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3.
BMC Health Serv Res ; 20(1): 881, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943066

RESUMO

BACKGROUND: HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. METHODS: The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents' uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services. RESULTS: Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents. CONCLUSIONS: We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.


Assuntos
Serviços de Saúde do Adolescente/estatística & dados numéricos , Teste de HIV/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adolescente , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , População Rural , Comportamento Sexual , Inquéritos e Questionários , Tanzânia , Adulto Jovem
4.
AIDS Care ; 32(12): 1565-1572, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32122168

RESUMO

Over three million youth live with HIV worldwide. Very little is known about whether youth disclose their HIV status to family, friends or sexual partners, and what risks and benefits may accrue from doing so. This study characterizes HIV disclosure among 250 youth with perinatally-acquired HIV (PHIV; age 13-24 years) living in Soweto, South Africa. A third had self-disclosed their HIV status to at least one person; similarly, only a third of sexually-active PHIV had disclosed their HIV status to their most recent partner. It is not clear whether HIV disclosure alone leads to positive impact: we found perceived social support from the family was negatively associated with disclosure (aOR 0.81, 95% 0.70-0.94). PHIV who spoke to a provider about disclosure were more likely to share their HIV status with a sexual partner (aOR 2.48; 95% CI 1.28-4.81). However, those PHIV who disclosed their status were no more likely to use a condom. The World Health Organization recommends that health providers advise adolescent patients on safe disclosure, but we still lack evidence on the consequences for young people and effective tools to help them weigh benefits and risks.


Assuntos
Revelação/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Autorrevelação , Parceiros Sexuais , Revelação da Verdade , Adolescente , Estudos Transversais , Família , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transmissão Vertical de Doenças Infecciosas , Masculino , Prevalência , Estigma Social , África do Sul , Adulto Jovem
5.
PLoS One ; 15(3): e0230085, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142550

RESUMO

BACKGROUND: Intimate partner violence (IPV) is prevalent in high- as well as low-income contexts. It results in a substantial public health burden and significant negative socioeconomic and health outcomes throughout the life-course. However, limited knowledge exists about IPV during early adolescence. This period is critical during the transition to adulthood for at least two reasons: it is when the majority of adolescents in low-income countries first encounter dating, sexuality and partnerships, often with older adolescents or adults, and it is also the period when lifelong patterns of violence and norms about acceptable IPV are formed. The current study is one of the first to measure IPV prevalence among young adolescents in a low-income setting, examine the potential etiology, and investigate relationships with gender ideology, poverty, mental health and childhood adversity. METHODS: We surveyed 2,089 adolescents aged 10-16 in Malawi using standardized instruments. We estimated the prevalence of IPV, and use multivariate logistic regression to test potential correlates. RESULTS: More than a quarter (27%) of ever-partnered adolescents in Malawi report being victimized. A substantial proportion of both male and female adolescents (15%) report committing violence against their partner. Girls were more likely than boys to report being a victim of sexual IPV (24% versus 8%), and boys more likely to perpetrate such (9% versus 1%). Almost 10% of the sample had both committed and been a victim of IPV. Cumulative childhood adversity (e.g., physical abuse, witnessing domestic violence) was a consistent and strong correlate of IPV victimization (adjusted odds ratio (aOR) 1.30) and of perpetration (aOR 1.35). Depression and PTSD were likewise associated with IPV victimization in the overall sample. Notably, gender ideology was not predictive of either victimization or perpetration, even among boys. CONCLUSIONS: IPV is common for both male and female young Malawian adolescents, and includes both victimization and perpetration. IPV compounds other adversities experienced by adolescents in this low-income setting, and it is rarely alleviated through help from the health system or other formal support. These findings underscore the need to intervene early when interventions can still break destructive pathways and help foster healthier relationships. This focus on early adolescence is particularly critical in low-income countries given the early onset and rapid pace of the transition to adulthood, with sexual activity, dating and partnership thus being common already in young adolescence. Promising interventions would be those that reduce violence against or around children, as well as those that reduce the impacts of such trauma on mental health during adolescence.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Adolescente , Criança , Depressão/epidemiologia , Depressão/patologia , Países em Desenvolvimento , Violência Doméstica/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Malaui , Masculino , Razão de Chances , Abuso Físico/estatística & dados numéricos , Pobreza , Prevalência , Parceiros Sexuais/psicologia
6.
AIDS Care ; 32(sup2): 23-31, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32178529

