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Bose DL, Hundal A, Singh S, Singh S, Seth K, Hadi SU, Saran A, Joseph J, Goyal K, Salve S. Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs). CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1297. [PMID: 36911864 PMCID: PMC9831290 DOI: 10.1002/cl2.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Adolescent girls and young women (AGYW), aged 15-24 years, are disproportionately affected by HIV and other sexual and reproductive health (SRH) risks due to varying social, cultural, and economic factors that affect their choices and shape their knowledge, understanding, and practices with regard to their health. Socio-Behavioral Change Communication (SBCC) interventions targeted at strengthening the capabilities of individuals and their networks have supported the demand and uptake of prevention services and participation in biomedical research. However, despite growing global recognition of the domain, high-quality evidence on the effectiveness of SBCC remains scattered. This evidence and gap map (EGM) report characterizes the evidence base on SBCC interventions for strengthening HIV Prevention and Research among AGYW in low- and middle-income countries (LMICs), identifying evidence gaps and outlining the scope of future research and program design. OBJECTIVES The objectives of the proposed EGM are to: (a) identify and map existing EGMs in the use of diverse SBCC strategies to strengthen the adoption of HIV prevention measures and participation in research among AGYW in LMICs and (b) identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research. METHODS This EGM is based on a comprehensive search of systematic reviews and impact evaluations corresponding to a range of interventions and outcomes-aimed at engaging AGYW in HIV prevention and research - that were published in LMICs from January 2000 to April 2021. Based on guidance for producing a Campbell Collaboration EGM, the intervention and outcome framework was designed in consultation with a group of experts. These interventions were categorized across four broad intervention themes: mass-media, community-based, interpersonal, and Information Communication and Technology (ICT)/Digital Media-based interventions. They were further sub-categorized into 15 intervention categories. Included studies looked at 23 unique behavioral and health outcomes such as knowledge attitude and skills, relationship dynamics, household dynamics, health care services, and health outcomes and research engagement. The EGM is presented as a matrix in which the rows are intervention categories/sub-categories, and the columns are outcome domains/subdomains. Each cell is mapped to an intervention targeted at outcomes. Additional filters like region, country, study design, age group, funding agency, influencers, population group, publication status, study confidence, setting, and year of publication have been added. SELECTION CRITERIA To be eligible, studies must have tested the effectiveness of SBCC interventions at engaging AGYW in LMICs in HIV prevention and research. The study sample must have consisted of AGYW between the ages of 15-24, as defined by UNAIDS. Both experimental (random assignment) and quasi-experimental studies that included a comparison group were eligible. Relevant outcomes included those at the individual, influencer, and institutional levels, along with those targeting research engagement and prevention-related outcomes. RESULTS This EGM comprises 415 impact evaluations and 43 systematic reviews. Interventions like peer-led interactions, counseling, and community dialogues were the most dominant intervention sub-types. Despite increased digital penetration use of media and technology-driven interventions are relatively less studied. Most of the interventions were delivered by peers, health care providers, and educators, largely in school-based settings, and in many cases are part of sex-education curricula. Evidence across geographies was mostly concentrated in Sub-Saharan Africa (70%). Most measured outcomes focused on disease-related knowledge dissemination and enhancing awareness of available prevention options/strategies. These included messaging around consistent condom use, limiting sexual partners, routine testing, and awareness. Very few studies were able to include psychographic, social, and contextual factors influencing AGYW health behaviors and decisions, especially those measuring the impact of social and gender norms, relationship dynamics, and household dynamics-related outcomes. Outcomes related to engagement in the research were least studied. CONCLUSION This EGM highlights that evidence is heavily concentrated within the awareness-intent spectrum of behavior change and gets lean for outcomes situated within the intent-action and the action-habit formation spectrum of the behavior change continuum. Most of the evidence was concentrated on increasing awareness, knowledge, and building risk perception around SRH domains, however, fewer studies focused on strengthening the agency and self-efficacy of individuals. Similarly, evidence on extrinsic factors-such as strengthening social and community norms, relationships, and household dynamics-that determine individual thought and action such as negotiation and life skills were also found to be less populated. Few studies explore the effectiveness of these interventions across diverse AGYW identities, like pregnant women and new mothers, sex workers, and people living with HIV, leading to limited understanding of the use of these interventions across multiple user segments including key influencers such as young men, partners, families, religious leaders, and community elders was relatively low. There is a need for better quality evidence that accounts for the diversity of experiences within these populations to understand what interventions work, for whom, and toward what outcome. Further, the evidence for use of digital and mass-media tools remains poorly populated. Given the increasing penetration of these tools and growing media literacy on one end, with widening gender-based gaps on the other, it is imperative to gather more high-quality evidence on their effectiveness. Timely evidence generation can help leverage these platforms appropriately and enable intervention designs that are responsive to changing communication ecologies of AGYW. SBCC can play a critical role in helping researchers meaningfully engage and collaborate with communities as equal stakeholders, however, this remains poorly evidenced and calls for investigation and investment. A full list of abbreviations and acronyms are available in Supporting Information: Appendix F.
