Vulnerabilities at first sex and their association with lifetime gender-based violence and HIV prevalence among adolescent girls and young women engaged in sex work, transactional sex, and casual sex in Kenya

Fri, 10 Aug 2018 00:00:00 GMT-05:00 - Becker, Marissa L; Bhattacharjee, Parinita; Blanchard, James F; Cheuk, Eve; Isac, Shajy; Musyoki, Helgar K; Gichangi, Peter; Aral, Sevgi; Pickles, Michael; Sandstrom, Paul; Ma, Huiting; Mishra, Sharmistha
Εισαγωγή: Adolescent girls and young women (AGYW) experience high rates of HIV early in their sexual life-course. We estimated the prevalence of HIV-associated vulnerabilities at first sex, and their association with lifetime gender-based violence (GBV) and HIV.
Μέθοδοι: We conducted a cross-sectional bio-behavioural survey among AGYW (14-24 years) in Mombasa, Kenya in 2015. We compared the prevalence of first sex vulnerabilities across AGYW who self-identified as engaging in sex work (N=408), transactional sex (N=177) or casual sex (N=714); and used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes (GBV after first sex; HIV).
Αποτελέσματα: The median age at first sex was 16 years (IQR 14 - 18). 43.6% received gifts or money at first sex; 41.2% and 11.2% experienced a coerced and forced first sex respectively. First sex vulnerabilities were generally more common among AGYW in sex work. GBV (prevalence 23.8%) and HIV (prevalence 5.6%) were associated with first sex before age 15 (GBV AOR 1.4, 95% CI 1.0-1.9; HIV AOR 1.9, 95% CI 1.1-1.3); before or within 1 year of menarche (GBV AOR 1.3, 95% CI 1.0-1.7; HIV AOR 2.1, 95% CI 1.3-3.6); and receipt of money (GBV AOR 1.9, 95% CI 1.4-2.5; HIV AOR 2.0, 95% CI 1.2-3.4).
Συμπέρασμα: HIV-associated vulnerabilities begin at first sex and potentially mediate an AGYW’s trajectory of risk. HIV prevention programmes should include structural interventions that reach AGYW early, and screening for a history of first sex vulnerabilities could help identify AGYW at risk of ongoing GBV and HIV. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Corresponding Author: Marissa Becker Centre for Global Public Health Rady Faculty of Health Sciences University of Manitoba R070 Med Rehab Bldg 771 McDermot Avenue Winnipeg, Manitoba R3E 0T6 marissa.becker@umanitoba.ca phone: + 1 204 272 3123 Fax: + 1 204 789 3718 Conflicts of Interest and Sources of Funding: The authors declare no conflicts of interest. This study was funded by an operating grant (MOP-13044) from the Canadian Institutes of Health Research (CIHR) and analyses funded via CIHR grant FDN 13455. - Β© 2018

Comparing Youth Friendly Health Services to the Standard of Care through β€œGirl Power-Malawi”: A Quasi-Experimental Cohort Study

Fri, 10 Aug 2018 00:00:00 GMT-05:00 - Rosenberg, Nora E.; Bhushan, Nivedita L.; Vansia, Dhrutika; Phanga, Twambilile; Maseko, Bertha; Nthani, Tiyamike; Libale, Colleta; Bamuya, Catherine; Kamtsendero, Linda; Kachigamba, Annie; Myers, Laura; Tang, Jennifer; Hosseinipour, Mina C.; Bekker, Linda-Gail; Pettifor, Audrey E.
Εισαγωγή: Adolescent girls and young women (AGYW) face challenges to seeking HIV and sexual and reproductive health services in sub-Saharan Africa. Integrated approaches designed for AGYW may facilitate service uptake, but rigorous evaluation is needed.
Μέθοδοι: Four comparable public-sector health centers were selected in Malawi and randomly assigned to a service delivery model. One offered β€œstandard of care” (SOC), consisting of vertical HIV testing, family planning, and sexually transmitted infection management in adult-oriented spaces, by providers without extra training. Three offered youth-friendly health services (YFHS), consisting of the same SOC services in integrated youth-dedicated spaces and staffed by youth-friendly peers and providers. In each health center, AGYW 15-24 years old were enrolled and followed over 12 months to determine use of HIV testing, condoms, and hormonal contraception. The SOC and YFHS models were compared using adjusted risk differences and incidence rate ratios. Findings: In 2016, 1000 AGYW enrolled (N=250/health center). Median age was 19 years (inter-quartile range=17-21 years). Compared to AGYW in the SOC, those in the YFHS models were 23% (CI: 16%-29%) more likely to receive HIV testing, 57% (CI: 51%-63%) more likely to receive condoms, and 39% (CI: 34%-45%) more likely to receive hormonal contraception. Compared to AGYW in the SOC, AGYW in the YFHS models accessed HIV testing 2.4 (CI: 1.9-2.9) times more, condoms 7.9 (CI: 6.0-10.5) times more, and hormonal contraception 6.0 (CI: 4.2-8.7) times more.
Συμπέρασμα: A YFHS model led to higher health service use. Implementation science is needed to guide scale-up. Corresponding Author: Nora E. Rosenberg, PhD, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 919-602-8499, Nora_Rosenberg@unc.edu Conflict of Interest Statement and Funding Sources: We declare that we have no conflicts of interest. The study was funded by Evidence for HIV Prevention in Southern Africa (EHPSA), a DFID program managed by Mott MacDonald. NER is funded by the National Institute of Mental Health (R00 MH104154) and through the UNC Center for AIDS Research from the National Institute of Allergies and Infectious Diseases (P30 AI50410). NLB was supported by the National Institutes of Health Fogarty International Center (R25TW009340). - Β© 2018