Parental care status and sexual risk behavior in five nationally-representative surveys of sub-Saharan African nations

Background About 10% of children worldwide do not live with either of their biological parents, and although some of these children are orphans, many have living parents. While research shows that orphaned children in Sub-Saharan Africa tend to engage in more sexual risk behaviors than their peers, possibly due to decreased parental oversight and support, it is unclear if these effects also apply to children separated from their living parents. Exploring the question of whether living without parents, regardless of whether they are deceased, is linked to greater sexual risk-taking, this study is the first, to our knowledge, to examine correlates of parental care status in a multi-country, nationally-representative analysis. Methods This study was a secondary analysis of the Centers for Disease Control and Prevention’s Violence Against Children Surveys from Kenya, Malawi, Tanzania, Nigeria, and Zambia. We conducted logistic regressions on N = 6770 surveys of youth aged 13 to 17 years to determine if living with their biological parents predicted the odds of engaging in risky sexual behavior, controlling for demographic factors including orphanhood. Post-hoc regressions examined specific risk behaviors. Results Compared to those living with both parents, youth not living with either parent had heightened odds of engaging in any sexual risk behavior, even when controlling for orphanhood (OR = 2.56, 95% CI: [1.96, 3.33]). Non-parental care predicted heightened odds of non-condom use (OR = 3.35, 95% CI: [2.38, 4.72]), early sexual debut (OR = 1.80, 95% CI: [1.31, 2.46]), and more sexual partners (β = .60, p < .001). Conclusions This study extends prior research linking orphanhood and sexual risk behavior, lending credence to the idea that it is not parental death, but rather parental absence, that leads to sexual risk in youth. Public health programming in Sub-Saharan Africa should consider targeting not only “orphaned youth,” but all children separated from their parents.

Relationship of the balloon analog risk task to neurocognitive impairment differs by HIV serostatus and history of major depressive disorder

HIV and major depressive disorder (MDD) commonly co-occur and are both linked to greater risk-taking behavior, possibly due to neurocognitive impairment (NCI). The present study examined the concordance of the Balloon Analog Risk Task (BART), a gold standard measure of risk-taking propensity, with NCI and real-world sexual risk behaviors in PWH with comorbid MDD. Participants included 259 adults, stratified by HIV serostatus (HIV + /HIV −) and lifetime MDD (MDD + /MDD −), who completed neuropsychological testing, the BART, and sexual risk behavior questionnaires. Logistic regression, stratified by HIV serostatus, examined joint effects of MDD and BART (linear and quadratic) on NCI. Follow-up linear regressions examined sexual risk behavior and neurocognitive domain T-scores as correlates of the BART. NCI prevalence was lowest in HIV − /MDD − , but BART scores did not differ by HIV/MDD status. In the HIV + group, BART performance predicted NCI such that high and low BART scores related to greater odds of NCI, but only in dual-risk HIV + /MDD + individuals. HIV + /MDD + individuals with both low and high BART scores exhibited poorer learning and recall, whereas processing speed and executive function were only poor in low BART risk-taking HIV + /MDD + . Higher BART scores linearly related to higher sexual risk behaviors only in MDD + individuals, independent of HIV serostatus. Low and high risk-taking on the BART may reflect discrete neurocognitive profiles in HIV + /MDD + individuals, with differential implications for real-world sexual risk behavior. HIV and comorbid MDD may disturb corticostriatal circuits responsible for integrating affective and neurocognitive components of decision-making, thereby contributing to risk-averse and risk-taking phenotypes.

Adolescent sibling associations among alcohol, cannabis, and sexual risk behavior: A test of interdependence

Although siblings are conceptualized as a salient social influence during adolescence, few studies have examined how adolescent siblings influence each other’s substance use and risky sexual behavior. This study’s objective was to investigate the influence of alcohol use days, cannabis use days, and cannabis and alcohol co-use days on the sexual risk behavior of siblings while accounting for dyadic influence. At the baseline visit for a randomized controlled trial for adolescents referred due to parents’ concerns about their substance use (“referred adolescents”; n=99; Mage=15.95), we assessed alcohol and cannabis use days as well as sexual risk behavior of the referred adolescents and their sibling (Mage=15.03). We computed the number of days in the 30 days prior to the baseline that alcohol and cannabis use occurred on the same day. Using a cross-sectional actor partner interdependence model, we tested two models of how adolescents’ substance use is associated with their own (“actor effect”) and their siblings’ (“partner effect”) sexual risk behavior—one model for alcohol and cannabis use, and one model for co-use. Results indicated for referred adolescents and their siblings, within an individual, greater alcohol, cannabis, and co-use was significantly associated with sexual risk behavior (actor effects). Furthermore, more sibling co-use days were positively associated with referred adolescent sexual risk behavior (partner effect), representing interdependence. These findings confirm the influence siblings have on one another’s risky behavior in adolescence and have implications for prevention and intervention efforts for adolescent substance use.

Characteristics and Sexual Risk Behavior of Men Who Never Tested for HIV in Zambia

Compared with women and girls, proportionately fewer men and boys in sub-Saharan Africa receive HIV testing, treatment, and other services. This study determined factors associated with never testing for HIV and examined never testing as a predictor of sexual risk behavior among men in Zambia. The sample included 2,609 men aged 15 to 24 from the 2018 Zambia Demographic and Health Survey. Logistic regression results revealed that compared with men who ever tested for HIV, men who never tested were more likely to be younger, have less education, have no children, be unemployed, and belong to the low wealth bracket. They also had a higher likelihood of not using a condom at last sex but were less likely to have more than five lifetime sexual partners. HIV prevention programs can use sociodemographic characteristics to identify those who have a lower likelihood of testing for HIV. Prevention programs can use sociodemographic characteristics to develop profiles of those who may especially need to be targeted by initiatives to promote HIV testing. Awareness does not always engender behavior change; therefore, in addition to knowledge of HIV status, risk reduction should also be emphasized.