Informing HIV prevention efforts targeting Liberian youth: a study using the PLACE method in Liberia

Reproductive Health

Allison Pack³  Chinelo C Okigbo¹  Bolatito Aiyengba²  Stacey Succop³  Steve Sortijas³  Sam Wambugu⁵  Mario Chen⁴  Donna R McCarraher³ 

[1] Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA;Monitoring and Evaluation, FHI 360, Abuja, Abuja, Africa;Social and Behavioral Health Sciences, FHI 360, Durham, NC 27705, USA;Biostatistics, FHI 360, Research Triangle Park, Durham, NC, USA;Monitoring and Evaluation, FHI 360, Accra, Ghana, Africa

关键词: Africa;    Liberia;    Research method;    Youth;    HIV prevention;   

Others  :  811109
DOI  :  10.1186/1742-4755-10-54

 received in 2013-05-22, accepted in 2013-09-24,  发布年份 2013

【 摘 要 】

Background

Preventing HIV infection among young people is a priority for the Liberian government. Data on the young people in Liberia are scarce but needed to guide HIV programming efforts.

Methods

We used the Priorities for Local AIDS Control Efforts (PLACE) method to gather information on risk behaviors that young people (ages 14 to 24) engage in or are exposed to that increase their vulnerability for HIV infection. Community informants identified 240 unique venues of which 150 were visited and verified by research staff. 89 of the 150 venues comprised our sampling frame and 571 females and 548 males were interviewed in 50 venues using a behavioral survey.

Results

Ninety-one percent of females and 86% of males reported being sexually active. 56% of females and 47% of males reported they initiated sexual activity before the age of 15. Among the sexually active females, 71% reported they had received money or a gift for sex and 56% of males reported they had given money or goods for sex. 20% of females and 6% males reported that their first sexual encounter was forced and 15% of females and 6% of males reported they had been forced to have sex in the past year. Multiple partnerships were common among both sexes with 81% females and 76% males reporting one or more sex partners in the past four weeks. Less than 1% reported having experiences with injecting drugs and only 1% of males reporting have sex with men. While knowledge of HIV/AIDS was high, prevention behaviors including HIV testing and condom use were low.

Conclusion

Youth-focused HIV efforts in Liberia need to address transactional sex and multiple and concurrent partnerships. HIV prevention interventions should include efforts to meet the economic needs of youth.