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Social normative origins of the taboo gap and implications for adolescent risk for HIV infection in Zambia. Soc Sci Med 2022; 312:115391. [PMID: 36183540 PMCID: PMC9582197 DOI: 10.1016/j.socscimed.2022.115391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022]
Abstract
Zambian Demographic and Health Survey data reveal that increased discordance between professed attitudes and measures of behaviour regarding premarital sex among adults is strongly associated with increased risk of HIV in adolescents, particularly girls. We hypothesised that this was due to the reluctance to talk about premarital sex, resulting in a situation we call the “taboo gap” where sexual behaviour is a forbidden topic and adolescents feel unable to seek advice or sexual and reproductive health services. Our analysis revealed that the taboo gap is rooted in harmful gender norms that are perpetuated by schools, churches, cultural influences, development programmes and health systems. Challenges like food insecurity and household poverty may place girls in positions where they are vulnerable to sexual exploitation, increasing their risk of exposure to HIV. Unmarried adolescents, particularly girls, report being ridiculed when they go to reproductive health clinics, which discourages them from seeking care in the future. Strengthening peer support and parent-child interactions are important programmatic elements. We conclude that discordance serves as a novel measure and harbinger for the presence of gender norms which generated a taboo gap that impeded carseeking and increased risk for HIV among adolescents, especially girls, in Zambia. We propose that successful interventions must involve a multifaceted, gender transformative approach which engages peers and stakeholders in schools, churches, clinics, and families, particularly parents, to reduce the gendered gap in HIV risk and transmission. Premarital sex attitude-behaviour discordance is associated with risk of adolescent HIV. Taboo gap occurs where sexual behaviour is a forbidden topic and impedes care-seeking. Taboo gap was generated in schools, churches, culture, and development programmes. Unmarried adolescents, especially girls, risk sanction in seeking reproductive care. Strengthening peer support and parent-child interactions are important programmatically.
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Gavan L, Hartog K, Holland WC, Koppenol-Gonzalez G, Gronholm PC, Feddes AR, Kohrt BA, Jordans MJ, Peters RH. Assessing stigma in low- and middle-income countries: A systematic review of scales used with children and adolescents. Soc Sci Med 2022; 307:115121. [DOI: 10.1016/j.socscimed.2022.115121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
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Burke VM, Frimpong C, Miti S, Mwansa JK, Abrams EA, Merrill KG, Denison JA. "It must start with me, so it started with me": A qualitative study of Project YES! youth peer mentor implementing experiences supporting adolescents and young adults living with HIV in Ndola, Zambia. PLoS One 2022; 17:e0261948. [PMID: 35113861 PMCID: PMC8812956 DOI: 10.1371/journal.pone.0261948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about youth-led approaches to addressing HIV-related outcomes among adolescents and young adults (AYA) living with HIV. In response, Project YES! hired and trained youth living with HIV as peer mentors (YPMs) in four HIV clinics in Ndola, Zambia to hold meetings with 276 15-24-year-olds living with HIV. Within this randomized controlled trial, a qualitative sub-study was conducted to explore YPMs' implementing experiences. METHODS In-depth interviews were conducted with the eight YPMs (50% female) ages 21-26 years. YPMs were asked about their experiences working with clients, their feedback on program components, and what the experience meant to them personally and professionally. Interviews were audio-recorded, transcribed verbatim, and thematic analysis was performed. RESULTS YPMs connected with AYA clients by discussing shared struggles, modeling positive health behaviors, and establishing judgement-free environments. YPMs experienced powerful personal transformations in HIV-related health behaviors, conceptions of self, and plans for the future. Many expressed now seeing themselves as community leaders-"ambassadors", "game changers"-and "not just alone in this world." They described newfound commitments to reaching personal and professional goals. YPMs were adamant that Project YES! should expand so other HIV-positive AYA might benefit. CONCLUSION Well-trained and compensated YPMs who are integrated into HIV clinics can support AYA in unique and important ways due to their shared experiences. The transformational experience of becoming YPMs empowers youth to see themselves as role models and leaders. Future programs should engage youth living with HIV as partners in efforts to end the HIV epidemic.
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Affiliation(s)
- Virginia M. Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia
| | | | - Elizabeth A. Abrams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine G. Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Stangl AL, Mwale M, Sebany M, Mackworth-Young CR, Chiiya C, Chonta M, Clay S, Sievwright K, Bond V. Feasibility, Acceptability and Preliminary Efficacy of Tikambisane ('Let's Talk to Each Other'): A Pilot Support Group Intervention for Adolescent Girls Living With HIV in Zambia. J Int Assoc Provid AIDS Care 2021; 20:23259582211024772. [PMID: 34212766 PMCID: PMC8255553 DOI: 10.1177/23259582211024772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In Zambia, 84,959 adolescent girls and young women (AGYW) aged 15-24 are currently living with HIV. We explored the feasibility and acceptability of a 6-session, curriculum-based support group intervention designed to address key concerns of AGYW living with HIV. Setting: Urban Zambia Methods: Surveys and in-depth interviews were collected pre- and post-intervention from participants enrolled from 2 health facilities. Eight participant observations of sessions were conducted. Descriptive statistics at baseline were reported only for AGYW who participated in the intervention (N = 21), while analyses comparing baseline and endline outcome measures were restricted to participants who had data at both time points (N = 14). Results: Support groups were feasible to conduct and acceptable to participants. Co-facilitation by an adult counselor and peers living with HIV raised confidence about session content. Sessions on antiretroviral therapy (ART), disclosure and stigma, and grief and loss were most in demand. We did not observe significant differences in key outcome measures between baseline and follow-up. However, qualitative data supported the positive impact of the intervention on ART adherence and hope for the future following the intervention among our participants. Conclusion: A short-term, structured support group series holds promise for helping AGYW living with HIV safely navigate a complex time in their lives.
