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PLoS One. 2018 Apr 2;13(4):e0195217. doi: 10.1371/journal.pone.0195217. eCollection 2018.

Executive function associated with sexual risk in young South African women: Findings from the HPTN 068 cohort.

Author information

1
Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States of America.
2
Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America.
3
Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America.
4
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
5
Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
6
INDEPTH Network, Accra, Ghana.
7
Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
8
School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia.
9
Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
10
Laboratory of Immunoregulation, NIAID, NIH, Baltimore, MD, United States of America.
11
Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America.
12
Department of Biostatistics, University of Washington, Seattle, WA, United States of America.
13
Department of Psychiatry, University of Oxford, Oxford, United Kingdom.

Abstract

PURPOSE:

Heightened sexual risk in adolescence and young adulthood may be partially explained by deficits in executive functioning, the set of cognitive processes used to make reasoned decisions. However, the association between executive function and sexual risk is understudied among adolescent girls and young women, particularly in low- and middle-income countries.

METHODS:

In a cohort of 853 young women age 18-25 in rural Mpumalanga province, South Africa, we evaluated executive function with three non-verbal cognitive tests: I. a rule-finding test, II. a trail-making test, and III. a figure drawing test. Using log-binomial regression models, we estimated the association between lower executive function test scores and indicators of sexual risk (unprotected sex acts, concurrent partnerships, transactional sex, and recent HSV-2 infection).

RESULTS:

In general, young women with lower executive function scores reported higher frequencies of sexual risk outcomes, though associations tended to be small with wide confidence intervals. Testing in the lowest quintile of Test I was associated with more unprotected sex [aPR (95% CI): 1.4 (1.0, 1.8)]. Testing in the lowest quintile of Test II was associated with more concurrent relationships and transactional sex [aPR (95% CI): 1.6 (1.1, 2.5) and 1.7 (1.3, 2.4), respectively], and testing in the lowest four quintiles of Test III was associated with more concurrent relationships [aPR (95% CI): 1.7 (1.0, 2.7)].

CONCLUSIONS:

These results demonstrate an association between low executive function and sexual risk in South African young women. Future work should seek to understand the nature of this association and whether there is promise in developing interventions to enhance executive function to reduce sexual risk.

PMID:
29608615
PMCID:
PMC5880379
DOI:
10.1371/journal.pone.0195217
[Indexed for MEDLINE]
Free PMC Article

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