280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
HIV and violence among orphans are key measures of vulnerability in low-resource settings. Although Lesotho has the second highest HIV adult prevalence rate (21.1%) in the world, and the prevalence of orphanhood (44.2%) and violence exposure (67.0%) is high, little research exist on orphanhood vulnerabilities for violence and HIV in Lesotho. Using data from 4,408 youth (18-24 years old) from Lesotho's 2018 Violence Against Children and Youth survey, a nationally representative cross-sectional household survey, the study examined associations among orphan status, violence, and HIV and assessed how associations differed by education, sex, and orphan type, using logistic regression. Orphans had higher odds of violence (aOR, 1.21; 95% CI, 1.01-1.46) and HIV (aOR, 1.69; 95% CI, 1.24-2.29). Having primary education or less (aOR, 1.43; 95% CI, 1.02-2.02), male sex (aOR, 1.74; 95% CI, 1.27-2.36), and being a paternal orphan (aOR, 1.43; 95% CI, 1.14-1.80) were significant interaction terms for violence. Orphans who completed primary school or less (aOR, 1.61; 95% CI, 1.09-2.39), female (aOR, 3.08; 95% CI, 2.14-4.42) and double orphans (aOR, 2.54; 95% CI, 1.56-4.13) had higher odds of HIV. These relationships highlight the importance of comprehensive strategies to support education and family strengthening for orphans as core violence and HIV prevention efforts.
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Affiliation(s)
- NaeHyung Lee
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
- Copial Business Strategists LLC, Atlanta, GA, USA
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon R. Self-Brown
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Gretchen Bachman
- Office of Global HIV/AIDS, US Agency for International Development, Washington, DC, USA
| | - Ashleigh L. Howard
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leah K. Gilbert
- Office of Safety, Security, and Asset Management, Office of the Chief Operating Officer, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Hegle
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth W. Perry
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Janet Saul
- Office of the Global AIDS Coordinator and Health Diplomacy, US Department of State, Washington, DC, USA
| | - India Behl
- School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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6
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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7
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Howard AL, Chiang L, Picchetti V, Zhu L, Hegle J, Patel P, Saul J, Wasula L, Nantume S, Coomer R, Kamuingona R, Oluoch RP, Mharadze T, Duffy M, Kambona CA, Ramphalla P, Fathim KM, Massetti GM. Population Estimates of HIV Risk Factors to Inform HIV Prevention Programming for Adolescent Girls and Young Women. AIDS Educ Prev 2023; 35:20-38. [PMID: 37406147 DOI: 10.1521/aeap.2023.35.suppa.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Violence Against Children and Youth Survey (VACS) data from seven countries were analyzed to estimate population-level eligibility for the President's Emergency Plan for AIDS Relief (PEPFAR) Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) HIV prevention program for adolescent girls and young women (AGYW). The prevalence of overall eligibility and individual risk factors, including experiences of violence, social, and behavioral risks differ across countries and age groups. A large proportion of AGYW across all countries and age groups examined have at least one risk factor making them eligible for DREAMS. Experiencing multiple risks is also common, suggesting that researchers and programs could work together to identify combinations of risk factors that put AGYW at greatest risk of HIV acquisition, or that explain most new HIV infections, to more precisely target the most vulnerable AGYW. The VACS provides important data for such analyses to refine DREAMS and other youth programming.
