Delaying sexual debut amongst out-of-school youth in rural southwest Uganda

This paper focuses on ‘sexual debut’ among out-of-school youth in Masaka District, Uganda, factors influencing its timing and assistance young people feel they need to delay sexual initiation. Data were drawn from a sexual health needs assessment using applied anthropological techniques with young people aged 13–19 years. Parents, guardians and community leaders were also consulted. All participants felt that young people begin their sexual lives too early. Young men feel under pressure from friends and older men to prove their masculinity. Most delay further activity after debut and want assistance to resist the pressure. Young women's debut after physical maturation prompts ‘pestering’ for sex from boys and men who offer gifts. After debut, young women remain sexually active but believe younger women need assistance to resist pressure. Programmes are needed to help young people achieve these goals. Structurally, the community needs to develop means of preventing men from pestering young women for sex and of redeveloping both the social role and pathway to marriage for young women who are marrying later than is traditional.     

Sexual initiation among adolescent girls and boys: trends and differentials in sub-Saharan Africa

This paper examined trends in adolescent sexual initiation in sub-Saharan Africa, with emphasis on differentials in social determinants across gender and contexts. Data were drawn from Demographic and Health Surveys in 8 countries that had at least 2 surveys conducted approximately 5 years apart, each with distinct questionnaires for women and men of reproductive age regardless of marital status. The data were useful both for testing of substantive hypotheses about the correlates of adolescent sexual intercourse as well as for elaborating sexual health interventions in contexts of development. The main analytical tool was multivariate logistic models using a generalized estimating equation to consider the probability of a young man or young woman having first intercourse during adolescence. In some countries, observed declines over time in the proportion of adolescents having had sex were not statistically significant after taking into account changes in background characteristics, especially education. Important gender differentials were also found. While secondary schooling was associated with lower probability of early sex among girls in all countries, the relationship was often in the opposite direction among boys. Influences of other sociodemographic and community status variables were generally less important.     

Unwanted sexual experiences among young men in four sub-Saharan African countries: prevalence and context

Unwanted sexual experiences are most frequently examined from the woman's perspective, yet these experiences happen to men as well. Part of the reason for the paucity of studies on coerced sexual experiences among men is the difficulty in gathering information about such experiences. This study examines the prevalence of unwanted sexual experiences at sexual debut as well as ever among young men aged 12–19 years old in Burkina Faso, Ghana, Malawi and Uganda. The data come from nationally-representative surveys and in-depth interviews with approximately 50 young men in each country gathered around 2004. Between 4 and 12% of young men stated that they were ‘not willing at all’ at sexual debut and between 3 and 6% said that they had ever experienced unwanted sex. Narratives from in-depth interviews give insights into the context surrounding men's unwanted sexual experiences. The sometimes conflicting information provided by the respondents serve to confound rather than illuminate the contexts within which these unwanted sexual experiences occurred, demonstrating that coercion for young men looks extremely different than coercion for young women, spurring us to improve our measures of sexual coercion among men.     

妊娠少女性自我概念中介效应模型分析

目的 了解妊娠少女的性知识、性态度、性行为及性自我概念现状及其影响因素。方法 选取江苏省昆山市公立医院的245名妊娠少女为调查对象, 采用妊娠少女性知识、性态度、性行为及性自我概念4个量表进行测量。结果 妊娠少女性知识、态度、行为及自我概念得分分别为(3.29±0.43)、(2.66±0.49)、(2.66±0.49)、(2.93±0.46)分, 其中性态度与性自我概念得分相对较低;不同学历、父母婚姻关系及亲子关系对妊娠少女性知识得分影响差异有统计学意义(F_学历=6.97, P<0.01;F_{父母婚姻关系}=9.36, P<0.001;F_亲子关系=5.46., P<0.01), 不同父母婚姻关系对妊娠少女性态度得分(F_{父母婚姻关系}=4.79, P<0.01)、性行为得分(F_{父母婚姻关系}=7.22, P<0.05)影响差异有统计学意义, 不同亲子关系对性态度得分有影响(F_亲子关系=3.83, P<0.05), 不同学历对自我概念得分有影响(F_学历=10.033, P<0.001);妊娠少女性知识(β=0.44, P<0.001)与性态度(β=0.62, P<0.001)能直接预测性自我概念, 并经由性行为(β=1.29, P <0.001)间接影响妊娠少女的性自我概念。结论 妊娠少女整体情况堪忧, 家庭因素及受教育状况是影响少女妊娠的重要因素。     