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Affiliation(s)
- Anne L Stangl
- Department of Global Health, Youth and Development, International Center for Research on Women, Washington DC, USA.,Hera Solutions, Owings Mills, MD, USA
| | - Mwangala Mwale
- Social Science Unit, Zambart, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia, Africa
| | - Meroji Sebany
- Department of Global Health, Youth and Development, International Center for Research on Women, Washington DC, USA
| | - Constance Rs Mackworth-Young
- Social Science Unit, Zambart, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia, Africa.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC, United Kingdom
| | | | | | - Sue Clay
- 3C Regional Consultants, Lusaka, Zambia, Africa
| | - Kirsty Sievwright
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia Bond
- Social Science Unit, Zambart, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia, Africa.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC, United Kingdom
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Asuquo SE, Tahlil KM, Muessig KE, Conserve DF, Igbokwe MA, Chima KP, Nwanunu EC, Elijah LP, Day S, Rosenberg NE, Ong JJ, Nkengasong S, Tang W, Obiezu‐Umeh C, Nwaozuru U, Merino Y, Gbaja‐Biamila T, Oladele D, Iwelunmor J, Ezechi O, Tucker JD. Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review. J Int AIDS Soc 2021; 24:e25666. [PMID: 33569913 PMCID: PMC7876473 DOI: 10.1002/jia2.25666] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub-Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research. METHODS We followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub-Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart's ladder as substantial engagement (strong youth decision-making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision-making power) or no engagement. RESULTS We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty-two interventions were in low-income countries, 49 in middle-income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two-thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth-led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement. CONCLUSIONS We found limited youth engagement in youth HIV prevention intervention studies in sub-Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low-and-middle-income-country (LMIC) settings.
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Affiliation(s)
- Sarah E Asuquo
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kadija M Tahlil
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kathryn E Muessig
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and BehaviorArnold School of Public HealthUniversity of South CarolinaColumbiaSCUSA
| | - Mesoma A Igbokwe
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Kelechi P Chima
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Ezienyi C Nwanunu
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- Department of BiochemistryMichael Okpara University of AgricultureUmudikeNigeria
| | - Lana P Elijah
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineLagos State UniversityLagosNigeria
| | - Suzanne Day
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Nora E Rosenberg
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- University of North Carolina Project MalawiLilongweMalawi
| | - Jason J Ong
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Central Clinical SchoolMonash UniversityMelbourneVic.Australia
| | - Susan Nkengasong
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Dermatology HospitalSouthern Medical UniversityGuangzhouChina
| | - Chisom Obiezu‐Umeh
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Yesenia Merino
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - David Oladele
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Oliver Ezechi
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Joseph D Tucker
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Nakasone SE, Chimbindi N, Mthiyane N, Nkosi B, Zuma T, Baisley K, Dreyer J, Pillay D, Floyd S, Birdthistle I, Seeley J, Shahmanesh M. "They have this not care - don't care attitude:" A Mixed Methods Study Evaluating Community Readiness for Oral PrEP in Adolescent Girls and Young Women in a Rural Area of South Africa. AIDS Res Ther 2020; 17:55. [PMID: 32894138 PMCID: PMC7487548 DOI: 10.1186/s12981-020-00310-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/29/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) remain disproportionately affected by HIV. In a rural area of South Africa with an annual incidence (2011-2015) of 5 and 7% per annum for 15-19 and 20-24-year olds respectively, oral pre-exposure prophylaxis (PrEP) could provide AGYW with a form of HIV prevention they can more easily control. Using quantitative and qualitative methods, we describe findings from a study conducted in 2017 that assessed knowledge of and attitudes toward PrEP to better understand community readiness for an AGYW PrEP rollout. METHODS We used descriptive analysis of a quantitative demographic survey (n = 8,414 ages 15-86) to identify population awareness and early PrEP adopters. We also conducted semi-structured, in-depth interviews with a purposive sample of 52 potential PrEP gatekeepers (health care workers, community leaders) to assess their potential influence in an AGYW PrEP rollout and describe the current sexual health landscape. Interviews were recorded, transcribed, and iteratively coded to identify major themes. RESULTS PrEP knowledge in the general population, measured through a demographic survey, was low (n = 125/8,414, 1.49% had heard of the drug). Medicalized delivery pathways created hostility to AGYW PrEP use. Key informants had higher levels of knowledge about PrEP and saw it as a needed intervention. Community norms around adolescent sexuality, which painted sexually active youth as irresponsible and disengaged from their own health, made many ambivalent towards a PrEP rollout to AGYW. Health care workers discussed ways to shame AGYW if they tried to access PrEP as they feared the drug would encourage promiscuity and "risky" behaviour. Others interviewed opposed provision on the basis of health care equity and feared PrEP would divert both drug and human resources from treatment programs. CONCLUSIONS The health system in this poor, high-HIV incidence area had multiple barriers to a PrEP rollout to AGYW. Norms around adolescent sexuality and gatekeeper concerns that PrEP could divert health resources from treatment to prevention could create barriers to PrEP roll-out in this setting. Alternate modes of delivery, particularly those which are youth-led and demedicalize PrEP, must be explored.