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Affiliation(s)
- Ashleigh L Howard
- U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health, Atlanta, Georgia
| | - Laura Chiang
- CDC, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Viani Picchetti
- CDC, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Liping Zhu
- CDC, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Jennifer Hegle
- U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health, Atlanta, Georgia
| | - Pragna Patel
- U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health, Atlanta, Georgia
| | - Janet Saul
- U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health, Atlanta, Georgia
| | - Lydia Wasula
- Uganda Ministry of Gender, Labor and Social Development, Kampala, Uganda
| | | | | | - Rahimisa Kamuingona
- Namibia Ministry of Gender Equality, Poverty Eradication and Social Services, Windhoek, Namibia
| | | | | | | | | | - Puleng Ramphalla
- CDC, Lesotho Country Office, Maseru, Lesotho. Puleng Ramphalla, MS, is affiliated with the CDC, Côte d'Ivoire Country Office, Abidjan, Côte d'Ivoire
| | | | - Greta M Massetti
- CDC, National Center for Injury Prevention and Control, Atlanta, Georgia
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8
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Kanagasabai U, Valleau C, Cain M, Chevalier MS, Hegle J, Patel P, Benevides R, Trika JB, Angumua C, Mpingulu M, Ferdinand K, Sida F, Galloway K, Kambona C, Oluoch P, Msungama W, Katengeza H, Correia D, Duffy M, Cossa RMV, Coomer R, Ayo A, Ukanwa C, Tuyishime E, Dladla S, Drummond J, Magesa D, Kitalile J, Apondi R, Okuku J, Chisenga T, Cham HJ. Understanding Gender-Based Violence Service Delivery in CDC-Supported Health Facilities: 15 Sub-Saharan African Countries, 2017-2021. AIDS Educ Prev 2023; 35:39-51. [PMID: 37406144 DOI: 10.1521/aeap.2023.35.suppa.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Gender-based violence (GBV) is a complex issue deeply rooted in social structures, making its eradication challenging. GBV increases the risk of HIV transmission and is a barrier to HIV testing, care, and treatment. Quality clinical services for GBV, which includes the provision of HIV postexposure prophylaxis (PEP), vary, and service delivery data are lacking. We describe GBV clinical service delivery in 15 countries supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Through a descriptive statistical analysis of PEPFAR Monitoring, Evaluation, and Reporting (MER) data, we found a 252% increase in individuals receiving GBV clinical services, from 158,691 in 2017 to 558,251 in 2021. PEP completion was lowest (15%) among 15-19-year-olds. Understanding GBV service delivery is important for policy makers, program managers, and providers to guide interventions to improve the quality of service delivery and contribute to HIV epidemic control.
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Affiliation(s)
- Udhayashankar Kanagasabai
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | | | - Meagan Cain
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Michelle S Chevalier
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Jennifer Hegle
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Pragna Patel
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Regina Benevides
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Joseph B Trika
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Carrine Angumua
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Minlangu Mpingulu
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Kamanga Ferdinand
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Fikirte Sida
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Katelyn Galloway
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Caroline Kambona
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Patricia Oluoch
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Wezi Msungama
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Hans Katengeza
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Della Correia
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Meghan Duffy
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Raquel Maria Violeta Cossa
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Rachel Coomer
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Adeola Ayo
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Chioma Ukanwa
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Elysee Tuyishime
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Sibongile Dladla
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Jennifer Drummond
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Daniel Magesa
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Jane Kitalile
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Rose Apondi
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Jackson Okuku
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Tina Chisenga
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Haddi J Cham
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
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Kageyama M, Verani A, Patel P, Hegle J, Saul J. Gender-Based Violence Laws in Ten African Countries with High HIV Prevalence and Incidence Among Adolescent Girls and Young Women. UC Davis J Int Law Policy 2023; 29:59-92. [PMID: 38617015 PMCID: PMC11009944 DOI: 10.2139/ssrn.4358954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
To understand laws pertaining to gender-based violence (GBV) in countries with high HIV prevalence particularly among adolescent girls and young women (AGYW), we reviewed GBV laws and regulations from initial ten eastern and southern African countriesparticipating in the United States President's Emergency Plan for AIDS Relief (PEPFAR) Determined, Resilient, AIDS-free, Mentored, and Safe (DREAMS) Initiative and highlighted similarities and differences across these jurisdictions. All ten countries (Eswatini, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe) have GBV legislation in place but lack robust information on its implementation and enforcement. Given the known association between GBV and HIV acquisition among AGYW, an increased understanding of GBV laws, their variation across countries and respective gaps, as well as the interplay between enabling, protective, and punitive laws can strengthen policy environments for improved GBV prevention and response, which in turn can lower incidental HIV acquisition among AGYW. For greater impact, GBV policies would require reform, implementation, monitoring, and enforcement.
