Adolescent Mothers in Eastern and Southern Africa: An Overlooked and Uniquely Vulnerable Subpopulation in the Fight Against HIV

Groves, Allison K.; Gebrekristos, Luwam T; Smith, Patrick; Stoebenau, Kirsten; Stoner, Marie; Ameyan, Wole; Ezeh, Alex

doi:10.1016/j.jadohealth.2021.12.012

Cited by 11 publications

(12 citation statements)

References 40 publications

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“…The studies that were included reported qualitative and quantitative data on the experiences of adolescent mothers affected by HIV from sub-Saharan African countries: 12 studies from South Africa [4,11,12,13,15,22,23,24,25,26,29,32], 2 from Malawi [17,21], 1 from Zimbabwe [16], 6 Kenyan studies [18,20,27,31,33,34] (n=6), 1 from Lesotho [28] 1 from Uganda [19], and 2 multi-country studies [14, 30].…”

Section: Resultsmentioning

confidence: 99%

HIV and Pregnancy among Adolescents in Sub-Saharan Africa: A Scoping Review

Akinsolu,

Adewole,

Lawale

et al. 2024

Preprint

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The interaction of adolescent pregnancy with HIV is a complex and crucial public health issue worldwide. This is evident in sub-Saharan Africa, where the co-occurrence of HIV and adolescent pregnancies represents a high risk for additional health and social consequences for both adolescent mothers and their children. This study aims to explore literature to provide a clear synthesis of data related to pregnancies among adolescents living with HIV in Sub-Saharan Africa. A literature search was conducted in July 2023 using PubMed, Scopus, CINAHL, Cochrane Library, African Journals Online, and World Health Organization Global Index Medicus. Two authors screened potential studies. Articles selected were those published in or translated into the English language between 2002 and 2022. Among 1,560 identified results, 25 peer-reviewed publications on pregnancy among adolescents living with HIV in Sub-Saharan Africa were included after screening. The studies, included both qualitative and quantitative data, with a total of 178,227 participants in the age range of 12-18 years. The majority of the studies reported quantitative data, while a few presented qualitative or mixed-methods findings. This scoping review highlights disparities in pregnancy prevalence, revealing varied rates among different age groups. The underrepresentation of adolescents in demographic studies suggests diverse vulnerabilities and access to healthcare. The study also emphasizes the need for tailored healthcare services and comprehensive interventions addressing HIV risk, mental health challenges, and socio-economic barriers.

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Section: Resultsmentioning

confidence: 99%

HIV and Pregnancy among Adolescents in Sub-Saharan Africa: A Scoping Review

Akinsolu,

Adewole,

Lawale

et al. 2024

Preprint

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“…1 Centre for Social Science Research, University of Cape Town, Cape Town, South Africa (E-mail: zhou.siyah@gmail.com, wylene.saal@spu.ac.za, bolade.banougnin@gmail.com); 2 Department of Social Policy and Intervention, University of Oxford, Oxford, UK (E-mail: William.rudgard@spi.ox.ac.uk, nontokozo.langwenya@nuffield.ox.ac.uk, janina.jochim@spi.ox.ac.uk); 3 Division of Social and Behavioural Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (E-mail: lucie.cluver@spi.ox.ac.uk); 4 Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa (E-mail: christina.a.laurenzi@gmail.com); 5 Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK (E-mail: camille.wittesaele@spi.ox.ac.uk); 6 UNICEF Eastern and Southern Africa Office (UNICEF-ESARO), Nairobi, Kenya (E-mail: lgulaid@unicef.org, aarmstrong@unicef.org); 7 National Institute for Communicable Diseases, Johannesburg, South Africa (E-mail: gayles@nicd.ac.za); 8 Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 9 MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK (Email: o.edun19@imperial.ac.uk); 10 Institute for Global Health, University College London, London, UK (E-mail: l.sherr@ucl.ac.uk); 11 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa…”

Section: A U T H O R S ' a F F I L I At I O N Smentioning

confidence: 99%

“…Adolescent girls and young women (AGYW) aged 15-24 represented nearly one-quarter of new HIV infections in 2022 in sub-Saharan Africa [1]. In parallel, AGYW living with HIV in sub-Saharan Africa continue to experience early pregnancy: nearly 30% of AGYW have had a child before age 20 [2,3]. Recent multi-country analyses of nationally representative Eastern and Southern Africa datasets identified strong asso-ciations between HIV prevalence and early motherhood, highlighting the importance of these overlapping vulnerabilities for HIV programming and maternal care [2,4].…”

Section: Introductionmentioning

confidence: 99%

“…In parallel, AGYW living with HIV in sub-Saharan Africa continue to experience early pregnancy: nearly 30% of AGYW have had a child before age 20 [2,3]. Recent multi-country analyses of nationally representative Eastern and Southern Africa datasets identified strong asso-ciations between HIV prevalence and early motherhood, highlighting the importance of these overlapping vulnerabilities for HIV programming and maternal care [2,4]. AGYW living with HIV experience multiple adverse HIVrelated health outcomes, including poorer adherence to antiretroviral therapy (ART), retention in care, clinic attendance and viral suppression compared to older women [5].…”

Section: Introductionmentioning

confidence: 99%

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Healthcare provisions associated with multiple HIV‐related outcomes among adolescent girls and young women living with HIV in South Africa: a cross‐sectional study

Toska,

Zhou,

Laurenzi

et al. 2024

J Int AIDS Soc.