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Affiliation(s)
| | - Natsayi Chimbindi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute of Epidemiology and Health Care Mortimer Market Centre, University College London, London, WC1E 6JB UK
| | | | - Busisiwe Nkosi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Kathy Baisley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene & Tropical Medicine, London, UK
| | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute of Epidemiology and Health Care Mortimer Market Centre, University College London, London, WC1E 6JB UK
| | - Sian Floyd
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene & Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute of Epidemiology and Health Care Mortimer Market Centre, University College London, London, WC1E 6JB UK
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Denison JA, Burke VM, Miti S, Nonyane BAS, Frimpong C, Merrill KG, Abrams EA, Mwansa JK. Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15-24 years) in Ndola, Zambia. PLoS One 2020; 15:e0230703. [PMID: 32240186 PMCID: PMC7117673 DOI: 10.1371/journal.pone.0230703] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/21/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Youth-led strategies remain untested in clinic-based programs to improve viral suppression (VS) and reduce stigma among HIV-positive adolescents and young adults (AYA) in sub-Saharan Africa. In response, Project YES! placed paid HIV-positive youth peer mentors (YPM) in four HIV clinics in Ndola, Zambia including a Children's Hospital (pediatric setting), an adult Hospital and two primary care facilities (adult settings). METHODS A randomized controlled trial was conducted from December 2017 to February 2019. Consecutively recruited 15 to 24-year-olds were randomly assigned to an intervention arm with monthly YPM one-on-one and group sessions and optional caregiver support groups, or a usual care comparison arm. Survey data and blood samples were collected at baseline and at the six-month midline. Generalized estimating equation models evaluated the effect of study arm over time on VS, antiretroviral treatment (ART) adherence gap, and internalized stigma. RESULTS Out of 276 randomized youth, 273 were included in the analysis (Intervention n = 137, Comparison n = 136). VS significantly improved in both arms (I:63.5% to 73.0%; C:63.7% to 71.3.0%) [OR:1.49, 95% CI:1.08, 2.07]. In a stratified analysis intervention (I:37.5% to 70.5%) versus the comparison (C:60.3% to 59.4%) participants from the pediatric clinic experienced a relative increase in the odds of VS by a factor of 4.7 [interaction term OR:4.66, 95% CI:1.84, 11.78]. There was no evidence of a study arm difference in VS among AYA in adult clinics, or in ART adherence gaps across clinics. Internalized stigma significantly reduced by a factor of 0.39 [interaction term OR:0.39, 95% CI:0.21,0.73] in the intervention (50.4% to 25.4%) relative to the comparison arm (45.2% to 39.7%). CONCLUSIONS Project YES! engaged AYA, improving VS in the pediatric clinic and internalized stigma in the pediatric and adult clinics. Further research is needed to understand the intersection of VS and internalized stigma among AYA attending adult HIV clinics. TRIAL REGISTRATION ClinicalTrials.gov NCT04115813.
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Affiliation(s)
- Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Virginia M. Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia
| | - Bareng A. S. Nonyane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Katherine G. Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth A. Abrams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Mahat G, Scoloveno MA. Effectiveness of Adolescent Peer Education Programs on Reducing HIV/STI Risk: An Integrated Review. Res Theory Nurs Pract 2019; 32:168-198. [PMID: 29792255 DOI: 10.1891/1541-6577.32.2.168] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is empirical evidence suggesting that peer education is efficacious in changing adolescent sexual risk behaviors; however, it is unclear if there are similarities in outcomes across studies. Thus, the purpose of this review was to synthesize published research on peer-led HIV/STI intervention programs for adolescents in an effort to determine the efficacy of peer education on knowledge, attitudes, normative beliefs, and sexual behavior. Data collection included online searches of published research from Index Medicus (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Educational Index, and PsycINFO (including PsycARTICLES) from 2000 to 2016. Twenty-four quantitative and six qualitative studies were included in the review. There appears to be evidence of the effectiveness of adolescent peer-led HIV education programs on knowledge, attitudes, normative beliefs, and self-efficacy. However, the studies reviewed were equivocal on changes in sexual behavior. The findings of the qualitative/process studies demonstrated perceived program efficacy among staff and peer educators. Peer educators and students placed a high value on peer-led programs. Mediators and/or covariates such as culture, gender, sexual experience, and age may impact findings of adolescent peer intervention studies; therefore, these factors need to be considered when implementing and evaluating peer education programs. Peer education should also focus on variables that were gleaned from qualitative studies, such as the role of the community and altruistic roles.
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van Brakel WH, Cataldo J, Grover S, Kohrt BA, Nyblade L, Stockton M, Wouters E, Yang LH. Out of the silos: identifying cross-cutting features of health-related stigma to advance measurement and intervention. BMC Med 2019; 17:13. [PMID: 30764817 PMCID: PMC6376667 DOI: 10.1186/s12916-018-1245-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many health conditions perceived to be contagious, dangerous or incurable, or resulting in clearly visible signs, share a common attribute - an association with stigma and discrimination. While the etiology of stigma may differ between conditions and, sometimes, cultural settings, the manifestations and psychosocial consequences of stigma and discrimination are remarkably similar. However, the vast majority of studies measuring stigma or addressing stigma through interventions employ a disease-specific approach. MAIN BODY The current paper opposes this siloed approach and advocates a generic concept of 'health-related stigma' in both stigma measurement and stigma interventions. Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, such as the Social Distance Scale, Explanatory Model Interview Catalogue, Internalized Stigma of Mental Illness, and Berger stigma scale, and stigma reduction interventions, such as information-based approaches, contact with affected persons, (peer) counselling, and skills building and empowerment, were used successfully across a variety of conditions to measure or address stigma. The results demonstrate that 'health-related stigma' is a viable concept with clearly identifiable characteristics that are similar across a variety of stigmatized health conditions in very diverse cultures. CONCLUSION A more generic approach to the study of health-related stigma opens up important practical opportunities - cross-cutting measurement and intervention tools are resource saving and easier to use for personnel working with multiple conditions, allow for comparison between conditions, and recognize the intersectionality of many types of stigma. Further research is needed to build additional evidence demonstrating the advantages and effectiveness of cross-condition approaches to stigma measurement and interventions.