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Affiliation(s)
- Mariko Kageyama
- K&L Gates LLP in Seattle, Washington, United States of America
| | - Andre Verani
- Division of Global HIV and TB, Center of Global Health, CDC in Atlanta, Georgia
| | - Pragna Patel
- Division of Global HIV and TB, Center of Global Health, CDC
| | - Jennifer Hegle
- Division of Global HIV and TB, Center of Global Health, CDC
| | - Janet Saul
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State in Washington, DC
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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 Negl 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Stamatakis C, Annor F, Massetti G, Hegle J, Low A, Ndagije F, Tlhomola M. Patterns of gendered risk factors and associations with intimate partner violence and low educational attainment among adolescent girls and young women in Lesotho: A latent class analysis. Child Abuse Negl 2022; 134:105927. [PMID: 36244210 PMCID: PMC10563704 DOI: 10.1016/j.chiabu.2022.105927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Globally, adolescent girls and young women (AGYW) are disproportionately impacted by economic, demographic, and social factors associated with a wide range of negative outcomes. OBJECTIVE The objective of this study was to use latent class analysis (LCA) to identify groupings of AGYW in Lesotho based on patterns of gendered risk factors, and to assess the association between the identified groupings and intimate partner violence (IPV) and low educational attainment. PARTICIPANTS AND SETTING Data were from the 2018 Lesotho Violence Against Children and Youth Survey. AGYW reported gendered risk factors: teen pregnancy, child marriage, intergenerational sex, early sexual debut, being HIV positive, transactional sex, endorsement of one or more negative traditional gender norms, and one or more norms supportive of violence against women. METHODS LCA identified latent classes of eight gendered risk factors. Multivariable logistic regression assessed associations between latent classes and IPV victimization and low educational attainment. RESULTS A three-class solution was selected, and classes were named as: Low Risk class, Behavioral Risk class, and Attitudinal Risk class. Odds of low educational attainment and IPV were higher in the Attitudinal Risk class than the Low Risk class. Odds of low educational attainment and IPV were higher in the Behavioral Risk class than the Low Risk class and the Attitudinal Risk class. CONCLUSIONS In Lesotho, gendered risk factors form distinct classes that have variable associations with low educational attainment and IPV. LCA can be an important approach to better understand the complicated relationship gendered risk factors have with each other and with certain outcomes, to further elucidate the influence that gender has on the health of AGYW and to provide more targeted prevention programming.
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Affiliation(s)
- Caroline Stamatakis
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
| | - Francis Annor
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Greta Massetti
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer Hegle
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrea Low
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Felix Ndagije
- ICAP at Columbia Lesotho Office, Mailman School of Public Health, Columbia University, Maseru, Lesotho
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Currie DW, Apondi R, West CA, Biraro S, Wasula LN, Patel P, Hegle J, Howard A, Benevides de Barros R, Durant T, Chiang LF, Voetsch AC, Massetti GM. A comparison of two population-based household surveys in Uganda for assessment of violence against youth. PLoS One 2021; 16:e0260986. [PMID: 34932585 PMCID: PMC8691642 DOI: 10.1371/journal.pone.0260986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
Violence is associated with health-risk behaviors, potentially contributing to gender-related HIV incidence disparities in sub-Saharan Africa. Previous research has demonstrated that violence, gender, and HIV are linked via complex mechanisms that may be direct, such as through forced sex, or indirect, such as an inability to negotiate safe sex. Accurately estimating violence prevalence and its association with HIV is critical in monitoring programmatic efforts to reduce both violence and HIV. We compared prevalence estimates of violence in youth aged 15–24 years from two Ugandan population-based cross-sectional household surveys (Uganda Violence Against Children Survey 2015 [VACS] and Uganda Population-based HIV Impact Assessment 2016–2017 [UPHIA]), stratified by gender. UPHIA violence estimates were consistently lower than VACS estimates, including lifetime physical violence, recent intimate partner physical violence, and lifetime sexual violence, likely reflecting underestimation of violence in UPHIA. Multiple factors likely contributed to these differences, including the survey objectives, interviewer training, and questionnaire structure. VACS may be better suited to estimate distal determinants of HIV acquisition for youth (including experience of violence) than UPHIA, which is crucial for monitoring progress toward HIV epidemic control.
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Affiliation(s)
- Dustin W. Currie
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Rose Apondi
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Christine A. West
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Lydia N. Wasula
- Uganda Ministry of Gender, Labour, and Social Development, Kampala, Uganda
| | - Pragna Patel
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer Hegle
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ashleigh Howard
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Strategic Innovative Solutions, LLC, Clearwater, Florida, United States of America
| | - Regina Benevides de Barros
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tonji Durant
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura F. Chiang
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrew C. Voetsch
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Greta M. Massetti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Agathis NT, Annor FB, Coomer R, Hegle J, Patel P, Forster N, O'Malley G, Ensminger AL, Kamuingona R, Andjamba H, Manyando M, Massetti GM. HIV Prevention Program Eligibility Among Adolescent Girls and Young Women - Namibia, 2019. MMWR Morb Mortal Wkly Rep 2021; 70:1570-1574. [PMID: 34758009 PMCID: PMC8580202 DOI: 10.15585/mmwr.mm7045a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) relies on comprehensive and reliable population data to implement interventions to reduce HIV transmission in high-incidence areas among populations disproportionately affected by the HIV epidemic. Adolescent girls and young women in sub-Saharan Africa account for a disproportionate number of new HIV infections compared with their male peers (1). The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) program includes multisectoral, layered interventions aimed at reducing factors that contribute to vulnerability to HIV infection among adolescent girls and young women in PEPFAR-supported sub-Saharan African countries (1). Namibia, a southern African country with a population of approximately 2.55 million among whom approximately 8% live with HIV infection, had their DREAMS program first implemented in 2017* (2,3). Data from the 2019 Namibia Violence Against Children and Youth Survey (VACS), the most recent and comprehensive nationally representative data source available to study the epidemiology of violence and other HIV risk factors, were used to estimate the percentage of adolescent girls and young women aged 13-24 years who would be eligible for DREAMS program services. The prevalence of individual DREAMS eligibility criteria, which comprise known age-specific risk factors associated with HIV acquisition, were estimated by age group. Among all adolescent girls and young women in Namibia, 62% were eligible for DREAMS based on meeting at least one criterion. Common eligibility criteria included adverse childhood experiences, specifically exposure to physical, emotional, and sexual violence and being an orphan;† and high-risk behaviors, such as early alcohol use,§ recent heavy alcohol use,¶ and infrequent condom use.** Using VACS data to estimate the prevalence of HIV risk factors and identify adolescent girls and young women at elevated risk for HIV acquisition in countries like Namibia with high HIV-incidence can inform programs and policies aimed at improving the well-being of these adolescent girls and young women and help control the HIV epidemics in these countries.