RESUMO

Over a third of new HIV infections occur in adolescents aged 10-19 globally. Pre-exposure prophylaxis (PrEP) could be a powerful tool for prevention. Understanding more about the drivers of PrEP interest could inform implementation strategies among this age group. Moreover, family dynamics may play a uniquely critical role for this younger age group, thus it is important to gauge whether caregivers would support their children's use of PrEP. We surveyed 2,089 adolescents (aged 10-16) and their caregivers in Malawi during 2017-2018. Data were collected on PrEP interest, factors that may facilitate PrEP use, and preferences for PrEP modality. We used multivariate logistic regression to estimate the association between the above characteristics and PrEP interest. We find that young adolescents are engaging in behaviors that would put them at substantial risk of acquiring HIV, would likely benefit from PrEP, are largely (82%) interested in using such, would prefer to get an injection over taking a daily pill, and are considerably discouraged by the prospect of side effects. Endorsement by caregivers was even greater (87%). Our findings demonstrate initial support for adolescent PrEP, and suggest parents may be a surprising advocate.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fármacos Anti-HIV/administração & dosagem , Cuidadores/psicologia , Infecções por HIV/prevenção & controle , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/métodos , Adolescente , Comportamento do Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Criança , Feminino , Infecções por HIV/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Malaui , Masculino , Sexo Seguro , Inquéritos e Questionários , Adulto Jovem
7.
Am J Prev Med ; 58(2): 285-293, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31810632

RESUMO

INTRODUCTION: Childhood adversity is robustly associated with poor health across the life course. However, very few studies have examined the prevalence and implications of adverse childhood experiences in low- and middle-income countries. The objective of this study is to measure adverse childhood experiences among adolescents in Malawi and examine the association with mental and physical health outcomes. METHODS: From 2017 to 2018, baseline data were collected among adolescents aged 10-16 years (n=2,089). Respondents were interviewed in their local language at their homes. Respondents completed questions on childhood adversity (Adverse Childhood Experiences-International Questionnaire), self-rated health, mortality expectations, and mental health (Beck Depression Inventory and Post-Traumatic Stress Disorder Scale). Stunting, obesity, and grip strength were measured. Analyses were conducted in 2018. Frequencies described the prevalence of adverse childhood experiences, and adjusted multivariate models examined whether cumulative adversity predicts current health. RESULTS: Adolescents reported a high burden of adversity (i.e., 5 lifetime adverse childhood experiences on average). Adolescents who scored in the top adverse childhood experiences quintile were more likely to report depression (OR=3.11, 95% CI=2.10, 4.60), post-traumatic stress disorder (OR=4.19, 95% CI=2.43, 7.23), worse self-rated health (OR=3.72, 95% CI=2.03, 6.81), and a higher expected likelihood of dying in the next 5 years (RR=5.02, 95% CI=2.15, 7.88) compared with those in the bottom quintile. However, adverse childhood experiences did not demonstrate a graded relationship with obesity, stunting, or grip strength. CONCLUSIONS: These patterns are quite consistent with evidence from high-income countries and suggest that primary prevention of adverse childhood experiences should be a priority to ensure lifelong health in low-resources settings.