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Affiliation(s)
| | - Janine Cataldo
- Department of Physiological Nursing, Center for Tobacco Control Research and Education, University of California San Francisco, 2 Koret Way, San Francisco, CA, 94143-0610, USA
| | | | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | | | - Melissa Stockton
- Epidemiology Department, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Edwin Wouters
- Centre for Longitudinal & Life Course Studies, University of Antwerp, Antwerp, Belgium.,Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Lawrence H Yang
- College of Global Public Health, New York University, New York, NY, USA.,Mailman School of Public Health, Columbia University, New York, NY, USA
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Kemp CG, Jarrett BA, Kwon CS, Song L, Jetté N, Sapag JC, Bass J, Murray L, Rao D, Baral S. Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review. BMC Med 2019; 17:6. [PMID: 30764820 PMCID: PMC6376798 DOI: 10.1186/s12916-018-1237-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to alleviate stigma are demonstrating effectiveness across a range of conditions, though few move beyond the pilot phase, especially in low- and middle-income countries (LMICs). Implementation science offers tools to study complex interventions, understand barriers to implementation, and generate evidence of affordability, scalability, and sustainability. Such evidence could be used to convince policy-makers and donors to invest in implementation. However, the utility of implementation research depends on its rigor and replicability. Our objectives were to systematically review implementation studies of health-related stigma reduction interventions in LMICs and critically assess the reporting of implementation outcomes and intervention descriptions. METHODS PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of stigma reduction interventions in LMICs reporting at least one implementation outcome. Study- and intervention-level characteristics were abstracted. The quality of reporting of implementation outcomes was assessed using a five-item rubric, and the comprehensiveness of intervention description and specification was assessed using the 12-item Template for Intervention Description and Replication (TIDieR). RESULTS A total of 35 eligible studies published between 2003 and 2017 were identified; of these, 20 (57%) used qualitative methods, 32 (91%) were type 1 hybrid effectiveness-implementation studies, and 29 (83%) were evaluations of once-off or pilot implementations. No studies adopted a formal theoretical framework for implementation research. Acceptability (20, 57%) and feasibility (14, 40%) were the most frequently reported implementation outcomes. The quality of reporting of implementation outcomes was low. The 35 studies evaluated 29 different interventions, of which 18 (62%) were implemented across sub-Saharan Africa, 20 (69%) focused on stigma related to HIV/AIDS, and 28 (97%) used information or education to reduce stigma. Intervention specification and description was uneven. CONCLUSION Implementation science could support the dissemination of stigma reduction interventions in LMICs, though usage to date has been limited. Theoretical frameworks and validated measures have not been used, key implementation outcomes like cost and sustainability have rarely been assessed, and intervention processes have not been presented in detail. Adapted frameworks, new measures, and increased LMIC-based implementation research capacity could promote the rigor of future stigma implementation research, helping the field deliver on the promise of stigma reduction interventions worldwide.
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Affiliation(s)
| | - Brooke A. Jarrett
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Lanxin Song
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Jaime C. Sapag
- Departments of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Office of Transformative Global Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Judith Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, MD USA
| | - Laura Murray
- Department of Mental Health, Johns Hopkins University, Baltimore, MD USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
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The effects of an educational program on knowledge, attitudes and intentions regarding condom and emergency contraceptive pill use among Thai female university students. JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.1108/jhr-05-2018-033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
University students who have low knowledge, attitudes and intentions regarding the prevention of unintended pregnancies may experience higher rates of unintended pregnancies. An educational program was developed based on the self-efficacy theory and peer-led education to improve unintended pregnancy problems among university students. The purpose of this paper is to examine the effect of an educational program on knowledge, attitudes and intentions regarding the use of condoms and emergency contraceptive pills among Thai university students.
Design/methodology/approach
The effectiveness of the educational program was tested by a quasi-experimental study with a pre- and post-test design. The study was conducted between September and October 2017. Multistage sampling was used to recruit 73 Thai female university students, including 36 students in the intervention group and 37 students in the comparison group. The intervention group received an eight-week educational program, while the comparison group did not. A self-administered questionnaire was used to assess the improvement of knowledge, attitudes and intention regarding condom and emergency contraceptive pill use. Descriptive statistics, paired samples t-test, Wilcoxon test and Mann–Whitney tests were used for data analysis.
Findings
Most participants in both groups had sexual intercourse. After the end of the program, the before-after mean score of the intervention group’s knowledge (8.0, 11.0), attitudes (29.4, 32.4) and intention (17.4, 20.4) were significantly increased (p-value<0.001). Post-intervention, there were statistically significant differences in knowledge scores (p-value<0.001) and intention scores (p-value=0.04) between the intervention group and the comparison group.
Originality/value
This educational program increases knowledge and intention but does not influence attitudes toward using condoms and emergency contraceptive pills.
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Closson K, Dietrich JJ, Lachowsky NJ, Nkala B, Palmer A, Cui Z, Beksinska M, Smit JA, Hogg RS, Gray G, Miller CL, Kaida A. Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa. JOURNAL OF SEX RESEARCH 2018; 55:522-539. [PMID: 29466024 DOI: 10.1080/00224499.2017.1421607] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual self-efficacy (SSE), one's perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.
