Combination Social Protection for Reducing HIV-Risk Behavior amongst Adolescents in South Africa

BACKGROUND:

Social protection (i.e. cash transfers, free schools, parental support) has potential for adolescent HIV-prevention. We aimed to identify which social protection interventions are most effective and whether combined social protection has greater effects in South Africa.

METHODS:

In this prospective longitudinal study, we interviewed 3516 adolescents aged 10-18 between 2009 and 2012. We sampled all homes with a resident adolescent in randomly-selected census areas in four urban and rural sites in two South African provinces. We measured household receipt of fourteen social protection interventions and incidence of HIV-risk behaviors. Using gender-disaggregated multivariate logistic regression and marginal-effects analyses, we assessed respective contributions of interventions and potential combination effects.

RESULTS:

Child-focused grants, free schooling, school feeding, teacher support, and parental monitoring were independently associated with reduced HIV-risk behavior incidence (OR 0.10-0.69). Strong effects of combination social protection were shown, with cumulative reductions in HIV-risk behaviors. For example, girls' predicted past-year incidence of economically-driven sex dropped from 11% with no interventions, to 2% amongst those with a child grant, free school and good parental monitoring. Similarly, girls' incidence of unprotected/casual sex or multiple-partners dropped from 15% with no interventions to 10% with either parental monitoring or school feeding, and to 7% with both interventions.

CONCLUSION:

In real-world, high-epidemic conditions, 'combination social protection' shows strong HIV-prevention effects for adolescents and may maximize prevention efforts.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Full PDF article at:  http://goo.gl/ojMVoi  Abstract:  http://goo.gl/fXkGhX

By:  Cluver LD1, Orkin MF, Yakubovich AR, Sherr L.

• 1Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK 2Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa 3DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa 4University College London, London, UK. 

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Sex and Secrecy: How HIV-Status Disclosure Affects Safe Sex among HIV-Positive Adolescents

HIV-positive adolescents who engage in unsafe sex are at heightened risk for transmitting or re-acquiring HIV. Disclosure of HIV-status to sexual partners may impact on condom use, but no study has explored the effects of (i) adolescent knowledge of one's HIV-status, (ii) knowledge of partner status and (iii) disclosure to partners, on safer sex behaviour. 

This study aimed to identify whether knowledge of HIV-status by HIV-positive adolescents and partners was associated with safer sex. Eight fifty eight HIV-positive adolescents (10–19 years old, 52% female, 68.1% vertically infected) who had ever initiated antiretroviral treatment in 41 health facilities in the Eastern Cape, South Africa, were interviewed using standardised questionnaires. Quantitative analyses used multivariate logistic regressions, controlling for confounders. Qualitative research included interviews, focus group discussions and observations with 43 HIV-positive teenagers and their healthcare workers. N = 128 (14.9%) of the total sample had ever had sex, while N = 109 (85.1%) of sexually active adolescents had boy/girlfriend. In total, 68.1% of the sample knew their status, 41.5% of those who were sexually active and in relationships knew their partner's status, and 35.5% had disclosed to their partners. 

For adolescents, knowing one's status was associated with safer sex (OR = 4.355, CI 1.085–17.474,p = .038). Neither knowing their partner's status, nor disclosing one's HIV-status to a partner, were associated with safer sex. HIV-positive adolescents feared rejection, stigma and public exposure if disclosing to sexual and romantic partners. Counselling by healthcare workers for HIV-positive adolescents focused on benefits of disclosure, but did not address the fears and risks associated with disclosure. 

These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents, who may be ill-equipped to negotiate safer sex. There is a pressing need for effective interventions that mitigate the risks of disclosure and provide HIV-positive adolescents with skills to engage in safe sex.

Below:  Rates of safe sex by type of disclosure

Below:  Levels of disclosure from HIV-positive adolescents to their partners (boyfriend or girlfriend)

Full article at:   http://goo.gl/1NXOCZ

By:  Elona Toska, a , * Lucie D. Cluver, a , b Rebecca Hodes, c and Khameer K. Kidia d

^aCentre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, Oxford, UK

^bDepartment of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa

^cAIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa

^dIcahn School of Medicine at Mount Sinai, New York, USA

^* Corresponding author. Email: ku.ca.xo.ips@aksot.anole

  

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Longitudinal Predictors of Child Sexual Abuse in a Large Community-Based Sample of South African Youth

Sexual abuse has severe negative impacts on children's lives, but little is known about risk factors for sexual abuse victimization in sub-Saharan Africa. 

This study examined prospective predictors of contact sexual abuse in a random community-based sample of children aged 10 to 17 years (N = 3,515, 56.6% female) in South Africa. Self-report questionnaires using validated scales were completed at baseline and at 1-year follow-up (96.8% retention rate). Cross-sectional and longitudinal associations between hypothesized factors and sexual abuse were examined. 

For girls, previous sexual abuse, baseline school dropout, and physical assault in the community predicted sexual abuse at follow-up. Peer social support acted as a protective factor. Previous contact sexual abuse was the strongest predictor of subsequent sexual abuse victimization. In addition, peer support moderated the relationship between baseline assault and subsequent sexual abuse. 

For boys, no longitudinal predictors for sexual abuse victimization were identified. These results indicate that the most vulnerable girls-those not in school and with a history of victimization-are at higher risk for sexual abuse victimization. High levels of peer support reduced the risk of sexual abuse victimization and acted as a moderator for those who had experienced physical assault within the community. 

Interventions to reduce school drop-out rates and revictimization may help prevent contact sexual abuse of girls in South Africa.

Purchase full article at: http://goo.gl/Gq2cyT

By: Meinck F1, Cluver LD2, Boyes ME3.

• 1University of Oxford, Oxford, UK Franziska.Meinck@spi.ox.ac.uk.
• 2University of Oxford, Oxford, UK University of Cape Town, Cape Town, South Africa.
• 3University of Oxford, Oxford, UK Curtin University, Perth, Australia.  

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