Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya.

OBJECTIVES: This study presents findings from piloting an adapted evidence-based intervention, Stepping Stones and Creating Futures, to change street-connected young people's HIV knowledge, condom-use self-efficacy, and sexual practices. METHODS: Eighty street-connected young people participated in a pre- and post-test mixed methods design in Eldoret, Kenya. The primary outcome of interest was HIV knowledge. Secondary outcomes included condom-use self-efficacy and sexual practices. Multiple linear regression models for change scores with adjustment for socio-demographic variables were fitted. Qualitative and quantitative findings are presented together, where integration confirms, expands on, or uncovers discordant findings. RESULTS: Participants had a significant increase in HIV knowledge from pre- to post-intervention. The median HIV knowledge score pre-intervention was 11 (IQR 8-13) and post-intervention 14 (IQR 12-16). Attendance was significantly associated with HIV knowledge change scores. Qualitatively participants reported increased HIV and condom-use knowledge and improved condom-use self-efficacy and health-seeking practices. CONCLUSIONS: Our findings support the potential for further testing with a rigorous study design to investigate how best to tailor the intervention, particularly by gender, and increase the overall effectiveness of the program.

A social ecological approach to understanding correlates of lifetime sexual assault among sexual minority women in Toronto, Canada: results from a cross-sectional internet-based survey.

Stigma, discrimination and violence contribute to health disparities among sexual minorities. Lesbian, bisexual and queer (LBQ) women experience sexual violence at similar or higher rates than heterosexual women. Most research with LBQ women, however, has focused on measuring prevalence of sexual violence rather than its association with health outcomes, individual, social and structural factors. We conducted a cross-sectional online survey with LBQ women in Toronto, Canada. Multivariate logistic regression analyses were conducted to assess correlates of lifetime sexual assault (LSA). Almost half (42%) of participants (n = 415) reported experiences of LSA. Participants identifying as queer were more likely to have experienced LSA than those identifying as lesbian. When controlling for socio-demographic characteristics, experiencing LSA was associated with higher rates of depression, sexually transmitted infections (STIs), receiving an STI test, belief that healthcare providers were not comfortable with their LBQ sexual orientation, and sexual stigma (overall, perceived and enacted). A history of sexual violence was associated with lower: self-rated health, overall social support, family social support and self-esteem. This research highlights the salience of a social ecological framework to inform interventions for health promotion among LBQ women and to challenge sexual stigma and sexual violence.