HIV among out-of-school youth in Eastern and Southern Africa: a review

Stroeken, Koenraad; Remes, Pieter; Koker, Petra De; Michielsen, Kristien; Vossole, Anke Van; Temmerman, Marleen

doi:10.1080/09540121.2011.596519

Cited by 37 publications

(37 citation statements)

References 33 publications

(30 reference statements)

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“…These findings based on longitudinal data are consistent with those from prior studies indicating that young women who are in school have fewer lifetime partners, 5,10,11 and fewer partners older than themselves compared to young people who do not attend school. 5,12–14,23 Most notably, our results are similar to a cross-sectional study in South Africa that found that young men who were in school were less likely to be HIV infected, but both young men and women in school had fewer lifetime partners, and young women had fewer partners more than 3 years older than themselves. 5 Another recent study in Zimbabwe found that age-disparate relationships were associated with incident HIV infection and that completion of secondary school was inversely associated with age-disparate relationships.…”

Section: Discussionsupporting

confidence: 86%

“…But to date, a temporal relationship between school attendance, grade repetition, and school dropout with sexual behaviors has not been established. 5,10–12,14 Given that attending school has a strong preventative association with HIV acquisition in young women, a better understanding of the sexual behaviors affected by attending school would provide clarity on how to reduce transmission in this population.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Schooling on Age-Disparate Relationships and Number of Sexual Partners Among Young Women in Rural South Africa Enrolled in HPTN 068

Stoner

Edwards

Miller

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Attending school may have a strong preventative association with sexually transmitted infections among young women, but the mechanism for this relationship is unknown. One hypothesis is that students who attend school practice safer sex with fewer partners, establishing safer sexual networks that make them less exposed to infection. Setting We used longitudinal data from a randomized controlled trial of young women age 13-20 in the Bushbuckridge district, South Africa, to determine if the percentage of school days attended, school dropout and grade repetition are associated with having a partner five or more years older (age-disparate) and with the number of sexual partners in the previous 12 months. Methods Risks of having an age-disparate relationship and counts of sex partners were compared using inverse probability of exposure weighted Poisson regression models. Generalized estimating equations were used to account for repeated measures. Results Young women who attended fewer school days (<80%) and who dropped out of school were more likely to have an age-disparate relationship (risk difference (RD) 9.9%, 95% CI 3.9%,16.0%; RD (%) dropout 17.2%, 95% CI: 5.4%,29.0%) and those who dropped out reported having fewer partners (count difference (CD) dropout 0.343, 95% CI: 0.192, 0.495). Grade repetition was not associated with either behavior. Conclusion Young women who less frequently attend school or who drop out are more likely to have an age-disparate relationship. Young women who drop out have more partners overall. These behaviors may increase risk of exposure to HIV infection in young women out of school.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Effect of Schooling on Age-Disparate Relationships and Number of Sexual Partners Among Young Women in Rural South Africa Enrolled in HPTN 068

Stoner

Edwards

Miller

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

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“…12 Sub-Saharan Africa studies of out-of-school youth have demonstrated more risk behaviours and higher rates of STIs and HIV than those in school. [13][14][15] Data specific to SCCY report engagement in high-risk behaviours including transactional sex and inconsistent condom use, and limited HIV knowledge. [16][17][18][19][20] Drug use is common.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya

et al. 2015

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PurposeThe objectives of this study were to characterise the sexual health of street-connected adolescents in Eldoret, Kenya, analyse gender disparity of risks, estimate the prevalence of sexually transmitted infections (STIs), and identify factors associated with STIs.MethodsA cross-sectional study of street-connected adolescents ages 12–21 years was conducted in Eldoret, Kenya. Participants were interviewed and screened for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus-2, syphilis and HIV. Descriptive statistics and logistic regression were used to identify factors associated with having any STI.ResultsOf the 200 participants, 81 (41%) were female. 70.4% of females and 60.5% of males reported sexual activity. Of those that participated in at least one STI test, 28% (55/194) had ≥1 positive test, including 56% of females; 14% (28/194) had >1 positive test. Twelve females and zero males (6% overall, 14.8% of females) were HIV positive. Among females, those with HIV infection more frequently reported transactional sex (66.7% vs 26.1%, p=0.01), drug use (91.7% vs 56.5%, p=0.02), and reported a prior STI (50.0% vs 14.7%, p<0.01). Having an adult caregiver was less likely among those with HIV infection (33.3% vs 71.0%, p=0.04). Transactional sex (AOR 3.02, 95% CI (1.05 to 8.73)), a previous STI (AOR 3.46 95% CI (1.05 to 11.46)) and ≥2 sexual partners (AOR 5.62 95% (1.67 to 18.87)) were associated with having any STI.ConclusionsStreet-connected adolescents in Eldoret, Kenya are engaged in high-risk sexual behaviours and females in particular have a substantial burden of STIs and HIV. There is a need for STI interventions targeted to street-connected youth.

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“…Clinic based approaches may not be effective at reaching young men under the age of 25 years because young men access health services at disproportionately lower rates than females in part due to traditional masculine gender norms (Galdas, Cheater & Marshall, 2005; Nyamhanga, Muhondwa, Shayo, 2013). Worksite and school based approaches may also not be the most effective approach, because many young men most at risk are not in school and not formally employed (Stroeken et al, 2012). Intervention strategies to engage men are also lacking, particularly those that address the structural determinants of risk.…”

Section: Introductionmentioning

confidence: 99%

Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention

Maman

Kajula

Balvanz

et al. 2015

Global Public Health

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Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analyzed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomized trial of the microfinance and peer health leadership intervention.

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HIV among out-of-school youth in Eastern and Southern Africa: a review

Cited by 37 publications

References 33 publications

Effect of Schooling on Age-Disparate Relationships and Number of Sexual Partners Among Young Women in Rural South Africa Enrolled in HPTN 068

Effect of Schooling on Age-Disparate Relationships and Number of Sexual Partners Among Young Women in Rural South Africa Enrolled in HPTN 068

Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya

Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention

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