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

Abstract

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.

Food Insecurity and Engagement in Transactional Sex Among Female Secondary Students in Rwanda

“…[ 9 ] Another study in South Africa found that among nulliparous AGYW (aged 11–25), being food secure was protective against transactional sex. [ 23 ] Our study is unique in that it extends this literature with its focus on in-school AGYW in the understudied Rwandan context, as well as its focus on food security. Successful interventions addressing transactional sex include cash transfers, which address its upstream drivers, such as FI; [ 24 , 25 ] other behavioral interventions have not demonstrated impact.…”

Associations of formal childcare use with health and human capital development for adolescent mothers and their children in South Africa: A cross‐sectional study

“…Previous research showed that, across 73 developing countries, increasing preschool enrolment to 50% in a single year could increase a countries' productivity by $33 billion across those children's lifetimes (Engle et al, 2011 ). Evidence‐based multi‐sectoral packages, which could include access to childcare, for pregnant adolescents and adolescent mothers are a crucial step in supporting their school progression and HIV risk reduction, strengthening positive future outlook and supporting the healthy development for the next generation (Cluver et al, 2022 ; Jochim et al, Forthcoming ). There are important future areas for research in understanding associations of different kinds of childcare settings with child and adolescent mother outcomes and differential impacts by age of children.…”

Associations between lifetime pregnancy and sexual risk behaviors among 15-24-year-old adolescent girls and young women in South Africa: Secondary analyses of the 2016 Demographic Health Survey

“…Designing focused interventions and public health strategies requires a thorough understanding of the prevalence of these risk factors. Studies have linked the experience of violence [ 11 ], lack of comprehensive sexual health education [ 12 ], and motherhood status [ 13 ] to multiple sexual risks among AGYW. However, there is a notable dearth of research concerning the relationship between lifetime pregnancy and multiple sexual risk behaviors among AGYW in South Africa.…”