Coital frequency and condom use in age-disparate partnerships involving women aged 15 to 24: evidence from a cross-sectional study in KwaZulu-Natal, South Africa

George, Gavin; Maughan-Brown, Brendan; Beckett, Sean; Evans, Meredith; Cawood, Cherie; Khanyile, David; Govender, Kaymarlin; Kharsany, Ayesha B. M.

doi:10.1136/bmjopen-2018-024362

Cited by 16 publications

(9 citation statements)

References 41 publications

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“…On average, consistent condom use and condom use at last sex decreased between survey rounds, with the greatest decrease occurring among Kenyan YW. While previous research shows that proper condom use is protective against HIV acquisition,53–55 condom uptake among adolescent and youth populations is consistently suboptimal,53 56–59 a pattern that is reinforced by our findings. A post hoc trend decomposition analysis suggests that condom use behaviours may have shifted for YW as they entered martial partnerships (results not shown).…”

Section: Discussionsupporting

confidence: 72%

Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia

et al. 2022

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ObjectivesTo assess temporal shifts in HIV risk factors among adolescent girls (AG, aged 15–19 years) and young women (YW, aged 20–24 years) in Kenya, Malawi and Zambia.DesignProspective cohorts with two time points (Kenya: 2016/2017, 2018; Malawi: 2017, 2018; Zambia: 2016/2017, 2018)SettingCommunity-based programming.Participants1247 AG (Kenya: 389, Malawi: 371, Zambia: 487) and 1628 YW (Kenya: 347, Malawi: 883, Zambia: 398)InterventionDetermined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), a multisectoral approach to reduce AGYW’s HIV vulnerability by delivering a package of tailored, multilayered activities and services.Primary and secondary outcome measures: HIV testing, sexually transmitted infection (STI) symptom experience, number of sexual partners, condom use (consistently, at last sex), transactional sex, experience of physical violence (from intimate partners) and sexual violence (from intimate partners and strangers/non-partners).ResultsChanges in HIV-related risk behaviours among DREAMS participants varied by age group and country. Among AG, HIV testing increased (Kenya and Zambia) and sexual violence from partners (in Kenya and Malawi) and non-partners (in Malawi) decreased. Among YW, HIV testing increased and STI experience decreased in Malawi; consistent condom use decreased in Kenya; transactional sex increased in Kenya and Zambia; and physical violence (in Malawi) and sexual violence from partners (in Kenya and Malawi) and non-partners (all three countries) decreased over time.ConclusionsImprovements in HIV testing and reductions in experiences of sexual violence were coupled with variable shifts in HIV-related risk behaviours among DREAMS participants in Kenya, Malawi and Zambia. Additional consideration of AGYW’s risk circumstances during key life transitions may be needed to address the risk heterogeneity among AG and YW across different contexts.

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Section: Discussionsupporting

confidence: 72%

Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia

et al. 2022

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“…Evidence from several sources indicates that partnering with older men increases risk of HIV-infection for young women [3][4][5][6][7][8][9] . This evidence aligns with epidemiological data: older male partners are more likely to be HIV-infected with an unsuppressed viral load than younger partners [6] ; and behavioural data: condomless sex [10][11][12][13] , transactional sex [13] , higher frequency of sex [14][15][16] , and concurrent sexual partnering [17] , are more prevalent in age-disparate partnerships.…”

Section: Introductionsupporting

confidence: 78%

Recently formed age-disparate partnerships are associated with elevated HIV-incidence among young women in South Africa

Maughan-Brown

Venkataramani

Kharsany

et al. 2020

Aids

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Objective: Cross-sectional and cohort studies draw different conclusions on whether agedisparate partnerships increase HIV-acquisition risk for young women. We investigated whether age-disparities were associated with HIV-infection risk early in relationships. This could result in the exclusion of women who seroconverted during high-risk age-disparate partnerships from cohort studies of HIV-incidence -which exclude HIV-positive women -and explain null findings in these studies. Design: Prospective cohort studyMethods: We used data on 15-24 year-old, HIV-negative women in heterosexual partnerships (N=830) in KwaZulu-Natal, South Africa. The association between age-disparate partnering (i.e.,

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“…The prevalence of condom non-use among adolescents in SSA is estimated to be 60% [5]. In South Africa, even though many young people are sexually active [6][7][8], condom use is inconsistent, with a reported rate of condom use inconsistency at 46-55% [9,10]. Recent findings presented in the South African Demographic and Health Survey, suggests that 50% of young women and 66% of young men reported having sex before the age of 18, of which 4.6% of young women and 20.7% of young men had more than 2 sexual partners in the 12 months before the survey.…”

Section: Introductionmentioning

confidence: 99%

Exploring condom use decision-making among adolescents: the synergistic role of affective and rational processes

et al. 2021

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Background Condom use remains the most effective behavioural method for the prevention of HIV and unplanned pregnancies. However, condom use remains inconsistent among young people. Exploring the condom use decision-making processes that adolescents engage in might provide information that would assist in the prevention of many challenges related to poor sexual and reproductive health outcomes. This study therefore aimed to explore the factors that influenced decision-making about sexual debut and condom use of adolescents from two schools in the Western Cape, South Africa. Methods A sample of 16 adolescents were selected using purposive sampling. Data were collected using semi-structured, individual interviews. Thematic analysis was used to analyse the data generated. Results The link between sexual debut and affective processes was frequently discussed in condom use decision-making. Decisions about sexual debut were influenced by the belief that sex was a perceived symbol of ‘true love’ on the one hand, and respect for perceived parental expectations of age-appropriate sex, on the other. Condom use decision-making was shaped by adolescents’ concerns about their future and lack of stability in their lives. Adolescents’ fears of pregnancy, parenthood and disease shaped their condom use decision-making. It became evident that rational and affective decision-making in condom use choice were not mutually exclusive, but that these processes happened simultaneously. Conclusions The study highlighted the role of affective states as part of the process of examining alternatives when deciding to use a condom or not. Interventions to strengthen condom use decision-making should therefore incorporate not only rational but also affective processes to improve adolescent sexual and reproductive outcomes.

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Coital frequency and condom use in age-disparate partnerships involving women aged 15 to 24: evidence from a cross-sectional study in KwaZulu-Natal, South Africa

Cited by 16 publications

References 41 publications

Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia

Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia

Recently formed age-disparate partnerships are associated with elevated HIV-incidence among young women in South Africa

Exploring condom use decision-making among adolescents: the synergistic role of affective and rational processes

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