Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework

Introduction: Unmet need for contraception, unintended pregnancy, and access to safe abortion remain global challenges preventing adolescent girls and young women (AGYW) from achieving optimal reproductive health. Furthermore, AGYW face difficulties navigating sexual autonomy, lack of agency or experience negotiating sexual acts, and challenges accessing sexual health information and services. The aim of this systematic review is to assess the psychosocial outcomes of AGYW who have experienced an abortion with particular focus on sub-Saharan Africa, which bears the global burden of unintended pregnancy and risk of death due to unsafe abortion.Materials and Methods: The systematic review was registered and used search terms to identify peer-reviewed articles relevant to “post-abortion,” “psychosocial,” “adolescent girls,” and “young women” from PubMed, Embase, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature. Examples of psychosocial experiences include quality of life, stigma, and mental health outcomes. Rayyan software (Qatar, 2020) was used by two reviewers to assess the relevance of each article to psychosocial outcomes of AGYW any time after an abortion or accessing post-abortion services. Analysis was conducted with a focus on data from Africa and comparisons are made to non-African settings.Results: A total of 2,406 articles were identified and 38 articles fit the criteria. Six selected articles were from Africa, including Ghana, Kenya, Uganda, and Zambia, and the remaining articles were from other regions. Themes around stigma, shame, and abandonment associated with the experience of abortion were prevalent in all regions. Studies of psychosocial outcomes of AGYW in sub-Saharan Africa highlight social isolation as well as learned resilience among young women who abort.Discussion: Navigating abortion as an AGYW involves managing internalized and perceived stigma, fear of violence, secrecy, and growing resilient in order to overcome the significant barriers that society and culture place on access to an essential service in sexual and reproductive health. Post-abortion psychosocial outcomes highlight the need for support services and investigation of contexts that perpetuate and necessitate unsafe abortion. Empowerment of AGYW may present an important opportunity to build self-agency and positive coping mechanisms to withstand social pressures during stigmatizing circumstances associated with abortion.

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Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

Reproductive Health ◽

10.1186/s12978-021-01076-0 ◽

2021 ◽

Vol 18 (S1) ◽

Author(s):

Martin K. Mutua ◽

Yohannes D. Wado ◽

Monica Malata ◽

Caroline W. Kabiru ◽

Elsie Akwara ◽

...

Keyword(s):

Family Planning ◽

West Africa ◽

Adolescent Girls ◽

Young Women ◽

Rate Of Change ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Sexually Active ◽

Sub Saharan ◽

Over Time

Abstract Background The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. Methods We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. Results Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique. Conclusion Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

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How to reduce HIV risk among adolescent girls and young women in sub-Saharan Africa? Implementation science around the DREAMS Initiative

10.31899/hiv7.1009 ◽

2016 ◽

Author(s):

Keyword(s):

Implementation Science ◽

Adolescent Girls ◽

Young Women ◽

Hiv Risk ◽

Sub Saharan Africa ◽

Sub Saharan

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Efficacy of an HIV Prevention Intervention for African American Adolescent Girls

JAMA ◽

10.1001/jama.292.2.171 ◽

2004 ◽

Vol 292 (2) ◽

pp. 171 ◽

Cited By ~ 320

Author(s):

Ralph J. DiClemente ◽

Gina M. Wingood ◽

Kathy F. Harrington ◽

Delia L. Lang ◽

Susan L. Davies ◽

...

Keyword(s):

African American ◽

Hiv Prevention ◽

Adolescent Girls ◽

Prevention Intervention ◽

Hiv Prevention Intervention ◽

African American Adolescent

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The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

Journal of the International AIDS Society ◽

10.1002/jia2.25299 ◽

2019 ◽

Vol 22 (S4) ◽

Cited By ~ 3

Author(s):

Samuel Ensor ◽

Bethan Davies ◽

Tanvi Rai ◽

Helen Ward

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Hiv Prevention ◽

Sub Saharan Africa ◽

Demand Creation ◽

Sub Saharan

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HIV Prevention in Young People in Sub-Saharan Africa: A Systematic Review

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2011.02.007 ◽

2011 ◽

Vol 49 (6) ◽

pp. 568-586 ◽

Cited By ~ 65

Author(s):

Sue M. Napierala Mavedzenge ◽

Aoife M. Doyle ◽

David A. Ross

Keyword(s):

Systematic Review ◽

Young People ◽

Hiv Prevention ◽

Sub Saharan Africa ◽

Sub Saharan

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Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials

AIDS ◽

10.1097/qad.0b013e3283384791 ◽

2010 ◽

Vol 24 (8) ◽

pp. 1193-1202 ◽

Cited By ~ 123

Author(s):

Kristien Michielsen ◽

Matthew F Chersich ◽

Stanley Luchters ◽

Petra De Koker ◽

Ronan Van Rossem ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Sub Saharan

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Hearing from men in Eswatini: Shifts in HIV risk and service uptake—Findings from DREAMS implementation science research

10.31899/hiv16.1000 ◽

2021 ◽

Author(s):

Keyword(s):

Implementation Science ◽

Adolescent Girls ◽

Young Women ◽

Hiv Risk ◽

Large Scale ◽

Hiv Infections ◽

Science Research ◽

Sub Saharan Africa ◽

Engaging Men ◽

Sub Saharan

HIV prevention efforts across sub-Saharan Africa are increasingly focused on engaging men, for their own health and that of their partners and families. We examined whether and how HIV risk and protective factors are changing among men in Eswatini (formerly Swaziland)—a country with a substantial HIV burden. The study is part of the Population Council’s implementation science research portfolio on the DREAMS Partnership1, a large-scale initiative to reduce new HIV infections among adolescent girls and young women (AGYW) and their partners.

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