Reducing the vulnerability of adolescents and young people to HIV and STIs

Since 2003, the HIV Voluntary Counselling and Testing (VCT) has been identified as one of the key strategies in the HIV/AIDS prevention, control and care programmes in Ghana. However, utilization of this service is low among Ghanaian youth. This study examined predictors associated with VCT utilization among youth in Ghana. This study utilized quantitative and qualitative data in a cross-sectional survey in three sub-metropolitan areas in Kumasi. Using a multi-variate regression, evidence from 120 respondents showed potential factors associated with VCT utilization. The qualitative data were subjected to a content analysis through direct quotes. The results suggest that less than 30% of the youth had ever tested for HIV through VC. Women were more likely to avail themselves for counselling testing than men. Psychological and emotional trauma experienced by the seropositive, lack of confidentiality, proximity to VCT sites, HIV-related stigma inter alia, were found to be strongly associated with HIV VCT in the study prefecture. VCT utilization among the youth in Ghana was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma.

The present paper is part of a larger study conducted by first author for academic purpose among 414 male tribal youth of two Underprivileged Tribal Groups in the state of Orissa, India namely, Juang and Lodha. Findings reveal that sexually transmitted diseases are very much prevalent among the underprivileged tribal groups. Among the factors responsible for the problem, people’s sexual behaviour is the most crucial one. This is crucial in the sense that it is simply not a segregated or individual behaviour. It is mainly shaped by their age-old culture and tradition. For example, their early age marriage, prevalence of pre-marital and extra-marital relations, and above all their perception about the disease itself are socio-culturally moulded to a great extent. Besides these, non-scientific or traditional perceptions have been transformed along with the knowledge about sex by various means. Majority of youth who have STD symptoms do not have knowledge about it, while some have incorrect perceptions. Multiple sexual partners remain one of the major causes of STD among the tribal youth. External factors also have definite plays a definite role.

Objective: To appraise the contribution of intensive programme among Long Distance Truck Drivers in terms of safe sex practices with paid female partners.Methods: The key variable -exposure to HIV prevention interventions was divided into three categories - less exposure, moderate exposure and intensive exposure. IBBA Truckers data were analyzed using multiple logistic regression methods to understand the relationship between program exposure and consistent condom use practices. Significant factors were further analyzed using decomposition method to examine the contribution of different components of that factor towards the total increase in consistent condom use over time.Results: There was significant increase in consistent condom use with paid female partners among long distance truck drivers from round1 to round2.Truckers, exposed to intensive intervention programmes were two times more likely to use condom consistently with paid partners (OR 2.1; 95% CI 1.4-3.1;p-value <0.0001). Out of total increase in consistent condom use practices with paid partners, truckers who were exposed to Avahan programme contributed 58%. Conclusions: This study results highlight the ability of intensive program to reach truckers who have sex outside marriage with HIV prevention interventions and promote safe sex behaviour among them.

Inadequate comprehensive efforts towards meeting the demands for sexual and reproductive health needs among adolescent and young people, intensifies the menace of loosing away the progress achieved towards the MDGs over last one decade, particularly in the context of developing countries including India. Using data from DLHS-3, this research evaluated the demographic and socioeconomic differentials in access to family life/sex education (FLE) among unmarried young women in India. Additionally, using the adjusted multiple logistic regression models, the association between access to FLE and attitudes towards range of sexual and reproductive health matters among unmarried women were investigated. Only 48% of unmarried women received some form of FLE. Importantly, the likelihood of possessing positive attitudes towards reproductive activities, knowledge and discussion of contraceptive methods, precise awareness about pathways of RTIs/STIs and HIV/AIDS were significantly higher among women who had access to the FLE. Present study underscores protective role of FLE towards improving the sexual and reproductive life experiences of young people. Henceforth, it emphasizes need for implementing a culturally appropriate and comprehensive programme of FLE to address the sexual and reproductive health needs of the younger cohort in India.

Background: Cross-sectional studies have linked multiple sexual partnerships to high risk of contracting HIV-infection among adolescents and young adults, and evidences about the social context of multiple sexual partnerships are scarce in South Africa.

Methods: Multilevel analysis was carried out using the Cape Area Panel Study (CAPS) data collected among young people living in Cape Town between 2002 and 2005.

Findings: The practice of multiple sexual partnerships (current) declined from 29 percent in 2002 to 16 percent in 2005 with a concomitant increase in the practice of abstinence and monogamy from 71 percent at the baseline to 84 percent in 2005. Using multilevel logistic regression model and controlling for all the variables in the study, the predictors of multiple sexual partnerships between 2002 and 2005 were sex of the respondents, population group, educational level, rating of opportunity in life, degree of happiness, alcohol/drug use, participation in prosocial activities and early sexual activity.

Conclusion: There was a decline in the practice of multiple sexual partnerships during the study period and different factors, both personal and contextual, significantly predict the outcome variable and should be focus of intervention programmes.