Mobility among youth in Rakai,Uganda: Trends,characteristics, and associations with behavioural risk factors for HIV

Mobility, including migration and travel, influences risk of HIV. This study examined time trends and characteristics among mobile youth (15–24 years) in rural Uganda, and the relationship between mobility and risk factors for HIV. We used data from an annual household census and population-based cohort study in the Rakai district, Uganda. Data on in-migration and out-migration were collected among youth (15–24 years) from 43 communities from 1999 to 2011 (N?=?112,117 observations) and travel among youth residents from 2003 to 2008 (N?=?18,318 observations). Migration and travel were more common among young women than young men. One in five youth reported out-migration. Over time, out-migration increased among youth and in-migration remained largely stable. Primary reasons for migration included work, living with friends or family, and marriage. Recent travel within Uganda was common and increased slightly over time in teen women (15–19 years old), and young adult men and women (20–24 years old). Mobile youth were more likely to report HIV-risk behaviours including: alcohol use, sexual experience, multiple partners, and inconsistent condom use. Our findings suggest that among rural Ugandan youth, mobility is increasingly common and associated with HIV-risk factors. Knowledge of patterns and characteristics of a young, high-risk mobile population has important implications for HIV interventions.     

Families matter: Social relationships and adolescent HIV testing behaviors in Ndola,Zambia

A cross-sectional survey among 550 randomly selected 16–19-year-olds in Ndola, Zambia, assessed the influence of individual (e.g., HIV knowledge), relational (e.g., discussed HIV testing with family), and environmental factors (e.g., distance) on adolescents’ use of HIV counseling and testing. A multivariable logistic regression analysis comparing respondents who have taken an HIV test to respondents who have not found that at the relational level believing that one’s family would not be upset if the youth has taken an HIV test (adjusted odds ratio [AOR] = 5.08; 95% confidence interval [CI] = 1.16–22.35); and having discussed with a family member whether or not to take an HIV test (AOR = 3.51; 95% CI = 1.08–11.47) were significantly related to adolescent testing. At the individual-level, having ever had sex (AOR = 6.43; 95% CI = 2.14–19.30) and being out-of-school (AOR = 2.95; 95% CI = 1.32–6.59) were also strongly associated with HIV testing. Environmental measures were not found to be significantly related to HIV testing. These findings support the need to examine not only individual characteristics but also relational level factors, particularly the role of families, when implementing and evaluating adolescent HIV testing strategies. Programs to increase communication about HIV testing and counseling within families should be tested in a prospective design in order to assess the impact on young people’s decisions to learn their HIV status and subsequent health seeking and protective behaviors.     

上海市女童青春期性发育指标年龄特征的流行病学研究

目的 了解目前上海市女童青春期各种性发育指标的年龄特征,分析其变化趋势,以进一步完善我国女性儿童青少年性发育评估体系。方法 采用分层整群抽样方法选取上海市中小学女生共1 675名,对乳房和第二性征发育水平进行Tanner分期评估,并记录月经初潮情况,概率单位回归法计算各种性发育指标的百分位年龄。结果 乳房达到TannerⅡ~Ⅴ期的中位年龄分别为8.26、10.62、12.88岁和16.64岁,阴毛达到TannerⅡ~Ⅴ期的中位年龄分别为11.48、12.71、15.23岁和19.07岁,腋毛开始发育和月经初潮的中位年龄分别为11.71岁和12.09岁。 结论 相对于同时期的其他国家,上海市女童的乳房发育较早,阴毛发育相对较晚,整个青春期性发育进程较为缓慢;长期趋势上,月经初潮年龄的再提前现象有待进一步观察。     

