Page 154 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 7 of 8 Original Research

Botswana’s national policy of opt-out HIV testing during risky sexual practice was not sought. However, the self-
antenatal care. There was no significant difference in the reported sexual practices with differences noted between
proportion of individuals with prior HIV testing experience age groups and within age groups by sex represent a strong
when comparing adolescent and young adult females starting point to inform HIV prevention programming.
without prior pregnancies (62%) and adolescent and young Lastly, we acknowledge that there are limitations and biases
adult males (61%) (p = 0.80). Certain strategies may lead to inherent in a cross-sectional study design.
increased HIV testing among adolescents and young adults.
For example, the Sustainable East African Research in Conclusion
Community (SEARCH) Trial, a community-based universal
test-and-treat trial in Uganda and Kenya offered mobile In our survey, adolescent and young adult females had a
multi-disease testing, during which participants were higher prevalence of HIV than males, with a unique set of
screened for hypertension, malaria and HIV. This self-reported risky sexual practices. Structural and
26
multi-faceted mobile approach significantly improved behavioural drivers of these risky sexual practices argue for
HIV testing uptake among younger participants aged contextualised interventions and prevention programming.
10–24 years, including very high participation (69%) among Given that female adolescents and young adults are
young males. experiencing the highest incidence of new HIV infections
globally, prioritising the identification and implementation
Our study has several limitations. For example, sexual of efficacious interventions will likely have a significant
practices were self-reported in a format that required impact on curtailing the global incidence of HIV. While
disclosure to a study team member. While our study staff PEPFAR and the Joint United Nations Programme on HIV/
underwent interview training and techniques to promote a AIDS (UNAIDS) have partnered with host governments to
non-judgemental, accepting environment through role develop and implement programmes focussed on curtailing
playing, it is likely that some individuals may not have felt incident HIV infections among adolescent and young adult
comfortable fully disclosing their sexual practices. Therefore, females, the specific findings from this study can be used
results may reflect conservative estimates. From its both to inform the further development of these programmes
inception, the YaTsie study was structured to evaluate HIV in Botswana and to highlight the importance of contextualising
incidence among community members aged 16–24 years. programming to the community and highest risk persons
Survey instruments were not administered or HIV testing within a community.
performed on individuals younger than 16 years of age in
the main study and, therefore, our analyses do not include Acknowledgements
persons < 16 years of age, a population also at risk for HIV We are grateful to all participants of the Botswana
acquisition. We asked about the age of sexual debut without Combination Prevention Project (BCPP) study in Botswana
providing a specific definition of what constituted sexual and community leaders across the country. We thank BCPP
debut or inquiring about the consensual nature of the
activity. It would be beneficial in future studies to provide study field team for their dedication and outstanding
respondents with a clear definition and inquire about outreach work. We thank the Botswana Ministry of Health
consensual participation. Our findings may not be and Wellness for their collaboration. We thank Tumalano
generalisable to urban settings, as the YaTsie study Sekoto and Jesse Rizutko for their outstanding regulatory
communities were located in rural and peri-urban settings. management of the BCPP study.
At the YaTsie study inception on an a priori basis, we
identified sexual practices that would likely place Competing interests
respondents at risk for HIV acquisition or identify The authors declare that this article is not under publication
individuals at high risk for HIV transmission. This was consideration elsewhere and that they have no financial
based on general evidence that has emerged as the HIV or personal relationships that may have inappropriately
epidemic matured. However, we did not include all potential influenced them in writing this article.
risk factors. Specifically, we did not inquire about whether
adolescent and young adult males were having sex with
males. Yet, prior surveys have noted that up to 20% of men Authors’ contributions
who have sex with men in Botswana are HIV-infected and T.G., J.M., M.M., M.E., K.M.P. and S.L. were involved in the
nearly 50% of these individuals also reported having female origination and development of the concept of the study.
sex partners. In this analysis, no attempt has been made to M.M., J.M., M.P.H., M.E., S.L. and K.M.P. provided overall
27
correlate the selected sexual practices with actual HIV guidance on the conduct of the study. U.C., E.K., K.M. and
transmission. As such, we are unable to comment on the T.G. facilitated collection of study data in the 30 BCPP
quantitative HIV risk associated with the practices included communities. K.M.P., K.W. and K.B. analysed and interpreted
in this analysis. Furthermore, while we use HIV status as a the data. U.C., K.M.P. and K.W. prepared the first draft. P.B.,
predictor as it relates to intergenerational sex among females T.M., L.B., S.D.-P., M.M., M.E.R., M.P.H. and S.L. provided
and early sexual debut among males, it may actually reflect edits to the manuscript with U.C., K.M.P., M.P.H. and S.L.
an outcome, as the timing of HIV acquisition relative to the finalising the manuscript.

http://www.sajhivmed.org.za 147 Open Access