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Affiliation(s)
- Kalysha Closson
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Janan J Dietrich
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Nathan J Lachowsky
- b British Columbia Centre for Excellence in HIV/AIDS
- d School of Public Health and Social Policy , University of Victoria
| | - Busiwe Nkala
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
- e Faculty of Humanities , University of the Witwatersrand
| | - Alexis Palmer
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Mags Beksinska
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Jennifer A Smit
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Robert S Hogg
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Glenda Gray
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Cari L Miller
- a Faculty of Health Sciences , Simon Fraser University
| | - Angela Kaida
- a Faculty of Health Sciences , Simon Fraser University
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Busza J, Simms V, Dziva Chikwari C, Dauya E, Bandason T, Makamba M, McHugh G, Ferrand RA. "It is not possible to go inside and have a discussion": how fear of stigma affects delivery of community-based support for children's HIV care. AIDS Care 2018; 30:903-909. [PMID: 29494218 PMCID: PMC5964455 DOI: 10.1080/09540121.2018.1445826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Caregivers mediate children's access to HIV care and their adherence to treatment. Support for caregivers may improve health outcomes in children, but fear of HIV stigma and discrimination can affect both uptake and delivery of support services. Within a trial evaluating community-based support for caregivers of newly HIV diagnosed children in Harare, Zimbabwe, we conducted a longitudinal qualitative study to explore how stigma affected delivery and acceptance of the intervention. We conducted semi-structured interviews with 36 caregivers, 15 children, and 20 community health workers (CHWs). Children and caregivers described experiencing or witnessing stigma and discrimination, causing some to resist home visits by CHWs. Anxiety around stigma made it difficult for CHWs to promote key messages. In response, CHWs adapted the intervention by meeting caregivers outside the home, pretending to be friends or relatives, and proactively counteracting stigmatising beliefs. As members of local communities, some CHWs shared concerns about discrimination. HIV stigma can hinder "getting a foot over the threshold" in community-based programmes, particularly for households most affected by discrimination and thus least likely to engage with services. For community support programmes to be effective, stigma-related resistance should be addressed from the outset, including CHWs' own concerns regarding HIV stigma.
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Affiliation(s)
- Joanna Busza
- a Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK
| | - Victoria Simms
- b Department of Infectious Disease Epidemiology , London School of Hygiene & Tropical Medicine , London , UK
| | - Chido Dziva Chikwari
- c Biomedical Research and Training Institute , Harare , Zimbabwe.,d Department of Clinical Research , London School of Hygiene & Tropical Medicine , London , UK
| | - Ethel Dauya
- c Biomedical Research and Training Institute , Harare , Zimbabwe
| | - Tsitsi Bandason
- c Biomedical Research and Training Institute , Harare , Zimbabwe
| | | | - Grace McHugh
- c Biomedical Research and Training Institute , Harare , Zimbabwe
| | - Rashida Abbas Ferrand
- c Biomedical Research and Training Institute , Harare , Zimbabwe.,d Department of Clinical Research , London School of Hygiene & Tropical Medicine , London , UK
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Butts SA, Kayukwa A, Langlie J, Rodriguez VJ, Alcaide ML, Chitalu N, Weiss SM, Jones DL. HIV Knowledge and Risk among Zambian Adolescent and Younger Adolescent Girls: Challenges and Solutions. SEX EDUCATION 2018; 18:1-13. [PMID: 31275062 PMCID: PMC6606053 DOI: 10.1080/14681811.2017.1370368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In sub-Saharan Africa, young women are at the highest risk of HIV infection. Comprehensive sexuality education (CSE) and open parent-child communication about sex have been shown mitigate risky sexual practices associated with HIV. This study aimed to identify sources of HIV prevention knowledge among young women aged 10-14 years and community-based strategies to enhance HIV prevention in Zambia. Focus group discussions were conducted with 114 young women in Zambian provinces with the highest rates (~20%) of HIV. Discussions were recorded, transcribed and coded, and addressed perceived HIV risk, knowledge and access to information. Participants reported that limited school-based sexuality education reduced the potential to gain HIV prevention knowledge, and that cultural and traditional practices promoted negative attitudes regarding condom use. Parent-child communication about sex was perceived to be limited; parents were described as feeling it improper to discuss sex with their children. Initiatives to increase comprehensive sexuality education and stimulate parental communication about sexual behavior were suggested by participants. Culturally tailored programmes aiming to increase parent-child communication appear warranted. Community-based strategies aimed at enhancing protective sexual behaviour among those most at risk are essential.
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Affiliation(s)
| | | | - Jake Langlie
- Miller School of Medicine University of Miami, Florida, USA
| | | | | | - Ndashi Chitalu
- School of Medicine, University of Zambia, Lusaka, Zambia
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16
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Sun WH, Miu HYH, Wong CKH, Tucker JD, Wong WCW. Assessing Participation and Effectiveness of the Peer-Led Approach in Youth Sexual Health Education: Systematic Review and Meta-Analysis in More Developed Countries. JOURNAL OF SEX RESEARCH 2018; 55:31-44. [PMID: 27898248 DOI: 10.1080/00224499.2016.1247779] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in more developed countries (MDCs). Electronic and manual searches across five social science, education, and medical databases were conducted. Fifteen articles were selected in total. Most (10 of 15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13 of 14) and attitudes (11 of 15) at postintervention stages. Two studies showed improved self-efficacy, and three showed behavioral changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges' g = 0.84, 95% confidence interval [CI]: 0.43 to 1.25) and a medium effect on attitude change (Hedges' g = 0.49, 95% CI: 0.19 to 0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitudes but not behaviors. Further research and action are needed to understand optimal implementation.