Retracted: Determinants of project success among HIV/AIDS nongovernmental organizations (NGOs) in Rakai,Uganda

The aim of the study was to identify the main determinants of grassroots project success among HIV/AIDS NGOs operating in Rakai, Uganda. It was a cross‐sectional study using face‐to‐face interviews in a mixed‐methods approach among community members and NGOs involved in providing HIV/AIDS and related health services. The study found that the success of grassroots projects of HIV/AIDS NGOs essentially relies on adequate financial resources, competent human resources, strong organizational leadership, and NGO networking. These data suggest that to increase grassroots project success, HIV and AIDS NGOs in Rakai need to improve not only the budget base and human capacities but as well decision‐making processes, organizational vision, mission and strategies, gender allocation in staffing, and beneficiary involvement. Copyright © 2010 John Wiley & Sons, Ltd.     

Immunogenicity of bivalent HPV vaccine among partially vaccinated young adolescent girls in Uganda

Background

Investigations of vaccine efficacy and immunogenicity for adult females receiving fewer than three doses of human papillomavirus (HPV) vaccine have suggested protection against infection and precancerous lesions. We investigated the immunogenicity of bivalent HPV vaccines among adolescent girls from Uganda who received one, two, or three vaccine doses.

Methods

Young girls vaccinated through a government program in Uganda were invited to participate. HPV16- and HPV18-specific antibodies were measured at ≥24 months after the last vaccine dose using an enzyme linked immunoassay in girls who received one (n = 36), two (n = 145), or three (n = 195) doses.

Results

Nearly all subjects (99%) were HPV16 and HPV18 seropositive at the time of blood-draw. Geometric mean antibody levels (GMTs) were: HPV16_1-dose = 230 EU/mL, HPV16_2-dose = 808 EU/mL, and HPV16_3-dose = 1607 EU/mL; HPV18_1-dose = 87 EU/mL, HPV18_2-dose = 270 EU/mL, and HPV18_3-dose = 296 EU/mL. The GMT ratio for 2:3 doses was 0.50 (HPV16) and 0.68 (HPV18) and did not meet the non-inferiority criteria (i.e., lower bound of 97.5% confidence interval of the GMT ratio greater than 0.50). The GMT ratio for 1:3 doses for HPV16 and HPV18 was inferior, but absolute GMTs for one dose were higher than adult women who received one dose (HPV16 = 124 EU/mL, HPV18 = 69 EU/mL) where efficacy has been demonstrated.

Conclusions

Even though immunogenicity with less than three doses did not meet a priori non-inferiority thresholds, antibody levels measured ≥24 months after last dose were similar to those of adult women who have been followed for more than eight years for efficacy.     

Sex-related alcohol expectancies and high-risk sexual behaviour among drinking adults in Kampala,Uganda

Alcohol consumption, a risk factor for HIV transmission in sub-Saharan Africa, is considered high in Uganda. A cross sectional study was conducted to determine whether sex-related expectations about the effects of alcohol explain the association between alcohol use and risky sexual behaviours in a population-based sample of adults in Kampala. Associations between alcohol use (current and higher risk drinking) and high-risk sexual behaviours (multiple regular partners and casual sex) were tested. In age–sex-adjusted models, having multiple regular partners was associated with current drinking (odds ratio [OR] = 2.76, 95% confidence intervals [CIs] = 1.15, 6.63) and higher risk drinking (OR = 3.35, 95% CI = 1.28, 8.71). Associations were similar but not statistically significant for having a causal sex partner. Sex-related alcohol outcome expectancy was associated with both alcohol use and high-risk sexual behaviour and attenuated relationships between multiple regular partners and both current drinking (OR = 1.94, 95% CI = 0.57, 6.73) and higher risk drinking (OR = 2.44, 95% CI = 0.68, 8.80). In this setting sexual behaviours related with alcohol consumption were explained, in part, by sex-related expectations about the effects of alcohol. These expectations could be an important component to target in HIV education campaigns.     

