Research Article: School, Supervision and Adolescent-Sensitive Clinic Care: Combination Social Protection and Reduced Unprotected Sex Among HIV-Positive Adolescents in South Africa

Date Published: September 8, 2016

Publisher: Springer US

Author(s): Elona Toska, Lucie D. Cluver, Mark E. Boyes, Maya Isaacsohn, Rebecca Hodes, Lorraine Sherr.

http://doi.org/10.1007/s10461-016-1539-y

Abstract

Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited. This study quantitatively tests whether social protection is associated with reduced unprotected sex among 1060 ART-eligible adolescents from 53 government facilities in South Africa. Potential social protection included nine ‘cash/cash-in-kind’ and ‘care’ provisions. Analyses tested interactive/additive effects using logistic regressions and marginal effects models, controlling for covariates. 18 % of all HIV-positive adolescents and 28 % of girls reported unprotected sex. Lower rates of unprotected sex were associated with access to school (OR 0.52 95 % CI 0.33–0.82 p = 0.005), parental supervision (OR 0.54 95 % CI 0.33–0.90 p = 0.019), and adolescent-sensitive clinic care (OR 0.43 95 % CI 0.25–0.73 p = 0.002). Gender moderated the effect of adolescent-sensitive clinic care. Combination social protection had additive effects amongst girls: without any provisions 49 % reported unprotected sex; with 1–2 provisions 13–38 %; and with all provisions 9 %. Combination social protection has the potential to promote safer sex among HIV-positive adolescents, particularly girls.

Partial Text

There are an estimated 1.3–2.2 million HIV-positive adolescents in Sub-Saharan Africa, both vertically and horizontally infected [1]. Studies have documented high rates of unprotected sex reported by HIV-positive adolescents even after HIV infection (27–90 %) [2–5]. While rates of unprotected sex among HIV-positive adolescents are comparable to those among the general adolescent population [2], HIV-positive adolescents are a key population for reducing onwards HIV transmission to sexual partners and children. In addition, HIV-positive adolescents experience a range of vulnerabilities that are likely to reduce the efficacy of HIV prevention programmes aimed at general populations, including cognitive and mental health issues [6, 7], family-related challenges [8, 9] and material deprivation [10, 11].

Findings from this study have several important implications. First, we found high rates of unprotected sex reported by HIV-positive adolescents, and significantly higher rates of virological failure amongst HIV-positive adolescents engaging in unprotected sex, suggesting greater transmission risk to uninfected peers. It is clear that effective programming to reduce sexual risk behavior for this vulnerable group is essential.

 

Source:

http://doi.org/10.1007/s10461-016-1539-y

 

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