Multiple sexual partnerships among female adolescents in rural Uganda: the effects of family structure and school attendance

Abstract Background: A better understanding is needed of the contextual factors that influence HIV risk behaviors among female adolescents in sub-Saharan Africa. The objectives of this study were to assess the influence of family structure on lifetime sexual partners and on the number of sexual partners in the last year among female adolescents in rural Rakai, Uganda. In addition, the study assessed whether the influence of family structure on these outcomes differed by the school attendance status of the adolescents. Methods: The sample consisted of 2337 unmarried adolescent girls, aged 15–19, enrolled in the Rakai Community Cohort Study. The last survey interview within the time period of 2001–2008 available for each girl was used. Analyses were stratified by age (15–17 year olds and 18–19 year olds) and school status. Multinomial logistic and poisson regressions were used. Results: Living in a household with a biological father was protective against both outcomes. Family structure was not associated with the outcomes among in-school adolescents but it was significantly associated with the outcomes among out-of-school adolescents. Conclusion: The findings suggest that understanding the familial context in which female adolescents develop, as well as its interaction with school attendance, is important for HIV prevention efforts. Both research and programmatic initiatives must consider the interplay between the family and school domains when considering ways to reduce HIV acquisition among adolescent women.

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HIV prevention is not all about HIV – using a discrete choice experiment among women to model how the uptake and effectiveness of HIV prevention products may also rely on pregnancy and STI protection

BMC Infectious Diseases ◽

10.1186/s12879-020-05399-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Peter Vickerman ◽

Matthew Quaife ◽

Maggie Kilbourne-Brook ◽

Mercy Mvundura ◽

Robyn Eakle ◽

...

Keyword(s):

Hiv Prevention ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Household Survey ◽

Sub Saharan Africa ◽

Adult Women ◽

Adolescent Women ◽

Sub Saharan ◽

Hiv Acquisition

Abstract Introduction In sub-Saharan Africa, considerable HIV-burden exists among women. Anti-retroviral (ARV) based prevention products could decrease this burden, and their uptake could be increased if they also protect against pregnancy and sexually transmitted infections (STI). Methods A discrete choice experiment (DCE) was undertaken in South Africa (2015) through a household survey of adult females (n = 158) and adolescent girls (n = 204) who self-reported HIV-negative status. The DCE was used to project the uptake (percentage using product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, and injectable long-lasting ARV agents among these women, and how uptake could depend on whether these products protect against pregnancy or STI acquisition. Uptake estimates were used to model how each product could decrease a women’s HIV acquisition risk. Results In adolescent women, there will be limited uptake (< 6% for any product) and impact (< 4% decrease in HIV acquisition risk) of new products unless they provide pregnancy protection, which could quadruple use and impact. Adult women have weaker preference for pregnancy protection, with moderate use (< 17% for each) and impact (< 14 percentage point decrease) if they only provide HIV protection. All women had highest preference for injectable ARVs, with oral PrEP having high preference if injectable ARVs are not available. Adult women will use the ring, but adolescent women will not. Importantly, even with three additional prevention products, all providing pregnancy and STI protection, > 14% of women will remain unprotected and > 31% of the baseline acquisition risk will remain. Conclusions Incorporating multiple prevention components into new ARV-based prevention products may increase their uptake and impact among women.

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HPV infection and vaccination in Sub‐Saharan Africa: 10 years of research in Tanzanian female adolescents

Tropical Medicine & International Health ◽

10.1111/tmi.13660 ◽

2021 ◽

Author(s):

Hilary Whitworth ◽

John Changalucha ◽

Kathy Baisley ◽

Deborah Watson‐Jones

Keyword(s):

Hpv Infection ◽

Sub Saharan Africa ◽

Female Adolescents ◽

Sub Saharan

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HIV acquisition in pregnancy: implications for mother‐to‐child transmission at the population level in sub‐Saharan Africa

Journal of the International AIDS Society ◽

10.1002/jia2.25783 ◽

2021 ◽

Vol 24 (S5) ◽

Author(s):

Milly Marston ◽

Kathryn Risher ◽

Mary I. Mahy

Keyword(s):

Population Level ◽

Sub Saharan Africa ◽

Mother To Child Transmission ◽

Child Transmission ◽

Sub Saharan ◽

Hiv Acquisition ◽

Mother To Child ◽

In Pregnancy

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Correction: The protective role of family structure for adolescent development in sub-Saharan Africa

PLoS ONE ◽

10.1371/journal.pone.0221723 ◽

2019 ◽

Vol 14 (8) ◽

pp. e0221723

Author(s):

Oluwaseyi Dolapo Somefun ◽

Clifford Odimegwu

Keyword(s):

Family Structure ◽

Adolescent Development ◽

Protective Role ◽

Sub Saharan Africa ◽

Sub Saharan

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Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Sexual Health ◽

10.1071/sh13094 ◽

2014 ◽

Vol 11 (2) ◽

pp. 126 ◽

Cited By ~ 9

Author(s):

Ying-Ru Lo ◽

Masaya Kato ◽

Nittaya Phanuphak ◽

Masami Fujita ◽

Duong Bui Duc ◽

...

