Accelerating reductions in HIV-risk for adolescents and young people in Namibia: A cross-sectional study.
1. Abstracts based on Formal Research WorkLucas Hertzog3, William Rudgard1, Elona Toska4, Lucie Cluver1, 5
1 Centre for Evidence-Based Intervention, University of Oxford
2 Green Templeton College, University of Oxford
3 School of Population Health, Curtin University
4 Centre for Social Science Research, University of Cape Town
5 Department of Psychiatry and Mental Health, University of Cape Town
Abstract
BACKGROUND: This study aimed to identify context-specific development accelerators (protective factors whose provision contributes toward achieving multiple SDG targets or goals) for adolescents and young people in Namibia. Intervening on these development accelerators is hypothesised to be highly cost-effective and impactful by concurrently reducing multiple pathways of vulnerability to HIV infection.
METHODS: Using nationally representative data from the 2019 Namibia Violence Against Children Survey (n=5167), three hypothesised accelerators (gender-equitable attitudes, parenting support, and food security) were investigated for their impact on 18 outcomes, including violence victimisation, sexual-risk behaviours, substance use, mental health, and education. Associations between the hypothesised accelerators and outcomes (all measured as in the previous 12 months or 30 days, except for lifetime child marriage) were assessed using logistic regressions, and adjusted probabilities were estimated using marginal effects modelling. All analyses were stratified by sex, included sociodemographic covariates, and were adjusted for multiple hypothesis testing using Anderson’s sharpened q-values.
RESULTS: Among girls, food security, gender-equitable attitudes, and parenting support qualified as accelerators, being associated with 8, 5, and 3 improved outcomes, respectively, and in combination, were associated with 10/18 improved outcomes. Combined provision was associated with >75% reductions in the prevalence of child marriage (p=0.015), early sexual debut (p=0.012), and tobacco use (p=0.009); >50% reductions in peer violence (p=0.005) and child abuse (p=0.008); >25% reductions in sexual violence (p=0.002), mental distress (p=0.013), and not completing primary school (p=0.006); and >10% reductions in not being enrolled in school or in paid work (p<0.001) and inconsistent condom use and not knowing HIV status (p=0.005). For example, food security was associated with reductions in early sexual debut (before age 16) from 8.1% prevalence to 1.3%.
Among boys, gender-equitable attitudes was an accelerator, being associated with 5 improved outcomes, including 50% reductions in multiple sexual partners (p<0.001), intimate partner violence (p=0.002), age-disparate or transactional sex (p=0.02), peer violence (physical or emotional) (p<0.001), and child abuse (physical or emotional) (p=0.001). For example, gender-equitable attitudes was associated with a reduction in multiple sexual partners from 18.6% prevalence to 9.6% and a reduction in age-disparate or transactional sex from 9.0% to 4.2%.
Synergies were noted for outcomes associated with multiple accelerators, which included four outcomes among girls (child abuse, child marriage, mental distress, and tobacco use). For example, the prevalence of child abuse among girls with no accelerators (30.5%) reduces to 14.4% from food security alone, to 20.5% from parenting support alone, or to 22.3% from gender-equitable attitudes alone, but in combination reduce the prevalence to 9.6%.
CONCLUSION: Implementation of gender-transformative social protection interventions via food security may contribute to advances in reducing multiple risk factors for contracting HIV among girls; further gains could be made by also implementing interventions for parenting support. Boys may also benefit from gender-transformative programming.