Concurrency and the limited effectiveness of behavioural interventions on sexual risk behaviour of youth in sub-Saharan Africa

Background Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM. Methods Participants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700–1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically. Results Fifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services. Conclusion While MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.

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Documenting and explaining the HIV decline in east Zimbabwe: the Manicaland General Population Cohort

BMJ Open ◽

10.1136/bmjopen-2017-015898 ◽

2017 ◽

Vol 7 (10) ◽

pp. e015898 ◽

Cited By ~ 12

Author(s):

Simon Gregson ◽

Owen Mugurungi ◽

Jeffrey Eaton ◽

Albert Takaruza ◽

Rebecca Rhead ◽

...

Keyword(s):

General Population ◽

Sexual Risk ◽

Risk Behaviour ◽

Small Towns ◽

Scientific Data ◽

Hiv Prevalence ◽

Sexual Risk Behaviour ◽

Sub Saharan ◽

Demographic Impact

PurposeThe Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour and the demographic impact of HIV in a sub-Saharan African population subject to a generalised HIV epidemic. The aims were later broadened to include provision of data on the coverage and effectiveness of national HIV control programmes including antiretroviral therapy (ART).ParticipantsGeneral population open cohort located in 12 sites in Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). 9,109 of 11,453 (79.5%) eligible adults (men 17-54 years; women 15–44 years) were recruited in a phased household census between July 1998 and January 2000. Five rounds of follow-up of the prospective household census and the open cohort were conducted at 2-year or 3-year intervals between July 2001 and November 2013. Follow-up rates among surviving residents ranged between 77.0% (over 3 years) and 96.4% (2 years).Findings to dateHIV prevalence was 25.1% at baseline and had a substantial demographic impact with 10-fold higher mortality in HIV-infected adults than in uninfected adults and a reduction in the growth rate in the worst affected areas (towns) from 2.9% to 1.0%pa. HIV infection rates have been highest in young adults with earlier commencement of sexual activity and in those with older sexual partners and larger numbers of lifetime partners. HIV prevalence has since fallen to 15.8% and HIV incidence has also declined from 2.1% (1998-2003) to 0.63% (2009-2013) largely due to reduced sexual risk behaviour. HIV-associated mortality fell substantially after 2009 with increased availability of ART.Future plansWe plan to extend the cohort to measure the effects on the epidemic of current and future HIV prevention and treatment programmes. Proposals for access to these data and for collaboration are welcome.

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The theory of planned behaviour as a framework for predicting sexual risk behaviour in sub-Saharan African youth: A critical review

Journal of Child and Adolescent Mental Health ◽

10.2989/17280583.2011.621067 ◽

2012 ◽

Vol 24 (1) ◽

pp. 15-35 ◽

Cited By ~ 14

Author(s):

Cleo Protogerou ◽

Alan J Flisher ◽

Leif Edvard Aarø ◽

Catherine Mathews

Keyword(s):

Sexual Risk ◽

Critical Review ◽

Theory Of Planned Behaviour ◽

Risk Behaviour ◽

Sexual Risk Behaviour ◽

Planned Behaviour ◽

African Youth ◽

Sub Saharan

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The Relationship of Sexual and Gender-Based Violence to Sexual-Risk Behaviour among Refugee Women in Sub-Saharan Africa

World Health & Population ◽

10.12927/whp.2007.18957 ◽

2007 ◽

Vol 9 (2) ◽

pp. 26-37 ◽

Cited By ~ 2

Author(s):

Johannes John-Langba

Keyword(s):

Risk Behaviour ◽

Sub Saharan Africa ◽

Sexual Risk Behaviour ◽

Gender Based Violence ◽

Refugee Women ◽

Sub Saharan ◽

Gender Based ◽

And Gender ◽

Relationship Of ◽

The Relationship

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Condom migration after introduction of pre-exposure prophylaxis among HIV-uninfected adolescents in South Africa: A cohort analysis

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v18i1.712 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Lennart P. Maljaars ◽

Katherine Gill ◽

Philip J. Smith ◽

Glenda E. Gray ◽

Janan J. Dietrich ◽

...

Keyword(s):

Condom Use ◽

Sexual Risk ◽

Sexual Debut ◽

Cohort Analysis ◽

Risk Behaviour ◽

Unprotected Sex ◽

Sub Saharan Africa ◽

Future Research ◽

Sexual Risk Behaviour ◽

Exposure Prophylaxis

Background: Approximately 3 million adolescents and young adults (AYA), between the ages of 15 years and 24 years, are living with HIV in sub-Saharan Africa. The use of pre-exposure prophylaxis (PrEP) may be a promising HIV prevention tool to bridge the high-risk years of AYA between sexual debut and adulthood.Objectives: Concerns have been raised that the use of PrEP could lead to an increase in sexual risk behaviour and sexually transmitted infections in general and less condom use in particular among adolescents.Methods: This study assesses condom use among South African adolescents enrolled on a demonstration PrEP study, called Pluspills, being conducted in Cape Town and Soweto. A questionnaire on sexual risk behaviour was administered at baseline and after 4, 8 and 12 weeks. Three different questions on condom use were asked at each visit. Unless all answers indicated condom use at all times, a participant was scored ‘at risk’. McNemar’s tests and a Cochran’s Q test were used to investigate changes in condom use over time.Results: We interviewed 148 adolescents (66% female) at baseline. Eighty-nine participants completed all visits. In this group, an increase in condom use was observed over the period of 12 weeks. Most participants who reported behavioural changes mentioned an increase in condom use.Conclusion: There was no sign of sexual risk compensation in the 12 weeks of the study. Observed increase in condom use can be explained by an increased awareness of personal HIV risk or by social desirability or recall biases. In future research, additional data including other biomarkers of unprotected sex and longer follow-up time would be useful to help understand the relationship between PrEP use, sexual risk perception and consequent behaviours, especially in adolescents.

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