Assuntos
Saúde do Adolescente/estatística & dados numéricos , Experiências Adversas da Infância/estatística & dados numéricos , Autoavaliação Diagnóstica , Adolescente , Depressão/psicologia , Países em Desenvolvimento , Feminino , Humanos , Malaui/epidemiologia , Masculino , Prevalência , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos
8.
AIDS ; 33(14): 2245-2250, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31449094

RESUMO

OBJECTIVES: To investigate whether adverse childhood experiences are important determinants of sexual debut and HIV testing. DESIGN: Adolescents (age 10-16; N = 2089) from rural Malawi were interviewed in 2017-2018 for the baseline wave of a longitudinal study of childhood adversity and HIV risk. METHODS: Respondents were interviewed in their local language. Surveys captured 13 lifetime childhood adversities (using the Adverse Childhood Experience - International Questionnaire); sexual debut; and previous HIV testing. We used multivariate regression models to test whether adversity, measured both cumulatively and separately, predicted HIV risk. RESULTS: For each additional adversity, there was a significant rise in the odds of sexual debut (odds ratio 1.13, confidence interval 1.07-1.20) and HIV testing (odds ratio 1.10, confidence interval 1.04-1.16). CONCLUSION: Preventing HIV among all young people necessitates a paradigm shift that recognizes the importance of early life social determinants in structuring HIV risk.


Assuntos
Experiências Adversas da Infância , Infecções por HIV/diagnóstico , Comportamento Sexual/estatística & dados numéricos , Adolescente , Comportamento do Adolescente , Criança , Feminino , Infecções por HIV/prevenção & controle , Humanos , Estudos Longitudinais , Malaui , Masculino , Análise Multivariada , Pobreza , Análise de Regressão , Assunção de Riscos
9.
Soc Sci Med ; 235: 112389, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31279254

RESUMO

A strong and consistent association between migration and health has been found in many settings, but the overwhelming focus of this research has been on adults. In addition, identifying the effect of migration on health largely remains an unresolved challenge, due in part to the inability to distinguish between the effect of migration on health and the selection of children of differing health status into migration streams. In this research we examine the relationship between internal migration and child health in Malawi. We use longitudinal panel data with pre- and post-migration health measures for children and their mothers, which permits us to measure both migration health selection and the effect of migration on health. We also examine if child health changes over time in post-migration destinations. We do not find evidence of migration health selection: children who move have similar pre-migration health status to non-migrant children. We find that the impact of migration on child health is mediated by mothers' characteristics. Before controlling for mothers' health status, we find a strong negative impact of migration on health, particularly for children moving to rural areas or cities, and children moving due to changes in mothers' marital status. After controlling for mothers' health status, however, the negative impact of migration on child health disappears. We also find that child health is worse with longer durations spent in post-migration residence, compared to children who don't move.


Assuntos
Emigração e Imigração/tendências , Dinâmica Populacional/tendências , Fatores Socioeconômicos , Criança , Serviços de Saúde da Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Malaui , Masculino , Análise de Regressão
10.
Child Abuse Negl ; 92: 139-145, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30974257

RESUMO

BACKGROUND: Adverse childhood experiences (ACEs) can have lifelong adverse impacts on health and behavior. While this relationship has been extensively documented in high-income countries, evidence from lower-income contexts is largely missing. In order to stimulate greater research on the prevalence and consequences of ACEs in low-income countries, the World Health Organization (WHO) developed the ACE-International Questionnaire (ACE-IQ). OBJECTIVE: In this paper, we explore the factor structure, validity and reliability of the original ACE-IQ, and evaluate whether potential adaptations improve its predictive validity. PARTICIPANTS AND SETTING: Four hundred and ten adolescents (age 10-16 years old) from Malawi. METHODS: The adolescents answered an adapted version of ACE-IQ and Beck Depression Inventory (BDI). RESULTS: Taken together, our results suggest that (a) the ACE-IQ is structured in three dimensions: household disruption, abuse, and neglect; (b) there is support for the validity of the scale evidenced by the correlation between subdimensions (average across 13 correlations, phi = .20, p < 0,01; across subdomains (phi = .10, p < 0,01); partial agreement among children with the same caregiver (ICC = .43, p < .001) and correlation between ACE and depression (predictive validity; r = .35, p < .001); (c) information on the timing of the adversities ("last year" in addition to "ever") modestly improved the predictive value of the ACE-IQ in models of depression (from R2 = .12 to .15, p < .001); and (d) additional HIV-related questions showed low endorsement and a modest correlation with BDI (r = .25, p < 0,01). CONCLUSION: Our findings suggest that the ACE-IQ is appropriate for use among adolescents from a low-income context.