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Stamatakis C, Howard A, Chiang L, Massetti GM, Apondi R, Stoebenau K, Hegle J, Wasula L, Patel P. Regional heterogeneity in violence and individual characteristics associated with recent transactional sex among Ugandan girls and young women: A national and regional analysis of data from the Violence Against Children and Youth Survey. PLoS One 2021; 16:e0257030. [PMID: 34473803 PMCID: PMC8412282 DOI: 10.1371/journal.pone.0257030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/22/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives This study assessed associations between recent transactional sex (TS) and potential determinants and variations in patterns across two geographic regions with high HIV burden compared to the rest of Uganda, among adolescent girls and young women (AGYW). Methods In 2015, a nationally representative cross-sectional household survey was conducted in Uganda. A stratified multi-stage cluster sample design produced nationally representative estimates and sub-national estimates for AGYW in two high HIV burden regions, DREAMS Central 1 (Bukomansimbi, Ssembabule, and Rakai districts) and DREAMS Central 2 (Mubende, Mityana, Gomba, and Mukono districts), and the rest of Uganda. To identify associations between recent TS (defined as sex in the past 12 months in exchange for material support or help) and risk factors, multivariable logistic regressions were conducted. Interaction terms assessed the associations between violence and recent TS across geographic regions. Results Nationally, 14.2% of sexually active AGYW engaged in recent TS. Region-specific significant associations emerged between recent TS and marriage, family wealth, friendship, orphanhood, and sexual debut. In DREAMS Central 1 and 2, AGYW who witnessed violence in the home or community, or experienced sexual, physical, or emotional violence had higher odds of recent TS than AGYW who did not experience that form of violence (adjusted odds ratio ranged between 2.10 (95% CI, 1.07, 4.13) and 8.25 (95% CI, 3.40, 20.06)). The magnitude of association between recent TS and types of violence varied by region. Conclusions Violence is strongly and consistently associated with recent TS, and patterns in prevalence and risk factors vary across regions in Uganda. Given the high risk of HIV association with recent TS, HIV epidemic control efforts may benefit from focus on comprehensive violence prevention and target persons who engage in TS. Comprehensive HIV prevention programming aimed at keeping AGYW HIV-negative should incorporate prevention of violence and TS as key components to facilitate HIV epidemic control in this vulnerable population.
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Affiliation(s)
- Caroline Stamatakis
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Ashleigh Howard
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura Chiang
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Greta M. Massetti
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rose Apondi
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kirsten Stoebenau
- School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Jennifer Hegle
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lydia Wasula
- Uganda Ministry of Gender, Labour and Social Development, Kampala, Uganda
| | - Pragna Patel
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Markiewicz M, Bevc CA, Hegle J, Horney JA, Davies M, MacDonald PDM. Linking public health agencies and hospitals for improved emergency preparedness: North Carolina's public health epidemiologist program. BMC Public Health 2012; 12:141. [PMID: 22361231 PMCID: PMC3337284 DOI: 10.1186/1471-2458-12-141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 02/23/2012] [Indexed: 11/10/2022] Open
Abstract
Background In 2003, 11 public health epidemiologists were placed in North Carolina's largest hospitals to enhance communication between public health agencies and healthcare systems for improved emergency preparedness. We describe the specific services public health epidemiologists provide to local health departments, the North Carolina Division of Public Health, and the hospitals in which they are based, and assess the value of these services to stakeholders. Methods We surveyed and/or interviewed public health epidemiologists, communicable disease nurses based at local health departments, North Carolina Division of Public Health staff, and public health epidemiologists' hospital supervisors to 1) elicit the services provided by public health epidemiologists in daily practice and during emergencies and 2) examine the value of these services. Interviews were transcribed and imported into ATLAS.ti for coding and analysis. Descriptive analyses were performed on quantitative survey data. Results Public health epidemiologists conduct syndromic surveillance of community-acquired infections and potential bioterrorism events, assist local health departments and the North Carolina Division of Public Health with public health investigations, educate clinicians on diseases of public health importance, and enhance communication between hospitals and public health agencies. Stakeholders place on a high value on the unique services provided by public health epidemiologists. Conclusions Public health epidemiologists effectively link public health agencies and hospitals to enhance syndromic surveillance, communicable disease management, and public health emergency preparedness and response. This comprehensive description of the program and its value to stakeholders, both in routine daily practice and in responding to a major public health emergency, can inform other states that may wish to establish a similar program as part of their larger public health emergency preparedness and response system.
