Speaker
Description
Background: Adolescents and youth with HIV (AYH) have poorer treatment outcomes exacerbated by HIV stigma, contributing to onward transmission. To support the development of focused anti-stigma interventions, we assessed sexual behaviors, sexual violence, and their relationship with HIV stigma.
Methods: We utilized baseline data from an ongoing trial across 30 facilities in Kenya evaluating the effectiveness of a psychological intervention among AYH ages 16–24 years with depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores>4). Poor adherence was defined as missing ≥2 doses of antiretroviral therapy in the past 30 days. Risky sexual behavior was characterized by any unprotected sex within the last three months, and life time history of transactional sex. Sexual partner type was categorized as stable, casual, or none. HIV-related stigma measured using the Wright’s brief youth stigma scale was dichotomized (Yes if score > median). Odds ratios (ORs) with 95% confidence intervals (95%CI) were estimated for associations between participant characteristics and sexual behaviors and HIV stigma.
Results: Of the 600 AYH enrolled, 67% were female and median age 19.6 years (IQR: 17–22). Majority (60%) were students, unemployed [among those out of school] 182/241 (76%), 68% were single, and 16% double orphans. Majority (85%) had good treatment adherence. Majority (51%) reported ever having sex, with a median sexual debut age of 17 years (IQR: 16–19) and median of two lifetime partners (IQR: 1–3). A third (34%) had a stable sexual partner, 3.5% a casual partner, and 47% no current sexual partner. Only 23.8% and 42.6% reported inconsistent condom use among those with casual and stable partners respectively. Transactional sex was reported by 6%. Experiences of sexual violence were reported by 13%, with a median age of 16 years at first experience (IQR: 14–20). Anticipated stigma was reported by 53%, perceived stigma by 40%, experienced stigma by 14%, and internalized stigma by 13%. Older age (OR: 1.17 [95%CI: 1.09-1.26]), being in a relationship (OR: 1.56 [95%CI:1.07-2.28]) and sexual violence (OR: 3.30 [95%ci:1.74-6.27]) were associated with any HIV-related stigma. Female gender (OR: 1.74 (95%CI: 1.23-2.45]) was associated with only anticipated stigma, having a casual partner (OR: 3.38 [95% CL: 1.31 – 8.66]) was associated with only experienced stigma, and sexual violence with all domains of HIV stigma.
Conclusion:
HIV-related stigma remains common among ALH, with anticipated and perceived stigma affecting a substantial proportion. Sexual relationships and sexual violence are key risk factors for HIV-related stigma, and should be considered when developing anti-stigma interventions. Inconsistent condom use among sexually active adolescents further highlights the need for integrated, adolescent-centered HIV and sexual and reproductive health services