Associations of social media use and informal m-Health use with sexual risk among adolescents in South Africa
1. Abstracts based on Formal Research WorkElona Toska1, 2, 3, Brendan Maughan-Brown4, William Rudgard3, Lucas Hertzorg1, Janina Jochim3, Alice Armstrong5, Lucie Cluver3, 6
1 Centre for Social Science Research, University of Cape Town, South Africa
2 Department of Sociology, University of Cape Town, South Africa
3 Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
4 Southern Africa Labour and Development Research Unit, University of Cape Town, South Africa
5 UNICEF Eastern and Southern Africa Region, Nairobi, Kenya
6 Department of Psychiatry, University of Cape Town, Cape Town, South Africa
Abstract
Background Increasing rates of mobile phone ownership and use present potential new opportunities and risks for adolescents’ sexual and reproductive health in resource-poor settings. We investigated associations of ownership and use of mobile phones with sexual risk in a cohort of HIV-positive and negative adolescents in South Africa.
Methods 1563 adolescents (69% living with HIV) were interviewed in three waves between 2014 and 2018. We assessed mobile ownership and use to search for health content (e.g., information related to sexual health or HIV, herein referred to as informal m-Health) and for social media (e.g., SMS, Facebook, Mixit, or WhatsApp). Self-reported sexual risk behaviours included: sex after substance use, unprotected sex, multiple sexual partnerships, and inequitable sexual partnerships (sex in exchange for material support or sexual partners at least five years older than participant) in the past 12 months. We examined associations between mobile phone ownership/ use and sexual risk behaviours using covariate-adjusted multivariable mixed-effects logistic regression models.
Findings Mobile ownership alone was not associated with any sexual risk behaviours. Social media use alone (vs. no mobile ownership) was associated with increased probability of unprotected sex (adjusted average marginal effects [AMEs] +4.7 percentage points, 95% CI 1.5 to 7.8, p=0.003). However, informal m-Health (vs. no mobile ownership) was associated with decreased probability of sex after substance use (AMEs –5.4 percentage points, 95% CI –7.4 to –3.3, p<0.001) and unprotected sex (AMEs –7.5 percentage points, 95% CI –10.7 to –4.4, p<0.001). Moderation analyses showed that boys owning mobile phones reported more risk than girls, and that social media use alone was associated with higher sexual risk for adolescents living with HIV.
Interpretation In this study, social media use alone was associated with increased sexual risk behaviours, but accessing sexual and reproductive health-focused digital information may bring important opportunities for reduced adolescent sexual risks. However, almost all adolescents accessed social media, while less than 25% of adolescents accessed health information on their phones. This suggests an urgent need for strategies to harness mobile phone use for protection from growing risks due to social media exposure.