Assuntos
Experiências Adversas da Infância , Maus-Tratos Infantis/psicologia , Adolescente , Adulto , Criança , Maus-Tratos Infantis/etnologia , Transtorno Depressivo/etnologia , Transtorno Depressivo/etiologia , Características da Família , Feminino , Humanos , Renda , Malaui/etnologia , Masculino , Pessoa de Meia-Idade , Prevalência , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas , Adulto Jovem
11.
AIDS Behav ; 22(12): 3892-3896, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29909588

RESUMO

A growing population of youth who acquired HIV from their mothers are surviving into adulthood. This group is unique in that they experience both internalized stigma (due to their HIV status) and associative stigma (due to their mothers' HIV status). Results of a cross-sectional survey of 250 perinatally HIV-infected South African youth suggests that internalized stigma is associated with greater risk of depression, and associative stigma is associated with greater risk of depression and substance use problems. Interventions currently focus on internalized stigma; this study highlights the importance of also addressing associative stigma to improve outcomes among perinatally HIV-infected youth.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Intoxicação Alcoólica/psicologia , Depressão/psicologia , Infecções por HIV/psicologia , Transmissão Vertical de Doenças Infecciosas , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Intoxicação Alcoólica/epidemiologia , Criança , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Recém-Nascido , Masculino , África do Sul/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
12.
Child Abuse Negl ; 79: 98-106, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29428881

RESUMO

Repeated exposure to childhood adversity (abuse, neglect and other traumas experienced before age 18) can have lifelong impacts on health. For HIV-infected adolescents and youth, such impacts may include onward transmission of HIV. To evaluate this possibility, the current study measured the burden of childhood adversity and its influence on risky health behaviors among perinatally-infected adolescents and youth. We surveyed 250 perinatally-infected adolescents and youth (13-24 years) receiving care in Soweto, South Africa. Both male and female participants reported on childhood adversity (using the ACE-IQ), sexual behavior, and psychosocial state. Viral load was also abstracted from their charts. We used logistic regressions to test the association between cumulative adversity and behavioral outcomes. Half the sample reported eight or more adversities. Overall, 72% experienced emotional abuse, 59% experienced physical abuse, 34% experienced sexual abuse, 82% witnessed domestic violence, and 91% saw someone being attacked in their community. A clear gradient emerged between cumulative adversities and behavioral risk. Having experienced one additional childhood adversity raised the odds of risky sexual behavior by almost 30% (OR 1.27, 95% CI 1.09-1.48). Viral suppression was poor overall (31% had viral loads >400 copies/ml), but was not related to adversity. Adversity showed a robust relationship to depression and substance abuse. Childhood adversity is common, influences the current health of HIV-positive adolescents and youth, and puts their sexual partners at risk for HIV infection. Greater primary prevention of childhood adversity and increased access to support services (e.g., mental health) could reduce risk taking among HIV-positive adolescents and youth.


Assuntos
Experiências Adversas da Infância , Infecções por HIV/transmissão , Sexo sem Proteção/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Adulto , Criança , Maus-Tratos Infantis/psicologia , Estudos de Coortes , Violência Doméstica/psicologia , Exposição à Violência/psicologia , Feminino , Infecções por HIV/psicologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Masculino , Saúde Mental , Gravidez , Reprodutibilidade dos Testes , Assunção de Riscos , Parceiros Sexuais , África do Sul , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Carga Viral , Adulto Jovem
13.
Glob Public Health ; 13(11): 1634-1649, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29345212