Keyword(s):

Hiv Transmission ◽

Sub Saharan Africa ◽

Treatment As Prevention ◽

The Pacific ◽

Prep Implementation ◽

Sub Saharan ◽

Hiv Acquisition ◽

Operational Issues ◽

Exposure Prophylaxis ◽

Firm Evidence

Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.

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Household water insecurity, missed schooling, and the mediating role of caregiver depression in rural Uganda

Global Mental Health ◽

10.1017/gmh.2017.14 ◽

2017 ◽

Vol 4 ◽

Cited By ~ 7

Author(s):

C. E. Cooper-Vince ◽

B. Kakuhikire ◽

D. Vorechovska ◽

A. Q. McDonough ◽

J. Perkins ◽

...

Keyword(s):

Risk Factor ◽

School Attendance ◽

Sub Saharan Africa ◽

Water Insecurity ◽

Cross Sectional ◽

Standard Deviation Increase ◽

Caregiver Depression ◽

Household Water ◽

Sub Saharan ◽

Household Heads

BackgroundSchool attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children's water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.MethodWe conducted a population-based, cross-sectional study of female household heads (N = 257) and their children ages 5–17 (N = 551) in the rural regions surrounding the town of Mbarara, in southwestern Uganda. We used multivariable linear regressions to estimate the association between water insecurity and missed schooling. We then assessed the extent to which the association was mediated by caregiver depression.ResultsAmong children, water insecurity had a statistically significant association with the number of missed school days (a standard deviation increase in water insecurity resulted in 0.30 more missed school days in the last week). The estimated association was partially mediated by caregiver depression. When stratified by sex, this mediating pathway remained significant for boys, but not among girls.ConclusionsWater insecurity is a risk factor for missed schooling among children in rural Uganda. Caregiver depression partially mediated this relationship. Also addressing caregiver mental health in water insecure families may more fully address the needs of sub-Saharan African families and promote educational participation among youth.

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Oral and injectable contraception use and risk of HIV acquisition among women in sub-Saharan Africa

AIDS ◽

10.1097/qad.0b013e32835da401 ◽

2013 ◽

Vol 27 (6) ◽

pp. 1001-1009 ◽

Cited By ~ 37

Author(s):

Sandra I. McCoy ◽

Wenjing Zheng ◽

Elizabeth T. Montgomery ◽

Kelly Blanchard ◽

Ariane van der Straten ◽

...

Keyword(s):

Sub Saharan Africa ◽

Contraception Use ◽

Sub Saharan ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition

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“I wish to remain HIV negative”: Pre-exposure prophylaxis adherence and persistence in transgender women and men who have sex with men in coastal Kenya

PLoS ONE ◽

10.1371/journal.pone.0244226 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244226

Author(s):

Makobu Kimani ◽

Elise M. van der Elst ◽

Oscar Chirro ◽

Elizabeth Wahome ◽

Fauz Ibrahim ◽

...

Keyword(s):

Risk Behaviour ◽

Healthcare Services ◽

Transgender Women ◽

Situational Factors ◽

Sub Saharan Africa ◽

Sexual Risk Behaviour ◽

Sub Saharan ◽

Sex With Men ◽

Hiv Acquisition ◽

Exposure Prophylaxis

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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Schistosoma and Other Relevant Helminth Infections in HIV-Positive Individuals—an Overview

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed4020065 ◽

2019 ◽

Vol 4 (2) ◽

pp. 65 ◽

Cited By ~ 1

Author(s):

Amrei von Braun ◽

Henning Trawinski ◽

Sebastian Wendt ◽

Christoph Lübbert

Keyword(s):

Neglected Tropical Diseases ◽

Sub Saharan Africa ◽

World Health ◽

Cross Sectional ◽

Treatment And Prevention ◽

Helminth Infections ◽

Helminthic Infections ◽

Sub Saharan ◽

Health Organization ◽

Hiv Acquisition

For many years, researchers have postulated that helminthic infections may increase susceptibility to HIV, and that immune activation may have contributed to the extensive spread of HIV in sub-Saharan Africa. In the meantime, immunological studies have provided some evidence in support of this hypothesis, while cross-sectional clinical studies were able to further support the assumed association between HIV infection and selected helminthic co-infections. However, as many of the helminthic infections relevant to HIV-infected patients belong to the group of “neglected tropical diseases”, as defined by the World Health Organization, a certain lack of attention has inhibited progress in fully scaling up treatment and prevention efforts. In addition, despite the fact that the challenges of co-infections have preoccupied clinicians for over two decades, relevant research questions remain unanswered. The following review aims to provide a concise overview of associations between HIV and selected helminthic co-infections concerning aspects of HIV acquisition and transmission, clinical and immunological findings in co-infected individuals, as well as treatment and prevention efforts.

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