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Affiliation(s)
- Wai Han Sun
- a Department of Family Medicine and Primary Care , The University of Hong Kong
| | - Heidi Yin Hai Miu
- a Department of Family Medicine and Primary Care , The University of Hong Kong
| | - Carlos King Ho Wong
- a Department of Family Medicine and Primary Care , The University of Hong Kong
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17
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Sani AS, Abraham C, Denford S, Ball S. School-based sexual health education interventions to prevent STI/HIV in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2016; 16:1069. [PMID: 27724886 PMCID: PMC5057258 DOI: 10.1186/s12889-016-3715-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background School-based sexual health education has the potential to provide an inclusive and comprehensive approach to promoting sexual health among young people. We reviewed evaluations of school-based sexual health education interventions in sub-Saharan Africa to assess effectiveness in reducing sexually transmitted infections and promoting condom use. Methods We searched ten electronic databases, hand-searched key journals, and reference lists of included articles for potential studies. Data were extracted on outcomes, intervention characteristics, methods and study characteristics indicative of methodological quality. Where possible, data were synthesized using random effect meta-analysis. Intervention features found predominantly in effective interventions were noted. Results The initial search retrieved 21634 potentially relevant citations. Of these, 51 papers reporting on 31 interventions were included. No evaluation reported statistically significant effects on the incidence or prevalence of Human Immunodeficiency Virus and Herpes Simplex Virus 2 infections. However, intervention participants reported statistically significant greater condom use in both randomised controlled trials and non-randomised trials for short (less than 6 months) follow-up periods (OR = 1.62, 95 % CI = 1.03–2.55 and OR = 2.88, 95 % CI = 1.41–5.90 respectively). For intermediate (6–10 months) and long-term (more than 10 months) follow-up periods, the effect was statistically significant (OR = 1.40, 95 % CI = 1.16–1.68) and marginally significant (OR = 1.22, 95 % CI = 0.99–1.50) among the randomised trials respectively. Only 12 of the 31 interventions reported implementation details, out of which seven reported on fidelity. Conclusion School-based sexual health education has the potential to promote condom use among young people in sub-Saharan Africa. However, further work is needed to develop and evaluate interventions that have measurable effects on sexually transmitted infections. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3715-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Sadiq Sani
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK.
| | - Charles Abraham
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK
| | - Sarah Denford
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK
| | - Susan Ball
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2 LU, UK
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18
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Brown LD, Redelfs AH, Taylor TJ, Messer RL. Comparing the Functioning of Youth and Adult Partnerships for Health Promotion. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2015; 56:25-35. [PMID: 26066568 PMCID: PMC4620943 DOI: 10.1007/s10464-015-9730-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Youth partnerships are a promising but understudied strategy for prevention and health promotion. Specifically, little is known about how the functioning of youth partnerships differs from that of adult partnerships. Accordingly, this study compared the functioning of youth partnerships with that of adult partnerships. Several aspects of partnership functioning, including leadership, task focus, cohesion, participation costs and benefits, and community support, were examined. Standardized partnership functioning surveys were administered to participants in three smoke-free youth coalitions (n = 44; 45 % female; 43 % non-Hispanic white; mean age = 13) and in 53 Communities That Care adult coalitions (n = 673; 69 % female; 88 % non-Hispanic white; mean age = 49). Multilevel regression analyses showed that most aspects of partnership functioning did not differ significantly between youth and adult partnerships. These findings are encouraging given the success of the adult partnerships in reducing community-level rates of substance use and delinquency. Although youth partnership functioning appears to be strong enough to support effective prevention strategies, youth partnerships faced substantially more participation difficulties than adult partnerships. Strategies that youth partnerships can use to manage these challenges, such as creative scheduling and increasing opportunities for youth to help others directly, are discussed.
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Affiliation(s)
- Louis D Brown
- The University of Texas Health Science Center at Houston School of Public Health, 1101 N. Campbell, Room 409, El Paso, TX, 79902, USA,
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FAMILIES' RESPONSE TO AIDS: NEW INSIGHTS INTO PARENTAL ROLES IN FOSTERING HIV/AIDS KNOWLEDGE. J Biosoc Sci 2014; 47:762-79. [PMID: 25268460 DOI: 10.1017/s0021932014000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Worldwide, there is a consensus that parents must be involved in children's HIV/AIDS education. However, there is little evidence that speaks to this advocacy for improving adolescent health. This study developed and tested four hypotheses about (i) the relationship between parents' and adolescents' knowledge of HIV/AIDS transmission routes and prevention strategies conditional upon (ii) parents' gender, (iii) communication about sexuality, and (iv) the parent-adolescent education gap. The sample consisted of 306 parent-adolescent dyads from the 2002 Cameroon Family and Health Survey. Adolescents were aged 12-19 years. Overall, fifteen items about HIV/AIDS transmission routes and prevention strategies were analysed. Descriptive results showed that parents fared better than adolescents regardless of the AIDS fact considered. An exception was the correct use of condoms (parents 57% vs adolescents 61%). The generation gap probably explains this result: parents are more conservative, reluctant and distant from condoms compared with adolescents, who are more receptive and open to discussing sex with peers. Multivariate ordered logistic regressions showed a significant positive effect of parents' HIV/AIDS knowledge on adolescents' HIV/AIDS knowledge, thus supporting the main hypothesis of direct parental influences. Parent-adolescent communication about sexuality showed positive and significant effects on adolescents' HIV/AIDS knowledge, suggesting an 'enhancing effect' when combined with the effect of parents' HIV/AIDS knowledge. Against the background that parents in sub-Saharan Africa do not teach their children about sexuality, the study demonstrated that families can play an important role in HIV/AIDS education. These findings have major implications for HIV/AIDS interventions involving adolescents, parents or both, in fostering accurate HIV/AIDS knowledge among adolescents, which could lead to protective sexual behaviours.
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Bulanda JJ, Bruhn C, Byro-Johnson T, Zentmyer M. Addressing mental health stigma among young adolescents: evaluation of a youth-led approach. HEALTH & SOCIAL WORK 2014; 39:73-80. [PMID: 24946423 DOI: 10.1093/hsw/hlu008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Stigma around mental illness puts adolescents at risk for not seeking help for themselves or helping peers dealing with mental distress. This program evaluation looks at a youth-led mental health awareness promotion campaign, in which high school students led educational workshops for at-risk middle school students in an after-school program. Pre- and posttests were used to measure knowledge about mental illness as well as social distance; a total of 57 pre- and posttests were analyzed. Analyses revealed statistically significant changes in both the Knowledge and Social Distance scales. The results suggest that salutary results can be realized as a result of very brief intervention with youths around the topic of mental health awareness.
