Role of Male Sex Partners in HIV Risk of Adolescent Girls and Young Women in Mozambique

Chapman, Julie; Nascimento, Nena do; Mandal, Mahua

doi:10.9745/ghsp-d-19-00117

Cited by 14 publications

(12 citation statements)

References 28 publications

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“…Following our secondary search for studies that described the interventions identified, we found 27 additional manuscripts. Thus, the total number of manuscripts reviewed was 112 [19‐130]. These manuscripts described 74 unique intervention research studies (Table 1) […”

Section: Resultsmentioning

confidence: 99%

Youth engagement in HIV prevention intervention research in sub‐Saharan Africa: a scoping review

Asuquo

Tahlil

Muessig

et al. 2021

J. Intern. AIDS Soc.

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Introduction Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub‐Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research. Methods We followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28 th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub‐Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart’s ladder as substantial engagement (strong youth decision‐making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision‐making power) or no engagement. Results We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty‐two interventions were in low‐income countries, 49 in middle‐income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two‐thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth‐led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement. Conclusions We found limited youth engagement in youth HIV prevention intervention studies in sub‐Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low‐and‐middle‐income‐country (LMIC) settings.

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Section: Resultsmentioning

confidence: 99%

Youth engagement in HIV prevention intervention research in sub‐Saharan Africa: a scoping review

Asuquo

Tahlil

Muessig

et al. 2021

J. Intern. AIDS Soc.

View full text Add to dashboard Cite

show abstract

“…Community leaders saw DREAMS multi-sectoral approach as a lost opportunity to include young men who faced similar youth development challenges [26]. While young men have sexual reproductive health (SRH) needs and are partners of AGYW [26] in our community this ambivalence mirrored the well-described barriers to shifting gender-norms in South Africa [27][28][29]. DREAMS implemented a package that addressed gender-based violence explicitly and gender dynamics implicitly (contraception education and access, stepping stones and cash transfers).…”

Section: Youth Development Was Embraced By the Community; Transformmentioning

confidence: 99%

Directed and target focused multi‐sectoral adolescent HIV prevention: Insights from implementation of the ‘DREAMS Partnership’ in rural South Africa

et al. 2020

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Introduction The “DREAMS Partnership” promotes a multi‐sectoral approach to reduce adolescent girls and young women's (AGYW) vulnerability to HIV in sub‐Saharan Africa. Despite widespread calls to combine structural, behavioural and biomedical HIV prevention interventions, this has not been delivered at scale. In this commentary, we reflect on the two‐year rollout of DREAMS in a high HIV incidence, rural and poor community in northern KwaZulu‐Natal, South Africa to critically appraise the capacity for a centrally co‐ordinated and AGYW‐focused approach to combination HIV prevention to support sustainable development for adolescents. Discussion DREAMS employed a directed target‐focused approach in which local implementing partners were resourced to deliver defined packages to AGYW in selected geographical areas over two years. We argue that this approach, with high‐level oversight by government and funders, enabled the rapid roll‐out of ambitious multi‐sectoral HIV prevention for AGYW. It was most successful at delivering multiple interventions for AGYW when it built on existing infrastructure and competencies, and/or allocated resources to address existing youth development concerns of the community. The approach would have been strengthened if it had included a mechanism to solicit and then respond to the concerns of young women, for example gender‐related norms and how young women experience their sexuality, and if this listening was supported by versatility to adapt to the social context. In a context of high HIV vulnerability across all adolescents and youth, an over‐emphasis on targeting specific groups, whether geographically or by risk profile, may have hampered acceptability and reach of the intervention. Absence of meaningful engagement of AGYW in the development, delivery and leadership of the intervention was a lost opportunity to achieve sustainable development goals among young people and shift gender‐norms. Conclusions Centrally directed and target‐focused scale‐up of defined packages of HIV prevention across sectors was largely successful in reaching AGYW in this rural South African setting rapidly. However, to achieve sustainable and successful long‐term youth development and transformation of gender‐norms there is a need for greater adaptability, economic empowerment and meaningful engagement of AGYW in the development and delivery of interventions. Achieving this will require sustained commitment from government and funders.

