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AIDS Behav. 2017 Sep;21(9):2746-2759. doi: 10.1007/s10461-016-1539-y.

School, Supervision and Adolescent-Sensitive Clinic Care: Combination Social Protection and Reduced Unprotected Sex Among HIV-Positive Adolescents in South Africa.

Author information

1
Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK. elona.toska@spi.ox.ac.uk.
2
AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, 4.26 Leslie Building, Private Bag Rondebosch, Cape Town, Western Cape, 7701, South Africa. elona.toska@spi.ox.ac.uk.
3
Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
4
Department of Psychiatry and Mental Health, Groote Schuur Hospital, University of Cape Town, J-Block, Observatory, Cape Town, 7925, South Africa.
5
Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia.
6
Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA.
7
AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, 4.26 Leslie Building, Private Bag Rondebosch, Cape Town, Western Cape, 7701, South Africa.
8
University College London, London, UK.

Abstract

Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited. This study quantitatively tests whether social protection is associated with reduced unprotected sex among 1060 ART-eligible adolescents from 53 government facilities in South Africa. Potential social protection included nine 'cash/cash-in-kind' and 'care' provisions. Analyses tested interactive/additive effects using logistic regressions and marginal effects models, controlling for covariates. 18 % of all HIV-positive adolescents and 28 % of girls reported unprotected sex. Lower rates of unprotected sex were associated with access to school (OR 0.52 95 % CI 0.33-0.82 p = 0.005), parental supervision (OR 0.54 95 % CI 0.33-0.90 p = 0.019), and adolescent-sensitive clinic care (OR 0.43 95 % CI 0.25-0.73 p = 0.002). Gender moderated the effect of adolescent-sensitive clinic care. Combination social protection had additive effects amongst girls: without any provisions 49 % reported unprotected sex; with 1-2 provisions 13-38 %; and with all provisions 9 %. Combination social protection has the potential to promote safer sex among HIV-positive adolescents, particularly girls.

KEYWORDS:

HIV-positive adolescents; Secondary prevention; Social protection; South Africa; Unprotected sex

PMID:
27631367
PMCID:
PMC5565649
DOI:
10.1007/s10461-016-1539-y
[Indexed for MEDLINE]
Free PMC Article

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