Family structure and sexual and reproductive health outcomes among adolescents in rural Sierra Leone

Orphanhood is common in sub-Saharan Africa, and is a critical issue shaping global assistance for children. Care arrangements for children are often fluid, and many ‘orphaned’ children have a surviving biological parent. This study examines the protective effects of family-level factors on early sex and pregnancy in rural Sierra Leone. A survey of 530 adolescents in 2 districts in Sierra Leone was analysed to evaluate associations between living arrangement and orphanhood on recent sexual activity and pregnancies out of wedlock. After controlling for confounders, living with one's mother (AOR = 0.46, 95% CI: 0.22–1.00) and living with both parents (AOR = 0.36, 95% CI: 0.17–0.73) were protective against recent sexual activity. Orphan status was not significantly associated with recent sexual activity. Among 164 sexually active adolescents, neither living arrangement nor orphanhood was associated with pregnancy. This study demonstrates the protective effect of living with a surviving biological parent to delay early sexual debut. Once an adolescent becomes sexually active; however, living arrangement is not associated with the risk of pregnancy out of wedlock. The findings suggest that supporting family connectedness and preventing unnecessary family separation may benefit at least some aspects of adolescent sexual and reproductive health in Sierra Leone.     

贵州兴义农村在校儿童性与生殖健康知识及行为调查

目的 了解贵州省兴义市农村在校儿童性与生殖健康知识知晓情况、发生性行为及其影响因素,为改善农村在校儿童性与生殖健康状况提供依据。方法 2015年3-4月采用整群抽样方法对兴义市小学五、六年级和初中一、二年级548名农村在校儿童进行调查,采用单因素及多因素logistic回归分析知识知晓及发生性行为的影响因素。结果 调查的548名儿童中,有297人（54.2%）知晓性与生殖健康知识;多因素logistic回归分析显示,男生（OR_调整=1.454,95% CI=1.027~2.058）、经常与父母交流沟通（OR_调整=1.460,95% CI=1.003~2.125）、经常与老师交流沟通（OR_调整=1.608,95% CI=1.129~2.289）、在校学习过性教育课程（OR_调整=2.035,95% CI=1.418~2.919）是知晓性与生殖健康知识的影响因素。5.8%（32/548）的农村在校儿童发生过性行为,多因素分析显示,经常与父母交流沟通（OR_调整=0.267,95% CI=0.128~0.558）和在校学习过性教育课程（OR_调整=0.447,95% CI=0.216~0.925）是减少儿童过早性行为的保护因素。结论 农村在校儿童性与生殖健康知识待完善,应注意加强学校及家庭教育,营造良好网络环境,促进农村儿童健康成长。     

中国大学生首次性行为年龄与危险性行为关系研究

目的探索首次性行为发生年龄对大学生危险性行为的影响,为制定适宜的生殖健康教育策略提供科学依据。方法采取无记名自填问卷方式,按照分层整群抽样方法,对我国18个省、市、自治区33 653名大学生进行健康危险行为问卷调查,对其中3 305名回答了首次性行为年龄大学生的问卷进行分析。结果在有性行为的大学生中,17.9%的大学生报告首次性行为发生在14岁前。大学生首次性行为的发生年龄与危险性行为存在较强的关联,首次性行为发生年龄≤14岁、首次性行为发生年龄在15~18岁之间的学生比首次性行为发生年龄≥19岁者发生多性伴侣、被迫性行为和意外怀孕的概率更高。结论首次性行为过早易导致危险性行为的发生。在初中和高中阶段对青少年进行性教育,推迟青少年首次性行为发生的年龄,对预防危险性行为的发生是十分必要的。