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IntroductionAdolescent girls and young women (AGYW) living with HIV experience poor HIV outcomes and high rates of unintended pregnancy. Little is known about which healthcare provisions can optimize their HIV‐related outcomes, particularly among AGYW mothers.MethodsEligible 12‐ to 24‐year‐old AGYW living with HIV from 61 health facilities in a South African district completed a survey in 2018–2019 (90% recruited). Analysing surveys and medical records from n = 774 participants, we investigated associations of multiple HIV‐related outcomes (past‐week adherence, consistent clinic attendance, uninterrupted treatment, no tuberculosis [TB] and viral suppression) with seven healthcare provisions: no antiretroviral therapy (ART) stockouts, kind and respectful providers, support groups, short travel time, short waiting time, confidentiality, and safe and affordable facilities. Further, we compared HIV‐related outcomes and healthcare provisions between mothers (n = 336) and nulliparous participants (n = 438). Analyses used multivariable regression models, accounting for multiple outcomes.ResultsHIV‐related outcomes were poor, especially among mothers. In multivariable analyses, two healthcare provisions were “accelerators,” associated with multiple improved outcomes, with similar results among mothers. Safe and affordable facilities, and kind and respectful staff were associated with higher predicted probabilities of HIV‐related outcomes (p<0.001): past‐week adherence (62% when neither accelerator was reported to 87% with both accelerators reported), clinic attendance (71%−89%), uninterrupted ART treatment (57%−85%), no TB symptoms (49%−70%) and viral suppression (60%−77%).ConclusionsAccessible and adolescent‐responsive healthcare is critical to improving HIV‐related outcomes, reducing morbidity, mortality and onward HIV transmission among AGYW. Combining these provisions can maximize benefits, especially for AGYW mothers.

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“…In Southern and Eastern Africa, adolescent girls and young women (AGYW) are more than twice as likely to acquire HIV than their male peers [1], and around 20% become pregnant before turning 20 [2][3][4]. AGYW who are pregnant or mothers experience significantly higher risk of HIV infection than their peers [5][6][7][8]. Additionally, although antenatal care commonly serves as a critical entry point for HIV testing, low rates of disclosure to partners and use of maternal anti-retroviral therapy (ART) is a risk for onwards HIV transmission to children and future sexual partners [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Food security reduces multiple HIV infection risks for high‐vulnerability adolescent mothers and non‐mothers in South Africa: a cross‐sectional study

et al. 2022

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Introduction Adolescent girls and young women, including adolescent mothers, in Southern Africa have high HIV seroconversion and transmission. We need to know which risks drive HIV infections, and what can reduce these risks. Methods We interviewed 1712 adolescent girls and young women (11–23 years), including 1024 adolescent mothers who had conceived before age 20 and had a living child, from two health municipalities of South Africa's Eastern Cape Province between March 2018 and July 2019. Recruitment was through multiple community, school and health facility channels. Associations between adolescent motherhood and seven HIV risk behaviours (multiple sexual partners, transactional sex, age‐disparate sex, condomless sex, sex on substances, alcohol use and not in education or employment) were investigated using the generalized estimating equations method for multiple outcomes specified with a logit link and adjusting for nine covariates. Using the same model, we investigated associations between having enough food at home every day in the past week (food security) and the same seven HIV risk behaviours. When we found evidence of moderation by HIV status, we report stratum‐specific odds ratios. Results Mean age was 17.51 years (SD: 2.54), 46% participants were living with HIV. Compared to non‐mothers, adolescent mothers had lower odds of alcohol use (AOR = 0.47, 95% CI = 0.29–0.75), but higher odds of multiple sexual partners (AOR = 1.93, 95% CI = 1.35–2.74), age‐disparate sex (HIV‐uninfected AOR = 1.73, 95% CI = 1.03–2.91; living with HIV AOR = 5.10, 95% CI = 2.98–8.73), condomless sex (AOR = 8.20, 95% CI = 6.03–11.13), sex on substances (AOR = 1.88, 95% CI = 1.10–3.21) and not in education/employment (HIV‐uninfected AOR = 1.83, 95% CI = 1.19–2.83; living with HIV AOR = 6.30, 95% CI = 4.09–9.69). Among non‐mothers, food security was associated with lower odds of multiple sexual partners (AOR = 0.45, 95% CI = 0.26–0.78), transactional sex (AOR = 0.32, 95% CI = 0.13–0.82) and not in education/employment (AOR = 0.48, 95% CI = 0.29–0.77). Among adolescent mothers, food security was associated with lower odds of transactional sex (AOR = 0.17, 95% CI = 0.10–0.28), age‐disparate sex (AOR = 0.66, 95% CI = 0.47–0.92), sex on substances (AOR = 0.51, 95% CI = 0.32–0.82), alcohol use (AOR = 0.45, 95% CI = 0.25–0.79) and not in education/employment (AOR = 0.56, 95% CI = 0.40–0.78). Conclusions Adolescent motherhood is associated with multiple vulnerabilities to HIV infection and transmission. Social protection measures that increase food security are likely to reduce HIV risk pathways for adolescent girls and young women, especially adolescent mothers.

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Adolescent Mothers in Eastern and Southern Africa: An Overlooked and Uniquely Vulnerable Subpopulation in the Fight Against HIV

Cited by 11 publications

References 40 publications

HIV and Pregnancy among Adolescents in Sub-Saharan Africa: A Scoping Review

HIV and Pregnancy among Adolescents in Sub-Saharan Africa: A Scoping Review

Healthcare provisions associated with multiple HIV‐related outcomes among adolescent girls and young women living with HIV in South Africa: a cross‐sectional study

Food security reduces multiple HIV infection risks for high‐vulnerability adolescent mothers and non‐mothers in South Africa: a cross‐sectional study

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