Every society develops social norms that serve to channel and direct sexual activities in youth. These norms are dispelled by the socio-economic transformation over the past decades. The study examines relationship between social expectations, choices and sexual health risks among youth in the study area. Both qualitative and quantitative techniques were used to collect data from the study area. A multistage cluster sampling technique was used to select respondents for the quantitative data from three informal settlements in Metropolitan Lagos. Social expectation regarding pre-marital sex still in place, but 76% of the youth interviewed have had pre-marital sex. The neighbourhood characteristics was a significant factor associated with the sexual risks identified in the study areas. Some of the sexual health risks identified include forced sexual coercion, gang rape, “sexual tournament” by male adolescents, use of sex toys for stimulations, concurrent partners and multiple partnerships. Economic deprivation, living conditions, partners’ age, parents communication about sexual health, parents educational status, and family size are predisposing factors for likelihood of making choices about pre-marital sex and use of contraceptives. The study recommends that peer education programmes must be linked with youth health services.

Quality education and sexual and reproductive health services are key to reducing the vulnerability of HIV and STI especially among young people. While the former enhances the knowledge capacity to develop the ‘power within’ to facilitate safer sex practices and reduce misconceptions and stigma, the latter provides hope via access to treatment. While external support is critical, local partnerships and development of innovative structures and arrangements are imperative. In Cape Coast, the Planned Parenthood Association of Ghana and the University of Cape Coast have partnered in this direction. Using various methodologies such as action-based teaching, peer education and mobile clinic, students’ knowledge about and access to HIV and STIs services have improved. These have contributed to students’ willingness to know their HIV status and seek treatment directly or through a referral system. The sustainability of such a partnership is essential.

In the context of low-income slums of Mumbai, the present study is an effort to highlight the social circumstances under which adolescents are involved in alcohol abuse and risky sexual behaviour. It is worthwhile to mention that low income urban slums in Mumbai provide a conducive environment for adolescents to indulge in deviant behaviors. The basic data used for this paper has been derived from a World AIDS Foundation (WAF) sponsored project entitled “Alcohol use and sexual risk taking in low income slum areas of Mumbai, India" Conducted under the auspices of IIPS, Mumbai with ICR and UCHC, Connecticut, USA as partners. The qualitative insights that emerged from the in-depth interviews reveal that the presence of beer bars, especially ladies bars, video parlors and proximity to brothel based commercial sex opportunities offer an extremely conducive environment for risky social transactions among adolescents. Study findings clearly reveal that adolescents from low-income slum communities are actively involved in unsafe sex. These findings coupled with lack of source of knowledge put the adolescents at a higher level of risk in the context of HIV epidemic hence merits attention to improve awareness about safe sex preferably through schools or CBOs interventions.

This paper examines the relationship between HIV/AIDS and fertility growth in North Centre zone (NCz) of Nigeria. The NCZ has the highest HIV/AIDS prevalence cases from the six Geo-political zones in Nigeria. The focus states in NCZ include: Benue, Niger, Nasarawa and the Federal Capital Territory (FCT). These four states have the highest HIV/AIDS prevalence rate in NCZ as revealed by National Bureau of Statistics (2009).The demographic transition theory by Thompson .W. (1929) and Traits-Desires-Intentions-Behavior (TDIB) framework developed by Miller (1994) were adopted as the theoretical framework and the empirical analysis was carried out using primary data of 200 women that are seropositive and 200 women that are not. The preliminary result shows that some seropositive women tend to have more children as a result of antiretroviral drugs and new developed drugs that reduce the risks of mother to child transmission. Also, other seropositive women tend to reduce the numbers of Children they desire to have as a result of high cost of health care and fear of short life expectancy. For the non- infected women, the result shows that fertility rate is declining. Currently, the relationship between HIV/AIDS and fertility growth is inconclusive in Nigeria.

Sub-Saharan Africa is not only the most affected region of the world by HIV/AIDS, but also the setting where the epidemic among adolescents is the fastest growing. Multiple sexual partners and lack of condom use remain two of the most important risk factors of HIV spread among adolescents in sub-Saharan Africa, yet research on this issue is limited.
Using data from nationally-representative survey of adolescents, this study examines the simultaneous effects of individual, socio-economic and contextual factors on multiple sexual partners and consistent condom use among adolescent of 12-19 years old in Burkina Faso, Ghana, Malawi and Uganda. Findings from bivariate probit models show that the two most important factors associated with protective behaviors are formal education and parental monitoring, with adolescents who reported high parental control being less likely to have had multiple sexual partners and more likely to have used condom consistently than adolescents who reported lower levels of parental control. In terms of policy and programmatic implications, this result is very important and suggests that parents’ influence over their children’s behavior, widely assumed to have declined, remains both important and pertinent to reproductive health interventions to reduce the vulnerability of adolescents to HIV and STIs.