Browsing by Subject "Adolescent girls "

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    Determinants of HIV infection among adolescent girls and young women aged 15–24 years in South Africa: a 2012 population-based national household survey
    (2018) Mabaso, Musawenkosi; Sokhela, Zinhle; Mohlabane, Neo; Chibi, Buyisile; Zuma, Khangelani; Simbayi, Leickness
    BACKGROUND: South Africa is making tremendous progress in the fight against HIV, however, adolescent girls and young women aged 15-24 years (AGYW) remain at higher risk of new HIV infections. This paper investigates socio-demographic and behavioural determinants of HIV infection among AGYW in South Africa. METHODS: A secondary data analysis was undertaken based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Multivariate stepwise backward and forward regression modelling was used to determine factors independently associated with HIV prevalence. RESULTS: Out of 3092 interviewed and tested AGYW 11.4% were HIV positive. Overall HIV prevalence was significantly higher among young women (17.4%) compared to adolescent girls (5.6%). In the AGYW model increased risk of HIV infection was associated with being young women aged 20-24 years (OR = 2.30, p = 0.006), and condom use at last sex (OR = 1.91, p = 0.010), and decreased likelihood was associated with other race groups (OR = 0.06, p < 0.001), sexual partner within 5 years of age (OR = 0.53, p = 0.012), tertiary level education (OR = 0.11, p = 0.002), low risk alcohol use (OR = 0.19, p = 0.022) and having one sexual partner (OR = 0.43, p = 0.028). In the adolescent girls model decreased risk of HIV infection was associated with other race groups (OR = 0.01, p < 0.001), being married (OR = 0.07), p = 0.016], and living in less poor household (OR = 0.08, p = 0.002). In the young women's models increased risk of HIV infection was associated with condom use at last sex (OR = 2.09, p = 0.013), and decreased likelihood was associated with other race groups (OR = 0.17, p < 0.001), one sexual partner (OR = 0.6, p = 0.014), low risk alcohol use (OR = 0.17, p < 0.001), having a sexual partner within 5 years of age (OR = 0.29, p = 0.022), and having tertiary education (OR = 0.29, p = 0.022). CONCLUSION: These findings support the need to design combination prevention interventions which simultaneously address socio-economic drivers of the HIV epidemic, promote education, equity and access to schooling, and target age-disparate partnerships, inconsistent condom use and risky alcohol consumption.
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    Determinants of HIV infection among adolescent girls and young women aged 15–24 years in South Africa: a 2012 population-based national household survey
    (BioMed Central, 2018-01-26) Mabaso, Musawenkosi; Sokhela, Zinhle; Mohlabane, Neo; Chibi, Buyisile; Zuma, Khangelani; Simbayi, Leickness
    Abstract Background South Africa is making tremendous progress in the fight against HIV, however, adolescent girls and young women aged 15–24 years (AGYW) remain at higher risk of new HIV infections. This paper investigates socio-demographic and behavioural determinants of HIV infection among AGYW in South Africa. Methods A secondary data analysis was undertaken based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Multivariate stepwise backward and forward regression modelling was used to determine factors independently associated with HIV prevalence. Results Out of 3092 interviewed and tested AGYW 11.4% were HIV positive. Overall HIV prevalence was significantly higher among young women (17.4%) compared to adolescent girls (5.6%). In the AGYW model increased risk of HIV infection was associated with being young women aged 20–24 years (OR = 2.30, p = 0.006), and condom use at last sex (OR = 1.91, p = 0.010), and decreased likelihood was associated with other race groups (OR = 0.06, p < 0.001), sexual partner within 5 years of age (OR = 0.53, p = 0.012), tertiary level education (OR = 0.11, p = 0.002), low risk alcohol use (OR = 0.19, p = 0.022) and having one sexual partner (OR = 0.43, p = 0.028). In the adolescent girls model decreased risk of HIV infection was associated with other race groups (OR = 0.01, p < 0.001), being married (OR = 0.07), p = 0.016], and living in less poor household (OR = 0.08, p = 0.002). In the young women’s models increased risk of HIV infection was associated with condom use at last sex (OR = 2.09, p = 0.013), and decreased likelihood was associated with other race groups (OR = 0.17, p < 0.001), one sexual partner (OR = 0.6, p = 0.014), low risk alcohol use (OR = 0.17, p < 0.001), having a sexual partner within 5 years of age (OR = 0.29, p = 0.022), and having tertiary education (OR = 0.29, p = 0.022). Conclusion These findings support the need to design combination prevention interventions which simultaneously address socio-economic drivers of the HIV epidemic, promote education, equity and access to schooling, and target age-disparate partnerships, inconsistent condom use and risky alcohol consumption.