RESUMO

The Sustainable Development Goals set ambitious targets for health. Meeting such will require drastic improvements in the social conditions for women and girls. Understanding which social conditions have the greatest impact on health can help prioritise action, yet there is little comparative data. We use microdata from 338,580 women in 47 low- and middle-income countries to estimate the relative contributions of improved social determinants in bringing about maternal and child health gains over the past 20 years. Regression analyses examine determinants related to education, work, health services, family, and violence; the potential health benefit that could be derived from improving conditions is calculated. Secondary education and child marriage emerge as the strongest and most consistent predictors of health. The largest impact is seen on adolescent births: we estimate that achieving universal completion of secondary schooling for young women could lower adolescent births by 18 percentage points; eliminating child marriages could lower adolescent births by 11 points. Intervening in these two areas could also bring about substantial reductions in the unmet need for family planning, past-year intimate partner violence, and child mortality. Thus, we suggest prioritising policies targeting secondary education and child marriage in order to accelerate gender equity and health.


Assuntos
Saúde da Criança , Países em Desenvolvimento , Internacionalidade , Determinantes Sociais da Saúde , Saúde da Mulher , Bases de Dados Factuais , Escolaridade , Feminino , Humanos , Análise de Regressão , Classe Social , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto Jovem
14.
J Acquir Immune Defic Syndr ; 77(1): 64-71, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29040165

RESUMO

BACKGROUND: As perinatal HIV-infected youth become sexually active, the potential for onward transmission becomes an increasing concern. In other populations, intimate partner violence (IPV) is a risk factor for HIV acquisition. We build on this critical work by studying the role of IPV in facilitating onward transmission among HIV-infected youth-an important step toward effective intervention. SETTING: Soweto, South Africa. METHODS: Self-report surveys were completed by 129 perinatal HIV-infected female youth (aged 13-24 years). We calculated the IPV prevalence and used logistic models to capture the association between IPV and health outcomes known to facilitate onward HIV transmission (eg, risky sex, poor medication adherence, depression, and substance abuse). RESULTS: A fifth of perinatal HIV-infected participants reported physical and/or sexual IPV in the past year; one-third reported lifetime IPV. Childhood adversity was common and positively associated with IPV. Past-year physical and/or sexual IPV was positively correlated with high-risk sex [odds ratio (OR) = 8.96; 95% confidence interval (CI): 2.78 to 28.90], pregnancy (OR = 6.56; 95% CI: 1.91 to 22.54), poor medication adherence to antiretroviral therapy (OR = 5.37; 95% CI: 1.37 to 21.08), depression (OR = 4.25; 95% CI: 1.64 to 11.00), and substance abuse (OR = 4.11; 95% CI: 1.42 to 11.86). Neither past-year nor lifetime IPV was associated with viral load or HIV status disclosure to a partner. CONCLUSIONS: We find that IPV may increase risk for onward HIV transmission in perinatal HIV-infected youth by both increasing engagement in risky sexual behaviors and lowering medication adherence. HIV clinics should consider integrating primary IPV prevention interventions, instituting routine IPV screening, and collocating services for victims of violence.


Assuntos
Infecções por HIV/prevenção & controle , Violência por Parceiro Íntimo/estatística & dados numéricos , Adesão à Medicação , Saúde Mental , Sexo sem Proteção , Adolescente , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Violência por Parceiro Íntimo/psicologia , Gravidez , Prevalência , Fatores de Risco , Assunção de Riscos , Autorrelato , Parceiros Sexuais , África do Sul/epidemiologia , Transtornos Relacionados ao Uso de Substâncias , Adulto Jovem
15.
J Adolesc Health ; 61(1): 99-106, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28363715