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Affiliation(s)
- Milissa Markiewicz
- North Carolina Preparedness and Emergency Response Research Center, North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Hegle J, Markiewicz M, Benson P, Horney J, Rosselli R, MacDonald P. Lessons learned from North Carolina public health regional surveillance teams' regional exercises. Biosecur Bioterror 2011; 9:41-7. [PMID: 21361796 DOI: 10.1089/bsp.2010.0061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
All-hazards exercises bring together emergency response partners at the local, regional, state, and federal levels for the primary purposes of testing response plans, defining roles and responsibilities, assessing capabilities, and making necessary improvements prior to an actual incident. To better understand the benefits and challenges of conducting regional (ie, multicounty) exercises, a study was carried out by the North Carolina Preparedness and Emergency Response Research Center at the University of North Carolina Gillings School of Global Public Health. This article describes 5 all-hazards regional exercises conducted by Public Health Regional Surveillance Teams (PHRSTs) in North Carolina in 2009 and highlights 4 unique benefits that resulted from the exercises beyond meeting explicit objectives to test plans and identify areas for improvement: (1) building relationships among response partners, (2) promoting public health assets, (3) testing multiple communications systems, and (4) training exercise evaluators. Challenges of planning and conducting regional exercises also are addressed, followed by recommendations for maximizing the effectiveness of regional public health exercises.
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Affiliation(s)
- Jennifer Hegle
- University of North Carolina Center for Public Health Preparedness, North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
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Horney JA, Markiewicz M, Meyer AM, Casani J, Hegle J, MacDonald PDM. Regional public health preparedness teams in North Carolina: an analysis of their structural capacity and impact on services provided. Am J Disaster Med 2011; 6:107-117. [PMID: 21678820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In December 2001, the North Carolina Division of Public Health established Public Health Regional Surveillance Teams (PHRSTs) to build local public health capacity to prevent, prepare for, respond to, and recover from public health incidents and events. Seven PHRSTs are colocated at local health departments (LHDs) around the state. The authors assessed structural capacity of the PHRSTs and analyzed the relationship between structural capacity and the frequency of support and services provided to LHDs by PHRSTs. Five categories of structural capacity were measured: human, fiscal, informational, physical, and organizational resources. In addition, variation in structural capacity among teams was also examined. The most variation was seen in human resources. Although each team was originally designed to include a physician/epidemiologist, industrial hygienist, nurse/epidemiologist, and administrative support technician, team composition varied such that only the administrative support technician is common to all teams. Variation in team composition was associated with differences in the support and services that PHRSTs provide to LHDs. Teams that reported having a medical doctor or a doctor of osteopathic medicine (chi2 = 9.95; p < 0.01) or an epidemiologist (chi2 = 5.35; p < 0.02) had larger budgets and provided more support and services, and teams that housed a pharmacist reported more partners (chi2 = 52.34; p < 0.01). Teams that received directives from more groups (such as LHDs) also provided more support and services in planning (Z = 21.71; p < 0.01), communication and liaison (Z = 12.11; p < 0.01), epidemiology and surveillance (Z = 5.09; p < 0.01), consultation and technical support (Z = 2.25; p = 0.02), H1N1 outbreak assistance (Z = 10.25; p < 0.01), and public health event response (Z = 2.19; p = 0.03). In the last 10 years, significant variation in structural capacity, particularly in human resources, has been introduced among PHRSTs. These differences explain much of the variation in support and services provided to LHDs by PHRSTs.
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Affiliation(s)
- Jennifer A Horney
- Department of Epidemiology, North Carolina Institute for Public Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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