Education, substance use, and HIV risk among orphaned adolescents in Eastern Zimbabwe

Pufall, Erica L.; Eaton, Jeffrey W.; Robertson, Laura; Mushati, Phyllis; Nyamukapa, Constance; Gregson, Simon

doi:10.1080/17450128.2017.1332398

Cited by 18 publications

(14 citation statements)

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“…With regard to schooling, the youth in school were more likely to be primary sexual abstainers than currently sexually active compared to their out of school peers. This finding is consistent with studies across different settings, which show that schooling promotes sexual abstinence and delays sexual debut [13,37,38]. Kirby argues that schooling reduces the amount of idle time youth have, increases their education and career aspirations, and empowers them with the necessary skills to reject unwanted sex [37].…”

Section: Discussionsupporting

confidence: 86%

Predictors of primary and secondary sexual abstinence among never-married youth in urban poor Accra, Ghana

Alhassan

Dodoo

2020

Reprod Health

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Background: Sexual abstinence is a key component of the strategy to address unwanted pregnancies, sexually transmitted infections and HIV among youth in sub-Sahara Africa. But contextual pressures make abstaining from sex a formidable task for urban poor youth in the sub-region. Nevertheless, some youth in these settings still manage to resist the pressure to initiate sex early, while others choose abstinence after an initial sexual debut. Few studies in the sub-region have examined sexual abstinence among urban poor youth. We therefore examined the factors that predict primary and secondary sexual abstinence among youth in urban poor Accra. The findings highlight the protective factors associated with sexual intercourse and should help to address the needs of youth at risk of unprotected sex. Methods: The study analysed pooled data from two rounds of the Urban Health and Poverty Survey. The surveys analysed were conducted in 2011 and 2013. The analysis was restricted to unmarried youth between age 20 and 24 years. The total sample comprised 235 female and male youth. We conducted multinomial logistic regression analysis to examine the predictors of primary and secondary abstinence relative to current sexual intercourse. Results: The results showed that being female, sexual communication with only fathers, sexual communication with only friends and slum residence were negatively associated with primary sexual abstinence. Contrarily, being in school, attaching importance to religion, residing in a household that received social support and sexual communication with both parents were positively associated with primary abstinence. Regarding secondary abstinence, only the sexual communication variables had significant effects. Sexual communication with both parents positively predicted secondary abstinence while communication with fathers-only and friends-only had a negative effect. Conclusion: Sexual abstinence is predicted by factors which range from individual through household factors to the locality of residence. Despite the importance of all the predictors, the study found that sexual communication with both parents was the only factor that predicted a higher likelihood of both primary and secondary sexual abstinence. We therefore recommend sexual communication between parents and youth as a key strategy for promoting sexual abstinence among urban poor youth in Accra, Ghana.

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Section: Discussionsupporting

confidence: 86%

Predictors of primary and secondary sexual abstinence among never-married youth in urban poor Accra, Ghana

Alhassan

Dodoo

2020

Reprod Health

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“…One study found a association between substance use and orphan status38, while another suggested that only paternal orphans are at increased risk of alcohol or drug use37, and a third found findings similar to ours, that maternal orphans were at higher risk of drug use39. This last study showed a strong correlation to drug use especially in males who lost their mothers, although it showed no correlation between orphan status and use of tobacco or alcohol39. On the other hand, the association between substance use in family and friends and personal initiation of use has long been strongly established40,41,42,43,44,45,46,47.…”

Section: Discussionsupporting

confidence: 75%

“…Among these studies, inconsistent correlations have been found. One study found a association between substance use and orphan status38, while another suggested that only paternal orphans are at increased risk of alcohol or drug use37, and a third found findings similar to ours, that maternal orphans were at higher risk of drug use39. This last study showed a strong correlation to drug use especially in males who lost their mothers, although it showed no correlation between orphan status and use of tobacco or alcohol39.…”

Section: Discussionsupporting

confidence: 69%

Depressive symptoms, sexual activity, and substance use among adolescents in Kampala, Uganda

et al. 2019

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BackgroundAdolescents experience high rates of depression, initiation of sexual activity, and substance use.ObjectivesTo better understand the demographics of adolescents presenting to an adolescent clinic in Uganda, and to elucidate which factors are associated with depressive symptoms, sexual initiation, and substance use.MethodsA retrospective review was performed on intake forms obtained during interviews with adolescents presenting to the Makerere/Mulago Columbia Adolescent Health Clinic (MMCAH) in Kampala, Uganda.ResultsDepressive symptoms in adolescents were correlated with having a chronic illness (p=.026), and reported poor quality of home life (p<.001). Initiation of sexual activity was also correlated with chronic illness (p=.008) and poor quality of home life (p=.006). Substance use was correlated with maternal death (p=.041), chronic illness (p=.038), and substance use among family members (p<.001) and friends (p<.001).ConclusionsKnowing the aforementioned risk factors can help us better understand the needs of adolescents presenting to MMCAH, and allows us to develop targeted interventions aimed at decreasing health risks in Kampala's adolescent population.

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“…Substance and alcohol use among orphans and vulnerable children (OVC; youth who are either single or double orphans and/or are at disproportionately high risk of poor outcomes compared to their peers) is of particular concern in Africa due to the link between substance use, including non-injection substances, and HIV risk, worse disease course for HIV, and other negative childhood outcomes (Kalichman et al, 2007; Morojele et al, 2006; Shuper et al, 2010; UNODC, 2012). Male orphans, in particular, may have an increased risk for substance abuse (Pufall et al, 2014). To accurately estimate the prevalence of substance and alcohol use disorders among youth and OVC populations in LMIC, screen for these problems in primary care centers, and evaluate interventions designed to manage and treat these problems, there is a need for locally validated instruments.…”

Section: Introductionmentioning

confidence: 99%

Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI)

Kane

Murray

Bass

et al. 2016

Drug and Alcohol Dependence

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Background-Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI).Methods-Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13-17 living in low-income, highdensity neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables.Results-Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68 -0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflict of InterestThe authors have no conflicts of interest to declare. ContributorsThe original study was conceived and designed by JCK, LKM, and PB. JCK conducted the statistical analysis. JCK wrote the first draft of the manuscript. JKB and RMJ provided critical feedback on the first draft and contributed to writing of subsequent drafts. All authors contributed significantly to and edited all sections of the manuscript and have approved the final version. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusions-ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.

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Education, substance use, and HIV risk among orphaned adolescents in Eastern Zimbabwe

Cited by 18 publications

References 60 publications

Predictors of primary and secondary sexual abstinence among never-married youth in urban poor Accra, Ghana

Predictors of primary and secondary sexual abstinence among never-married youth in urban poor Accra, Ghana

Depressive symptoms, sexual activity, and substance use among adolescents in Kampala, Uganda

Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI)

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