Contraceptive Method Mix and HIV Risk Behaviors Among Kenyan Adolescent Girls and Young Women Seeking Family Planning Services: Implications for Integrating HIV Prevention

Background: Understanding HIV risk behaviors among adolescent girls and young women (AGYW) seeking contraception could help inform integrating HIV prevention services within family planning (FP) clinics.Methods: From 10/2018 to 04/2019, we conducted a survey at 4 FP clinics in Kisumu, Kenya to evaluate risk behaviors among AGYW without HIV infection seeking contraception. All AGYW aged 15–24 were invited to participate following receipt of FP services. Adolescent girls and young women initiating or refilling contraception were included in this analysis. Long-acting reversible contraceptives (LARC) included intrauterine devices, implants, or injectables. Non-LARC methods included oral contraceptive pills (OCP) or condoms. We used an empiric risk score to assess HIV risk behaviors; HIV risk scores of ≥5 (corresponding to 5–15% HIV incidence) defined “high” HIV risk.Results: Overall, 555 AGYW seeking FP were included. Median age was 22 years [interquartile range (IQR) 20–23], median completed education was 12 years (IQR 10–12); 23% of AGYW had HIV risk scores of ≥5. The most frequent form of contraception was injectables (43%), followed by implants (39%). After adjustment for education, prior pregnancy, and marital status, LARC users more frequently engaged in transactional sex than non-LARC users [6 vs. 0%, adjusted prevalence ratio (PR) = 1.17, 95% CI 1.09–1.29, p < 0.001]; LARC use was not associated with HIV risk scores ≥5. Among LARC users, AGYW using injectables more frequently had condomless sex compared to AGYW using other LARC methods (85 vs. 75%, adjusted PR = 1.52, 95% CI 1.09–2.10, p = 0.012); injectable use was not associated with HIV risk scores ≥5.Conclusions: Adolescent girls and young women seeking contraception frequently had high HIV risk, emphasizing the importance of integrating HIV prevention within FP. Multipurpose technologies for contraception and HIV prevention could particularly benefit AGYW.

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Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya

International Journal of STD & AIDS ◽

10.1177/0956462420920423 ◽

2020 ◽

Vol 31 (7) ◽

pp. 652-664

Author(s):

Anna Larsen ◽

John Kinuthia ◽

Harison Lagat ◽

Joseph Sila ◽

Felix Abuna ◽

...

Keyword(s):

Family Planning ◽

Risk Behaviors ◽

Adolescent Girls ◽

Young Women ◽

Hiv Risk ◽

Partner Violence ◽

Depression Scale ◽

Severe Depression ◽

Hiv Risk Behaviors ◽

Western Kenya

We assessed prevalence of human immunodeficiency virus (HIV) risk behaviors and depressive symptoms among adolescent girls and young women (AGYW) aged 15–24 years attending four public family planning clinics in Western Kenya from January to June 2019. Moderate-to-severe depression (MSD) was defined as a Center for Epidemiologic Studies Depression Scale (CESD-10) score ≥10. Among 487 AGYW, the median age was 22 years (interquartile range 20–23), and 59 (12%) AGYW reported MSD. MSD was more prevalent among AGYW without a current partner (p = 0.001) and associated with HIV risk factors including partner ≥10 years older, recent transactional sex, forced sex, intimate partner violence, and alcohol use (each p ≤ 0.005). Thirty-four percent of AGYW with MSD had a high HIV risk score corresponding to 5 to 15 incident HIV cases per 100 person-years. Overlapping high prevalence of depression and HIV risk among AGYW underscores the need for integrated mental health and HIV services in family planning clinics.

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Reducing HIV Risk Behaviors: Perceptions of HIV Risk and Stage of Change

Journal of Drug Issues ◽

10.1177/002204269602600306 ◽

1996 ◽

Vol 26 (3) ◽

pp. 607-618 ◽

Cited By ~ 7

Author(s):

Sally J. Stevens ◽

Antonio L. Estrada

Keyword(s):

Hiv Prevention ◽

Risk Behavior ◽

Risk Behaviors ◽

Hiv Risk ◽

Sexual Behaviors ◽

Injection Drug Users ◽

Drug Users ◽

Stage Of Change ◽

Hiv Risk Behaviors ◽

Injection Drug

The HIV epidemic has had a dramatic impact on the lives of individuals, families, and communities around the world. Originally identified in homosexual men, HIV increasingly affects others, including: (1) those who inject drugs, (2) non-injection drug users who engage in unsafe sex, and (3) non-drug using heterosexuals who engage in high-risk sexual behaviors. The need for effective HIV prevention interventions is critical. All too often interventions have lacked sound theoretical frameworks. However, some attempts have been made to ground HIV risk behavior interventions in behavior theories such as: (1) the health belief model, (2) cognitive social learning theory, (3) the theory of reasoned action, and (4) the transtheoretical model of behavior change (TMBC). This paper describes an HIV prevention intervention that was developed from the TMBC model. The TMBC model hypothesizes stages of change. In this study, injection drug users (IDUs), crack cocaine users (CCUs), and female sexual partners of IDUs and CCUs identified their stage of change and were given an intervention based upon their identified stage. Baseline and post intervention follow-up data were obtained on participants' perceived stage and reported HIV sexual risk behavior. The data indicated that there was little congruence between perceived stage and reported risk. In spite of this incongruence, significant decreases in HIV risk behaviors were evidenced.

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