RESUMO

PURPOSE: Why do orphans have higher rates of HIV infection than nonorphaned peers? Research consistently assumes that orphans acquire HIV primarily through sexual behavior, but infections may instead be due to maternal transmission. Although these two pathways have very different implications for HIV programs and policies, their relative contribution has not been previously examined. In this research, we compare the contribution of maternal and sexual transmission to HIV infection among orphans in Africa. METHODS: We use Demographic and Health Survey data for 21,463 women and 18,359 men from 17 countries. We propose a conceptual framework linking orphanhood to HIV, and use mediation analysis and structural equation modeling to compare the potential contribution of maternal transmission (measured through direct pathways from orphanhood to HIV) and sexual transmission (measured through reports of risky sexual behavior) to orphan HIV infection. RESULTS: Our results suggest that maternal transmission is the predominant pathway of HIV infection among orphaned adolescents: there is strong evidence for a direct pathway from maternal (odds ratio [OR]: 2.45; 95% confidence interval [CI]: 1.72-3.51 for females and OR: 2.45; 95% CI: 1.53-3.90 for males) and double orphanhood (OR: 2.69; 95% CI: 1.97-3.66 and OR: 2.53; 95% CI: 1.68-3.82, respectively) to HIV; greater excess HIV risk in maternal versus paternal orphans. The contribution of sexual behavior is largely not significant. We do not observe correspondingly high orphan disparities in other sexually transmitted diseases. CONCLUSIONS: Maternal transmission is a more likely explanation than sexual transmission for heightened HIV infection among orphans. These results suggest that programs designed to address HIV infection among adolescents should focus on reducing maternal transmission and on identifying and testing undiagnosed HIV among orphans.


Assuntos
Crianças Órfãs , Infecções por HIV/transmissão , Soropositividade para HIV/epidemiologia , Transmissão Vertical de Doenças Infecciosas , Adolescente , África/epidemiologia , Crianças Órfãs/estatística & dados numéricos , Feminino , Humanos , Masculino , Mães , Doenças Sexualmente Transmissíveis
16.
Int J Epidemiol ; 46(2): 662-675, 2017 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-27733435

RESUMO

Background: : Studies in South Asia suggest that child marriage is a strong risk factor for intimate partner violence (IPV), but evidence outside the region is lacking. Methods: : This study uses standardized data from demographic and health surveys in 34 countries to test the hypothesis that young women (age 20-24) who married as children are at increased risk of past year physical and/or sexual IPV as compared with those women who married as adults. Results: : Globally, 9% of respondents were married before they turned 15; another 25% were married between the ages of 15 and 17. Past year physical and/or sexual IPV was higher among women who married as children (29%) compared with those who married as adults (20%). This difference persisted in logistic regression models that adjust for sociodemographic characteristics [odds ratio (OR) 1.41 (1.30-1.52) for marriage before 15, and 1.42 (1.35-1.50) for marriage at 15-17]. However, there was considerable heterogeneity between countries: marriage before age 15 was associated with a combined measure of past year physical and/or sexual IPV in nine countries; women married between 15 and 17 were at increased risk of physical and/or sexual IPV in 19 countries. This heterogeneity was most evident in sub-Saharan Africa, and warrants further investigation in so far as it may help identify protective policies and norms. Conclusion: : Substantial reductions in IPV will likely require interventions to combat child marriage itself and to protect women from IPV within child marriages.


Assuntos
Casamento/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Cooperação Internacional , Modelos Logísticos , Masculino , Fatores de Risco , Adulto Jovem
17.
AIDS Care ; 28 Suppl 2: 142-52, 2016 03.
Artigo em Inglês | MEDLINE | ID: mdl-27392009

RESUMO

In the wake of the HIV/AIDS epidemic, caregivers are struggling to support HIV-affected children. For reasons of equity and efficiency, their needs can be best met through strong social protections and policies. This paper presents a conceptual framework to help address the needs of HIV-affected caregivers and to prioritize policies. We describe the needs that are common across diverse caregiving populations (e.g., economic security); the needs which are intensified (e.g., leave to care for sick children) or unique to providing care to HIV-affected children (e.g., ARV treatment). The paper then explores the types of social policies that would facilitate families meeting these needs. We outline a basic package of policies that would support HIV-affected families, and would meet goals agreed to by national governments. We examine the availability of these policies in 25 highly affected countries in sub-Saharan Africa. The majority of countries guarantee short-term income protection during illness, free primary school, and educational inclusion of children with special needs. However, there are significant gaps in areas critical to family economic security and healthy child development. Fewer than half of the countries we analyzed guarantee a minimum wage that will enable families to escape poverty; only six have eliminated tuition fees for secondary school; and only three offer paid leave to care for sick children. Filling these policy gaps, as well as making mental health and social services more widely available, is essential to support caregiving by families for HIV-affected children. As part of the HIV agenda, the global community can help national governments advance towards their policy targets. This would provide meaningful protection for families affected by HIV, as well as for millions of other vulnerable families and children across the region.