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Beck EJ, Fasawe O, Ongpin P, Ghys P, Avilla C, De Lay P. Costs and cost-effectiveness of HIV community services: quantity and quality of studies published 1986-2011. Expert Rev Pharmacoecon Outcomes Res 2014; 13:293-311. [PMID: 23763528 DOI: 10.1586/erp.13.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Community services comprise an important part of a country's HIV response. English language cost and cost-effectiveness studies of HIV community services published between 1986 and 2011 were reviewed but only 74 suitable studies were identified, 66% of which were performed in five countries. Mean study scores by continent varied from 42 to 69% of the maximum score, reflecting variation in topics covered and the quality of coverage: 38% of studies covered key and 11% other vulnerable populations - a country's response is most effective and efficient if these populations are identified given they are key to a successful response. Unit costs were estimated using different costing methods and outcomes. Community services will need to routinely collect and analyze information on their use, cost, outcome and impact using standardized costing methods and outcomes. Cost estimates need to be disaggregated into relevant cost items and stratified by severity and existing comorbidities. Expenditure tracking and costing of services are complementary aspects of the health sector 'resource cycle' that feed into a country's investment framework and the development and implementation of national strategic plans.
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Affiliation(s)
- Eduard J Beck
- Office of the Deputy Executive Director, Programme Branch, UNAIDS Secretariat, 20 Avenue Appia, Geneva, Switzerland.
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Thin Zaw PP, Liabsuetrakul T, McNeil E, Htay TT. Gender differences in exposure to SRH information and risky sexual debut among poor Myanmar youths. BMC Public Health 2013; 13:1122. [PMID: 24304552 PMCID: PMC4235033 DOI: 10.1186/1471-2458-13-1122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 11/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, the proportion of youths has been steadily increasing, especially in Asia. This vulnerable population has limited exposure to sexual and reproductive health (SRH) information leading to various reproductive health (RH) problems including risky sexual debut, unwanted pregnancy, unsafe abortion as well as STI/HIV infections. Among known social variations which influence youth's RH, gender differences are critical for planning necessary gender appropriate interventions. This study aimed to identify gender differences in exposure to SRH information and risky sexual debut as well as associated factors among Myanmar youths in poor suburban communities of Mandalay City. METHODS A total of 444 randomly selected youths (aged 15-24 years) from all poor, suburban communities in Mandalay City took part in our survey. Gender differences in exposure to SRH information and risky sexual debut were assessed by bivariate analysis. Multivariate logistic regression was used to confirm gender differences and identify independent factors associated with main outcomes separately for males and females as well as for both. RESULTS Of 444 youths interviewed, 215 were males and 229 were females. Gender differences were seen in both exposures to SRH information (p = 0.013) and risky sexual debut (p = 0.003). These gender differences were confirmed by multivariate analysis even after adjusting for other risk factors. For exposure to SRH information, only age group and schooling status were significant factors for females. As well as those two factors, media exposure and parental guardianship were significant factors among males. Only positive norm of premarital sex increased the likelihood of risky sexual debut among males. In contrast, unwillingness at sexual debut was a risk factor and a higher education level was a protective factor for risky sexual debut among females. CONCLUSIONS Limited exposure to SRH information and high risky sexual debut among poor youths were found. There were different influential factors for RH behaviors between males and females. Policy makers as well as local RH care providers should be aware of these differences. Dissemination of reliable SRH information among youths through possible mass media, especially among males, is an urgent issue.
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Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc 2013; 16:18734. [PMID: 24242268 PMCID: PMC3833106 DOI: 10.7448/ias.16.3.18734] [Citation(s) in RCA: 446] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/23/2013] [Accepted: 08/29/2013] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION HIV-related stigma and discrimination continue to hamper efforts to prevent new infections and engage people in HIV treatment, care and support programmes. The identification of effective interventions to reduce stigma and discrimination that can be integrated into national responses is crucial to the success of the global AIDS response. METHODS We conducted a systematic review of studies and reports that assessed the effectiveness of interventions to reduce HIV stigma and discrimination between 1 January 2002 and 1 March 2013. Databases searched for peer-reviewed articles included PubMed, Scopus, EBSCO Host -CINAHL Plus, Psycinfo, Ovid, Sociofile and Popline. Reports were obtained from the www.HIVAIDSClearinghouse.eu, USAID Development Experience Clearinghouse, UNESCO HIV and AIDS Education Clearinghouse, Google, WHO and UNAIDS. Ancestry searches for articles included in the systematic review were also conducted. Studies of any design that sought to reduce stigma as a primary or secondary objective and included pre- and post-intervention measures of stigma were included. RESULTS Of 2368 peer-reviewed articles and reports identified, 48 were included in our review representing 14 different target populations in 28 countries. The majority of interventions utilized two or more strategies to reduce stigma and discrimination, and ten included structural or biomedical components. However, most interventions targeted a single socio-ecological level and a single domain of stigma. Outcome measures lacked uniformity and validity, making both interpretation and comparison of study results difficult. While the majority of studies were effective at reducing the aspects of stigma they measured, none assessed the influence of stigma or discrimination reduction on HIV-related health outcomes. CONCLUSIONS Our review revealed considerable progress in the stigma-reduction field. However, critical challenges and gaps remain which are impeding the identification of effective stigma-reduction strategies that can be implemented by national governments on a larger scale. The development, validation, and consistent use of globally relevant scales of stigma and discrimination are a critical next step for advancing the field of research in this area. Studies comparing the effectiveness of different stigma-reduction strategies and studies assessing the influence of stigma reduction on key behavioural and biomedical outcomes are also needed to maximize biomedical prevention efforts.
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Affiliation(s)
- Anne L Stangl
- Department of Global Health, International Center for Research on Women, Washington, DC, USA;
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