Page 150 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 8 Original Research

Ethical consideration TABLE 1: Summary of socio-demographic characteristics of adolescents and
young adults (aged 16–24 years) by gender.
Females
Males
The study protocol, informed consent and other materials Characteristic (n)† (n = 1417) (n = 1963) p
were approved by the Botswana Health Research n % n %
Development Committee, and the US Centers for Disease Education level (n = 3373) 0.02
Control and Prevention, the two governing Institutional None or primary 89 6 92 5
Review Boards for the BCPP study. Written informed Secondary 1147 81 1562 80
consent was obtained from all participants aged 18 years Tertiary 180 13 303 15
and above, while participants aged 16–17 years provided Sexually active (n = 3380) 815 58 1496 76 < 0.0001
written assent, with parents or guardians providing HIV status (n = 3372) < 0.0001
written permission. Positive 37 3 183 9
Negative 1377 97 1775 91
Results Household food insecurity (n = 3334) 960 69 1358 70 0.62
Never
Rarely 198 14 247 13
Among the 12 610 individuals who consented or assented Sometimes 182 13 250 13
with parental permission to participate in the parent study Often 55 4 84 4
at the initial baseline visit, 3413 were adolescents and Refrigeration in household (n = 3165) 641 51 863 47 0.28
young adults aged 16–24 years. A total of 3380 responded Cooking source in household (n = 3336) 0.10
to the sexual activity questionnaire, with 2311 (68%) Gas 356 26 444 23
reporting prior engagement in sexual activity and 1069 Electricity 235 17 336 17
(31%) reporting never having been sexually active. The Charcoal/wood 799 57 1144 59
majority (~80%) of participants reported a secondary level Other 5 < 1 17 1 0.11
Water source (n = 3335)
education. A higher proportion of sexually active Piped indoors 169 12 255 13
individuals reported lack of television (44% vs. 37%; p < Standpipe or tap in yard 888 64 1155 60
0.0001) or refrigeration (55% vs. 46%; p < 0.0001) and Communal stand pipe 306 22 483 25
reliance on a communal stand pipe for water (26% vs. 20%; Other 32 2 47 2
p < 0.0001). Toilet type (n = 3336) 0.09
Flush toilet in home 230 17 340 18
Pit latrine in yard 1021 73 1366 70
Female participants were significantly more likely to report
ever being sexually active than males (76% vs 58%, Communal toilet/pit latrine 100 7 3 143 7 5
92
Bush or other
44
respectively; p < 0.0001) (Table 1). Among all adolescents and Television in home (n = 3165) 788 40 1044 57 0.07
young adults, regardless of history of being sexually active, Access to internet (n = 3165) 169 13 237 13 0.99
93% were HIV-uninfected at the time of the survey. Among Own a cell phone (n = 3165) 1252 95 1747 95 0.51
the 1069 individuals reporting no prior sexual activity, Community population size in quartiles (n = 3380) 0.68
36 (3%) were HIV-infected, of whom 30 (83%) were 2700 to 3899 persons 223 16 332 17
adolescents, whereas 184 (8%) individuals reporting prior 3900 to 5199 persons 360 25 502 26
sexual activity were HIV-infected, with 85% of the infections 5200 to 7499 persons 378 27 493 25
456
32
7500 to 12 850 persons
636
32
occurring in young adults aged 20–24 years. Twelve (33%) of Distance from an urban area, in quartiles (n = 3380) 0.99
the individuals with HIV who reported no prior sexual 18 to 24 km 268 19 377 19
activity had documentation of diagnosis prior to 10 years of 24 to 40 km 467 33 640 33
age, suggesting perinatal acquisition of HIV, while nine (25%) 41 to 84 km 246 17 340 17
were newly diagnosed with HIV during the YaTsie baseline 85 to 380 km 436 31 606 31
household HIV testing. †, ‘n’ of < 3380 for any socio-demographic variable reflects lack of response from the
participant to that question.
Risky sexual practices by gender Predictors of gender-specific engagement in
Among the sexually active respondents, we evaluated risky high-risk sexual practices
sexual practices by gender (Table 2). Compared with males, We modelled factors associated with risky sexual practices,
females were significantly more likely to report inconsistent stratified by gender. For females, factors associated with
condom use (PR 1.61; 95% CI 1.44–1.80), intergenerational consistent condom use, intergenerational sex with a
sex (PR 9.00; 95% CI 5.84–13.88) and transactional sex partner ≥ 10 years older and transactional sex were
(PR3.46; 95% CI 2.07–5.77) during the prior 12 months. modelled. For males, factors associated with early sexual
However, female participants were significantly less likely debut, alcohol use with sex and ≥ two sex partners in the
to report having engaged in sex before 15 years of age (PR last 12 months were modelled (Table 3). Young adult
0.59; 95% CI 0.41–0.85), report use of alcohol (by either females aged 20–24 years were 30% (PR 1.30; 95% CI 1.13–
partner) during sexual intercourse (PR 0.59; 95% CI 0.45– 1.49) more likely to report inconsistent condom use
0.76) or having ≥ two partners in the last 12 months (PR 0.65; compared with adolescent females aged 16–19 years. In
95% CI 0.57–0.74). multivariate analysis, a positive HIV status was associated

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