Assuntos
Cuidadores/psicologia , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Política Pública , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , África ao Sul do Saara , Criança , Desenvolvimento Infantil , Epidemias , Feminino , Infecções por HIV/psicologia , Humanos , Renda , Masculino , Pobreza , Prevalência
18.
J Epidemiol Community Health ; 70(8): 791-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26865695

RESUMO

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 serving HIV-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.


Assuntos
Crianças Órfãs , Infecções por HIV/epidemiologia , Comportamento Sexual , Adolescente , África ao Sul do Saara/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino
19.
Child Abuse Negl ; 51: 172-80, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26631421

RESUMO

There are compelling reasons to believe that orphans - many millions due to the AIDS epidemic - are more likely to be sexually victimized during childhood. Few studies have empirically investigated sexual violence disparities, and those that do suffer from methodological limitations and limited geographic scope. We used nationally representative data on female adolescents (15-17 years) from 13 countries in sub-Saharan Africa. We built multilevel logistic models to test for an association between the dependent variables (orphanhood and parental absence) and sexual violence, both within countries and pooled across all countries. Approximately 10% of adolescent girls reported past experiences of sexual violence; a third of those victimized were 14 years or younger at the time of their first forced encounter. Paternal orphaning (OR 1.36, p≤0.01), double orphaning (OR 1.47, p≤0.05), and paternal absence (OR 1.28; p≤0.05) were significantly associated with experiencing sexual violence in pooled analyses. Fewer findings reached significance within individual countries. Our findings suggest that the lack of a father in the home (due to death or absence) places girls at heightened risk for childhood sexual abuse; further research identifying pathways of vulnerability and resilience specific to this population is needed. Our findings also indicate that abuse often starts at an early age; thus promising programs should be adapted for younger age groups and rigorously tested.


Assuntos
Abuso Sexual na Infância , Crianças Órfãs , Pais , Adolescente , África ao Sul do Saara/epidemiologia , Abuso Sexual na Infância/estatística & dados numéricos , Crianças Órfãs/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Inquéritos e Questionários
20.
Soc Sci Med ; 133: 2-10, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25828259

RESUMO

Intimate partner violence (IPV) has been found to be negatively associated with contraceptive use in developing countries, but evidence from Africa is mixed. This study examines whether the above association differs in conflict settings, which have the potential for both higher levels of violence and more limited access to family planning. We use nationally representative data from the Democratic Republic of the Congo to examine the relationship between individual- and community-level IPV and modern contraceptive use, and to explore whether conflict modifies the relationship between IPV and contraceptive use. Nationally, only 6% of women reported current modern contraceptive use, while 53% reported experiencing physical IPV and 32% reported experiencing sexual IPV. In multivariate models, we found that individual-level sexual IPV was positively associated with current using modern contraceptive use, but that a combined measure of physical and sexual IPV did not demonstrate a similar association. Community-level IPV was not associated with individual-level contraceptive use. Conflict exposure was neither an independent predictor nor modifier of contraceptive use. Results suggest improved access to family planning should be a priority for programming in DRC, and efforts should ensure that sufficient resources are allocated towards the reproductive health needs of women in both conflict and non-conflict regions.


Assuntos
Comportamento Contraceptivo , Parceiros Sexuais/psicologia , Maus-Tratos Conjugais , Guerra , Adolescente , Adulto , Anticoncepcionais , República Democrática do Congo , Feminino , Inquéritos Epidemiológicos , Humanos , Fatores de Risco , Violência , Adulto Jovem
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