Peer-Reviewed Publications, 2016

Publications (journal articles, book chapters, books) produced in 2016:

  • Folayan M, Harrison A, Brown B, Odetoyinbo M, et al. Relationship between forced sexual initiation, HIV status, sexual risk behaviour, life stressors and coping strategies among adolescents in Nigeria. PLOS One, 2016; 11(5): e0155210.

Objectives: Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status.

Methods: We analyzed data from 436 sexually active 10–19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman’s conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies.

Results: Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14–11.87), and transactional sex (OR: 2.80; 95% CI: 1.56–4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96–1.11) and loss and grief (OR: 1.34; 95% CI: 0.73–2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34–1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62–3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49–1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09–0.83).

Conclusion: History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.

  • Genberg BL, Shangani S, Sabatino K, Rachlis B, Wachira J, Braitstein P, Operario D. Improving engagement in the HIV care cascade: A systematic review of interventions involving people living with HIV/AIDS as peers. AIDS Behav, 2016;[epup ahead of print].

Improving patient engagement in HIV care is critical for maximizing the impact of antiretroviral therapy (ART). We conducted a systematic review of studies that used HIV-positive peers to bolster linkage, retention, and/or adherence to ART. We searched articles published and indexed in Pubmed, PsycINFO, and CINAHL between 1996 and 2014. Peers were required to be HIV-positive. Studies were restricted to those published in English. Nine studies with n = 4658 participants met the inclusion criteria. Peer-based interventions were predominantly focused on improving adherence to ART, or evaluations of retention and adherence via viral suppression. Five (56 %) were conducted in sub-Saharan Africa. Overall findings were mixed on the impact of peers on ART adherence, viral suppression, and mortality. While positive effects of peer interventions on improving linkage and retention were found, there were limited studies assessing these outcomes. Additional research is warranted to demonstrate the impact of peers on linkage and retention in diverse populations.

  • Harrison A, Hoffman S, Smit J, Mantell J, et al. Gender-focused HIV and pregnancy prevention for school-going adolescents: The Mpondombili pilot intervention in KwaZulu-Natal, South Africa. Journal of HIV/AIDS and Social Services, 2016; 15(1): 29-47.

This pilot study evaluated a 15-session classroom intervention for HIV and pregnancy prevention among grade 8–10 boys and girls (aged 14–17 years) in rural South Africa, guided by gender-empowerment theory and implemented by teachers, nurses, and youth peer educators. Pre- and post-intervention surveys included 933 male and female students in two intervention and two comparison schools. The main outcome was condom use at last sex; secondary outcomes were partner communication, gender beliefs and values, perceived peer behaviors, and self-efficacy for safer sex. At 5 months post-intervention, change in condom use did not differ between intervention and comparison schools. Intervention school youth had greater increases in self-efficacy for unsafe sex refusal (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.01–2.57) and condom use (OR 1.76, 95% CI 1.07–2.89), partner communication (OR 2.42, 95% CI 1.27–4.23), and knowledge of HIV testing opportunities (OR 1.76, 95% CI 1.08–2.87). This gender-focused pilot intervention increased adolescents’ self-efficacy and partner communication and has potential to improve preventive behaviors.

  • Midoun M, Shangani S, Mbete B, Babu S, Hackman M, van der Elst EM, Sanders EJ, Smith AD, Operario D. How intersectional constructions of sexuality, culture and masculinity shape ientities and sexual decision-making among men who have sex with men in coastal Kenya. Cult Health Sex, 2016; 18(6): 625-38.

Men who have sex with men are increasingly recognised as one of the most vulnerable HIV risk groups in Kenya. Sex between men is highly stigmatised in Kenya, and efforts to provide sexual health services to men who have sex with men require a deeper understanding of their lived experiences; this includes how such men in Kenya construct their sexual identities and how these constructions affect sexual decision-making. Adult self-identified men who have sex with men (n = 26) in Malindi, Kenya, participated in individual interviews to examine sociocultural processes influencing sexual identity construction and decision-making. Four key themes were identified: (1) tensions between perceptions of ‘homosexuality’ versus being ‘African’, (2) gender-stereotyped beliefs about sexual positioning, (3) socioeconomic status and limitations to personal agency and (4) objectification and commodification of non-normative sexualities. Findings from this analysis emphasise the need to conceive of same-sex sexuality and HIV risk as context-dependent social phenomena. Multiple sociocultural axes were found to converge and shape sexual identity and sexual decision-making among this population. These axes and their interactive effects should be considered in the design of future interventions and other public health programmes for men who have sex with men in this region.

  • Shangani S, Naanyu V, Mwangi A, Vermandere H, Mereish E, