Prevalence of HIV and Associated Risks of Kampala among Youth in the Slums of Kampala

Purpose. 

The purpose of this study is to examine the prevalence of and risk factors for engaging in sex work among youth living in Kampala, Uganda. 

Methods. 

Analyses are based on a cross-sectional study (N = 1,134) of youth aged 12-18 years, living in the slums of Kampala, conducted in Spring of 2014. The analytic sample consisted of only sexually active youth (n = 590). Youth who reported engaging in sex work were compared to youth who did not report sex work. Multivariable analyses were conducted to examine factors associated with sex work. 

Results. 

Among the youth who had ever had sexual intercourse (n = 590), 13.7% (n = 81) reported engaging in sex work. Self-reported HIV prevalence was 13.9% among the total sample (n = 81) and 22.5% (n = 18) among youth engaged in sex work. Engaging in sex work was associated with being female (AOR 10.4; 95% CI: 3.9, 27.4), being an orphan (AOR 3.8; 95% CI: 1.7, 8.4), ever drinking alcohol (AOR 8.3; 95% CI 3.7, 19.0), and experiencing any rape (AOR 5.3; 95% CI: 2.9, 9.5). 

Discussion. 

The reported prevalence of sex work is high among youth in the slums of Kampala and is associated with high HIV prevalence, ever drinking alcohol, previously being raped, and being an orphan.

Table 2

Bivariate and multivariable associations between sex work and covariates among youth living in the slums of Kampala (n = 590).

Variable	Sex workers Yes n (%)	Sex workers No n (%)	Total sample n (%)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	P
	81 (13.7)	509 (68.3)	590 (100)
Age
12–14 years	4 (4.9)	27 (5.3)	31 (5.3)	Ref	—	0.67
15-16 years	15 (18.5)	116 (22.8)	131 (22.2)	0.9 (0.3–2.8)
17-18 years	62 (76.5)	366 (71.9)	428 (72.5)	1.1 (0.4–3.4)
Sex, n (%)
Females	76 (93.8)	271 (53.2)	347 (58.8)	Ref	Ref	∗∗
Males	5 (6.2)	238 (46.8)	243 (41.2)	13.4 (5.3–33.5)	10.4 (3.9–27.4)
School attendance
Yes	67 (83.7)	480 (94.3)	547 (93.8)	Ref	Ref	∗∗
No	13 (16.3)	23 (5.7)	36 (6.2)	4.1 (2.0–8.4)	2.2 (0.8–5.7)
Religion
Christian Catholic	28 (34.6)	196 (38.5)	224 (38.0)	Ref	—	0.09
Christian (other)	37 (45.7)	169 (33.2)	206 (34.9)	1.5 (0.9–2.6)
Muslim	11 (13.6)	118 (23.2)	129 (21.9)	0.7 (0.3–1.4)
Other	5 (6.2)	26 (5.1)	31 (5.3)	1.3 (0.5–3.8)
Parental drunkenness
Yes	51 (63.0)	259 (51.0)	310 (52.6)	1.6 (1.0–2.7)	—	0.05
No	30 (37.0)	249 (49.0)	279 (47.4)	Ref
No parents alive	36 (44.4)	108 (21.2)	144 (24.4)	5.4 (2.7–10.9)	3.8 (1.7–8.5)	∗∗
1 parent alive	33 (40.7)	205 (40.3)	238 (40.3)	2.6 (1.3–5.2)	1.7 (0.8–3.6)
2 parents alive	12 (14.8)	196 (38.5)	208 (35.3)	Ref	Ref
Ever alcohol use
Yes	72 (90.0)	271 (53.5)	343 (58.4)	7.8 (3.7–16.6)	8.3 (3.7–19.0)	∗∗
No	8 (10.0)	236 (46.5)	244 (41.6)	Ref	Ref
Any rape
Yes	55 (67.9)	98 (19.2)	153 (25.9)	8.9 (5.3–14.9)	5.3 (2.9–9.5)	∗∗
No	26 (32.1)	411 (80.8)	437 (74.0)	Ref	Ref
Parental abuse of youth
Yes	35 (43.2)	197 (38.8)	232 (39.4)	1.8 (1.1–2.9)	0.8 (0.4–1.4)	0.45
No	46 (56.8)	311 (61.2)	357 (60.6)	Ref	Ref
HIVa
Yes	18 (22.5)	63 (12.5)	81 (13.9)	—	—	∗
No	62 (77.5)	440 (87.5)	502 (86.1)
Other STIa
Yes	63 (77.8)	248 (48.7)	311 (52.7)	—	—	∗∗
No	18 (22.2)	261 (51.3)	279 (47.3)

Note: P value is obtained from chi-square analyses.

aHIV and other STIs not included in the logistic regression analyses due to HIV/STI being hypothesized outcomes of commercial sex work instead of risk factors.

Full article at: http://goo.gl/vtZVwm

By:   Swahn MH¹, Culbreth R¹, Salazar LF¹, Kasirye R², Seeley J³.

¹School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995, USA.

²Uganda Youth Development Link, P.O. Box 12659, Kampala, Uganda.

³London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

AIDS Res Treat. 2016;2016:5360180. doi: 10.1155/2016/5360180. Epub 2016 Apr 28. 

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Sexual Behavior among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer, Psychosocial Support, and Entrepreneurship

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). 

The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. 

Significant predictors of increased female sexual activity included less program exposure, higher age, younger age at most recent parental death, fewer years of schooling, higher food consumption, higher psychological resilience, and lower general self-efficacy. Significant predictors of increased male sexual activity included more program exposure, higher age, better food consumption, not having a living father, and literacy. 

Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. 

Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission.

Purchase full article at:   http://goo.gl/6o5kAl

By:  Goodman ML1,2,3, Selwyn BJ2, Morgan RO2, Lloyd LE2, Mwongera M4, Gitari S4, Keiser PH3.

• 1 Sodzo International.
• 2 Division of Management, Policy and Community Health, School of Public Health , University of Texas , Houston.
• 3 Center for Global Health Education , University of Texas Medical Branch , Galveston.
• 4 Community Health Department , Maua Methodist Hospital , Meru County , Kenya.
• J Sex Res. 2016 Mar-Apr;53(3):331-45. doi: 10.1080/00224499.2015.1035429. Epub 2015 Sep 30. 

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Are Adolescent Orphans More Likely to be HIV-Positive? A Pooled Data Analyses Across 19 Countries in Sub-Saharan Africa

BACKGROUND:

Despite extensive resources and numerous programmes directed towards orphans in sub-Saharan Africa, evidence of their disadvantage is surprisingly limited. While initial research suggests that orphans are at greater risk of being HIV-positive, the evidence is limited in geographic scope.

METHODS:

To rigorously test disparities in HIV prevalence related to orphanhood and parental HIV status in sub-Saharan Africa, we used Demographic and Health Survey data from 19 countries in sub-Saharan Africa. We conducted pooled multilevel logistic regression on adolescents aged 15-17 years with HIV test results (N=22 837 girls and 20 452 boys).

RESULTS:

Regardless of their gender, orphans who lost their mother, lost both parents or had an HIV-infected mother were two to three times more likely to test positive for HIV infection (ORs 1.87-3.17). The loss of a father was also associated with HIV infection risk for females, but of slightly lower magnitude (OR 1.63).

CONCLUSIONS:

To better inform interventions, future research is needed to quantify the relative contribution of perinatally-acquired and sexually-acquired infections, and to investigate the specific mechanisms that may account for disparities in the latter. In the meantime, programmes servingHIV-infect adults as well as those serving orphaned and vulnerable children should invest in family-based HIV testing in order to identify adolescents in need of treatment.

Purchase full article at:   http://goo.gl/3hx3pm

By:  Kidman R1, Anglewicz P2.

• 1Program in Public Health and Department of Family, Population & Preventative Medicine, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA.
• 2Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA. 
• J Epidemiol Community Health. 2016 Feb 10. pii: jech-2015-206744. doi: 10.1136/jech-2015-206744.

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Effect of Savings-Led Economic Empowerment on HIV Preventive Practices among Orphaned Adolescents in Rural Uganda: Results from the Suubi-Maka Randomized Experiment

Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. 

Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents' cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10-17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. 

Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US 12.32, ±1.12) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group. The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home, pursue vocational training, and start a business. Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores, most commonly toward perceived risk of HIV (95.8%), sexual abstinence or postponement (91.6%), and consistent condom use (93.4%). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score. 

To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.

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

By:  Jennings L1, Ssewamala FM2, Nabunya P3.

• 1 Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
• 2 International Center for Child Health and Asset Development , Columbia University School of Social Work , New York , NY , USA.
• 3 School of Social Service Administration , University of Chicago , Chicago , IL , USA.

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Treating Unresolved Grief and Posttraumatic Stress Symptoms in Orphaned Children in Tanzania: Group-based Trauma-focused Cognitive Behavioral Therapy

The study was designed to test the feasibility and child clinical outcomes for a group-based application of Trauma-focused Cognitive Behavior Therapy (TF-CBT) for orphaned children with unresolved grief in Moshi, Tanzania. 

Sixty-four orphaned children with at least mild symptoms of unresolved grief and/or traumatic stress and their guardians participated in the open trial. The evidence-based TF-CBT protocol was adapted for group delivery, resulting in 12 weekly sessions for child and guardians separately with conjoint activities and three individual visits. Using a task-sharing approach, the intervention was delivered by lay counselors with no prior mental health experience. Primary outcomes assessed were symptoms of unresolved grief and posttraumatic stress (PTS); secondary outcomes included symptoms of depression and overall behavioral adjustment. All assessments were conducted pre-treatment, post-treatment, and 3- and 12-months after the end of treatment. 

Results showed improved scores on all outcomes post-treatment, sustained at 3 and 12 months. Effect sizes (Cohen’s d) for baseline to post-treatment were 1.36 for child reported grief symptoms; 1.87 for child-reported PTS, and 1.15 for caregiver report of child PTS.

Below:  Scatterplots comparing baseline and post-treatment the Posttraumatic Stress Disorder Reaction-Index (PTSD-RI), the Strengths and Difficulties Questionaire (SDQ), the Short Mood and Feelings Questionaire (SMFQ), and the Grief Screening Scale (GSS) scores for guardian and child participants

Full article at: http://goo.gl/Nmq5Xb

By: Karen O’Donnell, Shannon Dorsey, Wenfeng Gong, Jan Ostermann, Rachel Whetten, Judith A. Cohen, Dafrosa Itemba,Rachel Manongi, and Kathryn Whetten

The Center for Child and Family Health, Duke University;

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Impact of the Kenya Cash Transfer for Orphans & Vulnerable Children on Early Pregnancy & Marriage of Adolescent Girls

There is promising evidence that poverty-targeted cash transfer programs can have positive impacts on adolescent transitions to adulthood in resource poor settings, however existing research is typically from small scale programs in diverse geographic and cultural settings. 

We provide estimates of the impact of a national unconditional cash transfer program, the Kenya Cash Transfer for Orphans and Vulnerable Children, on pregnancy and early marriage among females aged 12 to 24, four years after program initiation. The evaluation was designed as a clustered randomized controlled trial and ran from 2007 to 2011, capitalizing on the existence of a control group, which was delayed entry to the program due to budget constraints. 

Findings indicate that, among 1549 females included in the study, while the program reduced the likelihood of pregnancy by five percentage points, there was no significant impact on likelihood of early marriage. Program impacts on pregnancy appear to work through increasing the enrollment of young women in school, financial stability of the household and delayed age at first sex. 

The Kenyan program is similar in design to most other major national cash transfer programs in Eastern and Southern Africa, suggesting a degree of generalizability of the results reported here. Although the objective of the program is primarily poverty alleviation, it appears to have an important impact on facilitating the successful transition of adolescent girls into adulthood.

Via: http://goo.gl/Pyv617  Purchase full article at: http://goo.gl/o8Aa18

By: Handa S1, Peterman A2, Huang C3, Halpern C4, Pettifor A5, Thirumurthy H6.

• 1Department of Public Policy, University of North Carolina, Chapel Hill, USA; UNICEF Office of Research Innocenti, Piazza SS. Annunziata 12, 50122 Florence, Italy.
• 2UNICEF Office of Research Innocenti, Piazza SS. Annunziata 12, 50122 Florence, Italy. Electronic address: apeterman@unicef.org.
• 3Department of Public Policy, University of North Carolina, Chapel Hill, USA.
• 4Department of Materal and Child Health, UNC Gillings School of Global Public Health, USA.
• 5Department of Epidemiology, UNC Gillings School of Global Public Health, USA.
• 6Department of Health Policy and Management, UNC Gillings School of Global Public Health, USA. 

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Sexual Behavior among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer, Psychosocial Support, and Entrepreneurship

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. 

Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. 

• Significant predictors of increased female sexual activity included 
• less program exposure, 
• higher age, 
• younger age at most recent parental death, 
• fewer years of schooling, 
• higher food consumption, 
• higher psychological resilience, 
• and lower general self-efficacy. 
• Significant predictors of increased male sexual activity included 
• more program exposure, 
• higher age, 
• better food consumption, 
• having a living father, 
• and literacy. 

Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. 

Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission.

Via: http://goo.gl/680j1q  Purchase full article at: http://goo.gl/Sjuxg6

By: Goodman ML1,2,3, Selwyn BJ2, Morgan RO2, Lloyd LE2, Mwongera M4, Gitari S4, Keiser PH3.

• 1a Sodzo International.
• 2b Division of Management, Policy and Community Health, School of Public Health , University of Texas , Houston.
• 3c Center for Global Health Education , University of Texas Medical Branch , Galveston.
• 4d Community Health Department , Maua Methodist Hospital , Meru County , Kenya 

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