Purpose This study sought to assess whether risky sexual behaviours and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya. Methods We analyzed baseline data from a cohort of orphaned adolescents aged 10–18 years living in 300 randomly-selected households and 19 Charitable Children’s Institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariable logistic regression compared these between participants in institutional care and family-based care, while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use. Results This analysis included 1,365 participants aged ≥10 years; 712 (52%) living in institutional environments and 653 (48%) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (AOR 0.46 95% CI: 0.3–0.72) or to have experienced forced sex (AOR=0.57 95% CI: 0.38–0.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables. Conclusion Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents’ sexual risk-taking behaviours. The use of single items to assess outcomes and non-explicit definition of sex suggest the findings should be interpreted with caution.

BackgroundMany factors contribute to an enhanced risk of infant HIV acquisition, two of which may include failure of a mother to disclose her HIV-positive status to her partner and exclusion of male partners in preventing mother-to-child transmission of HIV (PMTCT) interventions. To justify why HIV programmes need to integrate male partner involvement and partner disclosure, we need to establish an association between the two factors and infant HIV acquisition.ObjectiveTo determine whether failure to disclose an HIV-positive status to a male partner is associated with increased risk of infant HIV acquisition, and whether part of the association is explained by exclusion of male partner in PMTCT programmes.MethodsUsing a case–control study design, we identified a total of 180 mother–baby pairs with HIV-exposed infants. Thirty-six pairs with HIV-positive babies (cases) were compared to 144 pairs with HIV-negative babies (controls) on whether the mothers had disclosed their HIV status to their partner in order to determine whether a disclosure or lack of it contributed to increased risk of mother-to-child transmission of HIV (MTCT). Each case pair was matched to four control pairs from the same facility.ResultsOverall, 16.7% of mothers had not disclosed their HIV status to their partners, the proportion being significantly more among cases (52.8% vs. 7.6%, p < 0.001). Non-disclosure was significantly associated with infant HIV acquisition (aOR 9.8 (3.0–26.3); p < 0.001) and male partner involvement partially mediated the effect of non-disclosure on infant HIV acquisition (indirect coefficient = 0.17, p < 0.005).ConclusionsFailure of an HIV-positive woman to disclose her status to her male partner and exclusion of male partners in PMTCT programmes are two social factors that may curtail success of interventions towards the goal of eliminating MTCT.

When male partners of pregnant women living with HIV do not participate in antenatal care, it decreases the uptake of prevention of mother-to-child transmission interventions, which increases the risk of HIV transmission to newborns. We evaluated the association of male partner involvement and vertical HIV transmission at 6 weeks along 4 constructs: antenatal clinic accompaniment, mother's awareness of partner HIV status, disclosure of mother's HIV status to partner, and couple testing. Thirty-three HIV-exposed infants with positive 6-week polymerase chain reaction (PCR) results were compared with 144 HIV-exposed infants with a negative PCR. Mothers of PCR-negative infants were 14 times more likely to have disclosed their HIV status to their partners (odds ratio [OR] = 14.1 [5.0–39.4]), to be aware of partner HIV status (OR = 0.2 [0.1–0.96]), and to have been accompanied by their male partners to the antenatal clinic (OR = 0.6 [0.5–0.9]). There is a need for male engagement in prevention of mother-to-child transmission programs.

The capacity for intensive care and continuous monitoring in low and middle-income countries is often outstripped by demand due to the high burden of critical illness. 1 Early warning scores developed in resource-rich settings are being adopted in resource-limited settings to identify patients whose conditions are deteriorating and require escalation of care. Pediatric early warning systems (PEWS) are designed to trigger an algorithm-based response depending on a risk score derived from clinical symptoms and signs. 2 Agulnik et al 3 report on the findings of a qualitative study exploring barriers and facilitators to PEWS implementation in 5 resource-limited pediatric oncology centers in Latin America. Using the Consolidated Framework for Implementation Research, the authors identified that the factors crucial to PEWS implementation cut across all the 5 domains and barriers to implementation in one setting or at one stage can be enablers in another setting or transform over the implementation process. 4 Enablers of PEWS implementation included characteristics of the intervention, support from an established collaborative network, simplicity of the intervention, the perceived strength of evidence, and the availability of funding to support implementation. Examples of barriers identified in the study Open Access: This is an open access article distributed under the terms of the CC-BY License.