【 授权许可】

   
2013 McCarraher et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]National AIDS Commision Republic of Liberia: National HIV/AIDS Strategic Framework II 2010–2014. Monrovia: Liberia National AIDS Commission of Republic of Nigeria; 2010.
• [2]Kruk ME, Rockers PC, Williams EH, Varpilah ST, Macauley R, et al.: Availability of essential health services in post-conflict Liberia. Bull World Health Organ 2010, 88:527-534.
• [3]Liberia Institute of Statistics and Geo-Information Services (LISGIS), Liberia Ministry of Health and Social Welfare, Liberia National AIDS Control Program, Macro International Inc: Liberia Demographic and Health Survey 2007. Monrovia, Liberia: LIGIS and Marco International; 2008.
• [4]Jewkes RK, Dunkle K, Nduna M, Shai N: Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet 2010, 376:41-48.
• [5]Sa Z, Larsen U: Gender inequality increases women's risk of hiv infection in Moshi, Tanzania. J Biosoc Sci 2008, 40:505-525.
• [6]Waszak Geary C, Wedderburn M, McCarraher D, Cuthbertson C, Pottinger A: Sexual violence and reproductive health among young people in three communities in Jamaica. J Interpers Violence 2006, 21:1512-1533.
• [7]Jama Shai N, Jewkes R, Levin J, Dunkle K, Nduna M: Factors associated with consistent condom use among rural young women in South Africa. AIDS Care 2010, 22:1379-1385.
• [8]Lang DL, Salazar LF, Wingood GM, DiClemente RJ, Mikhail I: Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women. J Acquir Immune Defic Syndr 2007, 46:216-221.
• [9]Townsend L, Jewkes R, Mathews C, Johnston LG, Flisher AJ, et al.: HIV risk behaviours and their relationship to intimate partner violence (IPV) among men who have multiple female sexual partners in Cape Town, South Africa. AIDS Behav 2011, 15:132-141.
• [10]Maman S, Mbwambo JK, Hogan NM, Kilonzo GP, Campbell JC, et al.: HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. Am J Public Health 2002, 92:1331-1337.
• [11]Pulerwitz J, Michaelis A, Verma R, Weiss E: Addressing gender dynamics and engaging men in HIV programs: lessons learned from Horizons research. Public Health Rep 2010, 125:282-292.
• [12]van der Straten A, King R, Grinstead O, Serufilira A, Allen S: Couple communication, sexual coercion and HIV risk reduction in Kigali, Rwanda. AIDS 1995, 9:935-944.
• [13]Maman S, Mbwambo JK, Hogan NM, Weiss E, Kilonzo GP, et al.: High rates and positive outcomes of HIV-serostatus disclosure to sexual partners: reasons for cautious optimism from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. AIDS Behav 2003, 7:373-382.
• [14]Medley A, Garcia-Moreno C, McGill S, Maman S: Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ 2004, 82:299-307.
• [15]Lopez EJ, Jones DL, Villar-Loubet OM, Arheart KL, Weiss SM: Violence, coping, and consistent medication adherence in HIV-positive couples. AIDS Educ Prev 2010, 22:61-68.
• [16]Mepham S, Zondi Z, Mbuyazi A, Mkhwanazi N, Newell ML: Challenges in PMTCT antiretroviral adherence in northern KwaZulu-Natal, South Africa. AIDS Care 2011, 23:741-747.
• [17]Walker G, Millar Wood J, Allemano E: Liberia Youth Fragility Assesment 2009. Monrovia, Liberia: United States Agency for International Development; 2009.
• [18]Green EC: The anthropology of sexually transmitted disease in Liberia. Soc Sci Med 1992, 35:1457-1468.
• [19]Otti PN, Barh B: A Study on Socio-Cultural Barriers to HIV/AIDS Prevention Initiatives in Monrovia Liberia. Monrovia, Liberia: United Nations Development Programme; 2001.
• [20]Kennedy SB, Atwood KA, Harris AO, Taylor CH, Gobeh ME, et al.: HIV/STD Risk Behaviors Among In-School Adolescents in Post-conflict Liberia. J Assoc Nurses AIDS Care 2011, 23:350-360.
• [21]Muhwezi WW, Kinyanda E, Mungherera M, Onyango P, Ngabirano E, Muron J, Kagugube J, Kajungu R: Vulnerability to high risk sexual behaviour (HRSB) following exposure to war trauma as seen in post-conflict communities in eastern uganda: a qualitative study. Conflict and Health 2011, 5:1-15. BioMed Central Full Text
• [22]Joint United Nations Programme on HIV/AIDS (UNAIDS): Global Report: UNAIDS Report on the Global AIDS Epidemic. Geneva, Switzerland: UNAIDS; 2010.
• [23]Weir SS, Pailman C, Mahlalela X, Coetzee N, Meidany F, et al.: From people to places: focusing AIDS prevention efforts where it matters most. AIDS 2003, 17:895-903.
• [24]Weir S, Tate J, Hileman SB, Khan M, Jackson E, Johnston A, Herman C: Priorities for Local AIDS Control Efforts: A Manual for Implementing the PLACE Method Washington. DC: USAID and MEASURE Evaluation; 2005.
• [25]Lowndesa CM, Alaryb M, Belleauc M, Kofi Bosuc W, Kintinc DF, et al.: West Africa; HIV/AIDS Epidemiology and Response Synthesis; Implications for Prevention. Washington, DC: The International Bank for Reconstruction and Development / The World Bank; 2008.
• [26]FHI 360: Strategy document: HIV prevetion programming for young people at high risk in Liberia. RTP, NC: FHI 360; 2012.