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    Economic evaluation of cash "plus" interventions for risky sexual behaviour among adolescent girls & young women in low and middle-income countries: a systematic review
    (2025) Tibini, Vuyolwetu Thembekile; Alaba, Olufunke; Mchenga, Martina
    Background: Adolescent girls and young women (AGYW) are especially susceptible to risky sexual behaviours that increase their risk of HIV infection and other negative consequences related to their reproductive health, especially in low- and middle-income countries (LMICs). Globally, AGYW, who are between the ages of 15-24, are at risk of HIV infection at an average of 4900 every week, while in 2021 AGYW accounted for 63% of all new HIV infections. In response, cash transfer interventions have become a tool to lessen financial vulnerability and provide AGYW with the confidence to make safer decisions regarding their sexual health. However, cash transfer interventions alone might not adequately address the intricate social, biological, and economic issues that AGYW face. As a result, "cash plus" interventions which combine cash with complementary services such as training, health care, and skill development have piqued interest as potentially more effective fixes. The premise of this systematic review is to examine theeconomic evaluations of these "cash plus" programs and their effect on reducing risky sexual behaviours among AGYW in LMICs. Methods: The thesis first implemented a structured literature review. The structured literature delves into the implementation of cash transfers in LMICs and identifies any related shortcomings. Secondly, the structured literature review examines epidemiological evidence of risky sexual behaviours faced by AGYWs in LMICs; these include HIV acquisition, unplanned pregnancy, condomless sex, transactional sex, and multiple sexual partners. Finally, the structured literature review scrutinizes any cash transfer programs that have undergone economic evaluation to address the risky sexual behaviour among AGYWs in LMICs. After the structured literature review was completed, a systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed on several electronic databases, including EbscoHost, PubMed, Cochrane Library, Web of Science, and Scopus, along with relevant grey literature. The review included economic evaluations of cash "plus" interventions aimed at risky sexual behaviour among AGYW in LMICs and studies between 1 January 2000 – 31 December 2023. Studies were screened for eligibility based on pre-defined inclusion criteria, and data were extracted into a synthesis table. Costs were adjusted to 2023 U.S. dollars (USD) to standardize economic evaluations across studies. Full and partial economic evaluations, including cost effectiveness analysis (CEA), cost-utility analysis (CUA), and cost-benefit analysis (CBA), were analysed. The key gaps show how standard cash transfers for AGYW have a limited impact on complex needs, a lack of complementary support, and minimal long-term benefits. Cash Plus addresses these gaps by integrating additional components tailored to AGYW's needs, such as mentorship and skills training, which enhance resilience and support sustainable behavioural changes. However, the economic evaluation of Cash Plus interventions targeting AGYW's risky sexual behaviours in LMICs requires further work. The importance of this work is that it provides evidence of cost- effectiveness, scalability, and long-term economic impact, allowing for informed, resource- efficient decisions on implementing Cash Plus programs in LMICs. Results: This thesis' systematic review retrieved a total of 40 articles, six of which met the inclusion criteria. All these studies, conducted between 2018 and 2022, were based in Sub-Saharan Africa, specifically in Kenya, Uganda, and Liberia. The population covered in the six studies totalled 15,517 AGYW, with interventions targeting a wide age range of 12 to 24 years. The interventions included programs like DREAMS, Empowerment and Livelihood for Adolescents (ELA), Girl Empower Plus (GE+), and Bridge PLUS, among others. Economic evaluations revealed mixed results regarding the cost- effectiveness of the interventions. Five studies performed full economic evaluations using CEA and CBA. One study conducted a partial economic evaluation (cost analysis). The total unit cost for the six units was $2 446,90, but after adjusting for the 2023 value, the amount rose to $2 881,60. Conclusion: The thesis suggests that cash "plus" interventions aimed at reducing risky sexual behaviours among AGYW in Sub-Saharan Africa are cost-effective, particularly over longer time frames. The review highlights the need for further research into the long-term, non-monetary benefits of these interventions, such as improvements in health, education, and social well-being, to fully assess their value. The mixed economic evaluations and inflation-adjusted unit costs highlight the importance of ongoing research and careful resource allocation. The results underscore the importance of targeted, comprehensive strategies in addressing the complex needs of AGYW, while also pointing to the challenges of scaling such interventions in resource constrained environments.
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    Safe spaces for beneficiaries of a combination HIV prevention intervention for adolescent girls and young women in South Africa: access, feasibility, and acceptability
    (BioMed Central, 2022-05-21) Mathews, Catherine; Duby, Zoe; Bunce, Brittany; van Blydenstein, Nathanael; Bergh, Kate; Ambrose, Anthony; Mpungu, Fiona; Jonas, Kim
    Background Safe Spaces are a feature of combination HIV prevention interventions for adolescent girls and young women (AGYW) in South Africa. We investigated whether AGYW at risk for adverse sexual and reproductive health (SRH) outcomes accessed Safe Spaces that were part of an intervention, as well as their feasibility and acceptability. Methods In December 2020 to February 2021, as part of a process evaluation of a combination HIV prevention intervention, we randomly sampled 2160 AGYW intervention beneficiaries aged 15–24 years from 6 of the 12 intervention districts. We invited them to participate in a phone survey, with questions about their vulnerability to adverse SRH outcomes, and participation in intervention components including Safe Spaces. We examined factors associated with use of Safe Spaces using bivariate analyses and Pearson’s chi squared tests. We also conducted in-depth interviews with 50 AGYW beneficiaries, 27 intervention implementers, 4 health workers, 7 social workers, and 12 community stakeholders, to explore perceptions and experiences of the intervention. Thematic analysis of the qualitative data was performed. Results At least 30 Safe Spaces were established across 6 districts. Five hundred fifteen of two thousand one hundred sixty sampled AGYW participated in the survey of whom 22.6% visited a Safe Space, accessing HIV testing (52.2%), mobile health services (21.2%) and counselling for distress (24.8%) while there. Beneficiaries of lower socioeconomic status (SES) were less likely to have visited a Safe Space, compared with those of higher SES (13.6% versus 25.3%; p < 0.01). Implementers described political, structural and financial challenges in identifying and setting up Safe Spaces that were safe, accessible and adequately-resourced, and challenges with AGYW not utilising them as expected. AGYW shared positive views of Safe Spaces, describing benefits such as access to computers and the internet, support with homework and job and education applications, and a space in which to connect with peers. Conclusion AGYW are attracted to Safe Spaces by educational and employment promoting interventions and recreational activities, and many will take up the offer of SRH services while there. The poorest AGYW are more likely to be excluded, therefore, an understanding of the obstacles to, and enablers of their inclusion should inform Safe Space intervention design.