Understanding the Relationships Between HIV and Child Marriage: Conclusions From an Expert Consultation

Comparison of HIV prevention indicators among adolescent girls and young women in DREAMS and non-DREAMS intervention districts in Uganda

In sub-Saharan Africa, a significant number of new human immunodeficiency virus (HIV) infections occur among adolescent girls and young women (AGYW). The 2023 Uganda Annual Spectrum estimates indicated that about one-third of all new HIV infections are among AGYW. In 2016, the Ministry of Health in partnership with the United States President's Emergency Plan for AIDS Relief (PEPFAR) initiated the Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) program to reduce the vulnerability of AGYW to HIV by offering various direct and indirect HIV-related prevention services. These services influence the level of various HIV prevention indicators in the age group. This study aimed to compare these levels. The study was a secondary analysis of pooled Lot Quality Assurance Sampling (LQAS) survey data collected in DREAMS and non-DREAMS districts during 2021 and 2022. Fifteen HIV prevention indicators were independently compared between 8 DREAMS and 8 non-DREAMS districts. Chi-square tests were used to assess the significance in the differences. Of the 9,290 records of AGYW reviewed, 52.40% were of AGYW residing in DREAMS districts. Between DREAMS and non-DREAMS districts, significant differences in level of knowledge of HIV prevention methods (25.60% versus 14.63%, p < 0.001), condom use (58.99% versus 48.33%, p < 0.001), knowledge of HIV testing points (93.43% versus 92.38%, p = 0.049), having multiple sex partners (15.28% versus 10.11%, p < 0.001), condom use (58.99% versus 48.33%, p < 0.001), HIV testing (84.86% versus 82.00%, p < 0.001) and multiple sex partners (15.28% versus 10.11%, p < 0.001) among other indictors. AGYW in DREAMS districts had better outcomes for all indicators except multiple sex partners. Although this factor likely contributed to the initial selection of DREAMS-intervention districts, its persistence may continue to influence overall efforts towards the reduction of HIV prevalence. Moreover, this potentially mitigates the benefits from other better performing indicators.

Child marriage, educational attainment, and comprehensive knowledge of HIV/AIDS: a multi-country analysis

Understanding the link between HIV/AIDS knowledge and child marriage is important for designing and planning effective intervention programmes. Despite significant advances in HIV/AIDS prevention and treatment, it remains important to study the impact of child marriage on HIV/AIDS knowledge because HIV/AIDS continues to affect millions globally. This study investigated the association of child marriage with scores on an index measuring comprehensive knowledge about HIV/AIDS transmission and prevention. Analysis was conducted on a sample of women aged 18-24 years, using nationally representative DHS household surveys from 18 countries. Findings indicate that there is no direct statistically significant effect of child marriage on women's comprehensive knowledge about HIV/AIDS once controls for other factors affecting knowledge are included in the regression. However, the coefficients for educational attainment are statistically significant in most countries, at least when secondary or higher education is considered. This suggests that child marriage may affect knowledge about HIV/AIDS indirectly through its impact on educational attainment for girls who marry early.

Key normative, legal, and policy considerations for supporting pregnant and postpartum adolescents in high HIV-burden settings: a critical analysis

Rates of adolescent pregnancy within sub-Saharan Africa are increasing. Adolescent mothers ages 10-19 years face a distinct set of risks to their own and their children's health, compounded by many economic, social, and epidemiological challenges, such as living with HIV. In navigating this complex developmental period, many adolescent mothers face structural barriers impeding safe transitions to adulthood and motherhood. Drawing on existing literature and emerging data, we outline three normative, legal, and policy issues - violence and gender inequity, access to sexual and reproductive health services, and access to social and structural supports - which affect the health, wellbeing and development of adolescent mothers and their children. We also highlight emergent evidence about programming and policy changes that can better support adolescent mothers and their children. These key proposed responses include removing barriers to SRH and HIV service integration; ensuring implementation of return-to-school policies; and extending social protection systems to cater for adolescent mothers. Despite ongoing global crises and shifts in funding priorities, these normative, legal, and policy considerations remain critical to safeguard the health and wellbeing of adolescent mothers and their children.

What will it take to achieve the sexual and reproductive health and rights of women living with HIV?

This article outlines progress in realizing the sexual and reproductive health and rights of women and girls living with HIV over the last 30 years from the perspective of women living with HIV. It argues that the HIV response needs to go beyond the bio-medical aspects of HIV to achieve our sexual and reproductive health and rights, and considers relevant Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization, United States President's Emergency Plan for AIDS Relief (PEPFAR), Global Fund and other guidelines, what engagement there has been with women living with HIV and whether guidelines/strategies have been adopted. It has been written by women living with HIV from around the world and a few key supporters. Co-authors have sought to collate and cite materials produced by women living with HIV from around the world, in the first known effort to date to do this, as a convergence of evidence to substantiate the points made in the article. However, as the article also argues, research led by women living with HIV is seldom funded and rarely accepted as evidence. Combined with a lack of meaningful involvement of women living with HIV in others' research on us, this means that formally recognized evidence from women's own perspectives is patchy at best. The article argues that this research gap, combined with the ongoing primacy of conventional research methods and topics that exclude those most affected by issues, and the lack of political will (and sometimes outright opposition) in relation to gender equality and human rights, adversely affect policies and programmes in relation to women's rights. Thus, efforts to achieve an ethical, effective and sustainable response to the pandemic are hindered. The article concludes with a call to action to all key stakeholders.

Individual/Household and Community-Level Factors Associated with Child Marriage in Mali: Evidence from Demographic and Health Survey

Background

Child marriage is a major public health problem globally, and the prevalence remains high in sub-Saharan African countries, including Mali. There is a dearth of evidence about factors associated with child marriage in Mali. Hence, this studyaimed at investigating the individual/household and community-level factors associated with child marriage among women in Mali.

Methods

Using data from the 2018 Mali Demographic and Health Survey, analysis was done on 8,350 women aged 18-49 years. A Chi-square test was used to select candidate variables for the multilevel multivariable logistic regression models. Fixed effects results weree xpressed as adjusted odds ratios (aOR) at 95% confidence intervals (CI). Stata version 14 software was used for the analysis.

Results

The results showed that 58.2% (95% CI; 56.3%-60.0%) and 20.3% (95%; 19.0%-21.6%) of women aged 18-49 years were married before their 18^th and 15^th birthday, respectively. Educational status of women (higher education: aOR = 0.25, 95% CI; 0.14-0.44), their partner's/husband's educational status (higher education: aOR = 0.64, 95% CI; 0.47-0.87), women's occupation (professional, technical, or managerial: aOR = 0.50, 95% CI; 0.33-0.77), family size (five and above: aOR = 1.16, 95% CI; 1.03-1.30), and ethnicity (Senoufo/Minianka: aOR = 0.73, 95% CI; 0.58-0.92) were the identified individual/household level factors associated with child marriage, whereas region (Mopti: aOR = 0.27, 95% CI; 0.19-0.39) was the community level factor associated with child marriage.

Conclusions

This study has revealed a high prevalence of child marriage in Mali. To reduce the magnitude of child marriage in Mali, enhancing policies and programs that promote education for both girls and boys, creating employment opportunities, improving the utilization of family planning services, and sensitizing girls and parents who live in regions such as Kayes on the negative effects of child marriage is essential. Moreover, working with community leaders so as to reduce child marriage in the Bambara ethnic communities would also be beneficial.