Characterizing a sexual health and HIV risk stratification scale for sexually active adolescent girls and young women (AGYW) in Tanzania

Abstract

Adolescent girls and young women (AGYW) aged 15 to 24 years face disproportionately high risks of acquiring HIV and other sexually transmitted infections (STIs). A sexual health risk stratification tool can support the development and implementation of tailored HIV and STI prevention services for sub-groups of at-risk AGYW. Data were collected among sexually active AGYW aged 15 to 24 years in Tanzania between April 2015 and March 2017. Exploratory and confirmatory factor analyses were conducted to construct and assess the latent structure of a ten-item scale for rapid assessment of sexual health risks. Items with high factor loadings and minimal cross loadings were retained in the final scale. Scale performance was appraised against condomless sex (defined as unprotected vaginal or anal intercourse) reported by AGYW for construct validity. A three-factor structure of vulnerability to HIV among AGYW was supported with subscales for socioeconomic vulnerability; lack of adult support; and sexual behavioral risks. The chi-square goodness-of-fit test, root mean square error of approximation, comparative fit index, and Tucker-Lewis index indicated a strong goodness-of-fit of the three-factor scale. Cronbach alphas (0.55 for socioeconomic vulnerability, 0.55 for lack of support, and 0.48 for sexual risk) indicated sub-optimal internal consistency for all sub-scales. The factor-item and factor-factor correlations identified in these analyses were consistent with the conceptual framework of vulnerability of HIV infection in AGYW, suggesting good construct validity. The scale also demonstrated a statistically significant association with condomless sex and could be potentially used for sexual health risk stratification (OR = 1.17, 95% CI: 1.12, 1.23). The sexual health and HIV risk stratification scale demonstrated potential in identifying sexually active AGYW at high risk for HIV and other STIs. Ultimately, all AGYW in Tanzania are not at equal risk for HIV and this scale may support directing resources towards those at highest risk of HIV.

Social venues and HIV vulnerability of young venue workers: a cluster analysis of data from a national-level cross-sectional survey of social venues in Uganda

“…Relatedly, these alcohol-serving sex work venues with a provision of on-site sex attracted mostly young female workers with no or minimal education, and who were often not married. These individual characteristics are known indicators of HIV vulnerability 39 40…”

“…Based on earlier validated HIV vulnerability indices such as the girls’ HIV vulnerability index,39 40 this study selected a set of five indicators from the primary dataset and created a composite variable. These five were the only known indicators of HIV vulnerability in the primary dataset.…”

Determining HIV risk for Adolescent Girls and Young Women (AGYW) in relationships with “Blessers” and age-disparate partners: a cross-sectional survey in four districts in South Africa

“…This cocktail of factors play a significant role in increasing AGYW susceptibility to HIV infection. Structural factors, including low education levels, poverty and sexual abuse mediate many behavioural factors, including engaging in early sexual debut, transactional sex, age-disparate sex and multiple partnerships [ 2 ].…”

Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania

“…Implemented by Jhpiego in partnership with EngenderHealth, Pact, and the Tanzania National Institute for Medical Research, Sauti provided a core package of client-centered sexual and reproductive health services for key populations such as female sex workers and men who have sex with men (35)(36)(37)(38)(39). Sauti also delivered critical HIV-prevention services for vulnerable AGYW ages 15-24 within 14 regions of Tanzania between 2015 and 2020, and was also an implementing partner of the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) Initiative (Figure 1) (34,40). Programming delivered through Sauti for AGYW included biomedical services such as HIV testing and counseling, HIV case management, sexual risk assessments, family planning counseling and provision of contraception, screening for sexually transmitted infections (STI) and tuberculosis, nutritional assessments, and additional screening and referrals for substance use and…”