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“…A post hoc trend decomposition analysis suggests that condom use behaviours may have shifted for YW as they entered martial partnerships (results not shown). Previous literature suggests that low condom use among AG and YW could be a product of failed negotiations fueled by low self-efficacy, relationship power and gender-inequitable norms and practices 6 18 43 60 61. Alternatively, condom use could have decreased due to changes in contraceptive use—such as moving from condoms to hormonal contraceptives—or desires to have children with their spouse 62–64.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research shows that transactional sex can increase women’s HIV risk 19 20 41 65 66. To avert poverty, homelessness and food insecurity, some may turn to transactional sex to survive or to obtain desired commodities 17 18 67. AGYW’s economic disenfranchisement is characterised by a constellation of factors—including gendered discrimination and lack of social and business capital68—that make it difficult to AGYW to access the economic resources or earn a living wage.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, non-marital partnerships are associated with age–disparate relationships and inconsistent condom use among AGYW and sexual concurrency among their male partners 14–16. Further, economic disenfranchisement and limited social capital push some AGYW to seek out sexual partners for financial support; these transactional arrangements often include relationships with older men17 18 and increase AGYW’s HIV risk 19–21. Negative life and social transitions—such as experiencing paternal loss,22–25 divorce/widowhood7 26 and school dropout7 18 27—have also been associated with heighted engagement in risky sexual behaviours and precarious decision making.…”

Section: Introductionmentioning

confidence: 99%

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Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia

et al. 2022

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ObjectivesTo assess temporal shifts in HIV risk factors among adolescent girls (AG, aged 15–19 years) and young women (YW, aged 20–24 years) in Kenya, Malawi and Zambia.DesignProspective cohorts with two time points (Kenya: 2016/2017, 2018; Malawi: 2017, 2018; Zambia: 2016/2017, 2018)SettingCommunity-based programming.Participants1247 AG (Kenya: 389, Malawi: 371, Zambia: 487) and 1628 YW (Kenya: 347, Malawi: 883, Zambia: 398)InterventionDetermined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), a multisectoral approach to reduce AGYW’s HIV vulnerability by delivering a package of tailored, multilayered activities and services.Primary and secondary outcome measures: HIV testing, sexually transmitted infection (STI) symptom experience, number of sexual partners, condom use (consistently, at last sex), transactional sex, experience of physical violence (from intimate partners) and sexual violence (from intimate partners and strangers/non-partners).ResultsChanges in HIV-related risk behaviours among DREAMS participants varied by age group and country. Among AG, HIV testing increased (Kenya and Zambia) and sexual violence from partners (in Kenya and Malawi) and non-partners (in Malawi) decreased. Among YW, HIV testing increased and STI experience decreased in Malawi; consistent condom use decreased in Kenya; transactional sex increased in Kenya and Zambia; and physical violence (in Malawi) and sexual violence from partners (in Kenya and Malawi) and non-partners (all three countries) decreased over time.ConclusionsImprovements in HIV testing and reductions in experiences of sexual violence were coupled with variable shifts in HIV-related risk behaviours among DREAMS participants in Kenya, Malawi and Zambia. Additional consideration of AGYW’s risk circumstances during key life transitions may be needed to address the risk heterogeneity among AG and YW across different contexts.

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Role of Male Sex Partners in HIV Risk of Adolescent Girls and Young Women in Mozambique

Cited by 14 publications

References 28 publications

Youth engagement in HIV prevention intervention research in sub‐Saharan Africa: a scoping review

Youth engagement in HIV prevention intervention research in sub‐Saharan Africa: a scoping review

Directed and target focused multi‐sectoral adolescent HIV prevention: Insights from implementation of the ‘DREAMS Partnership’ in rural South Africa

Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia

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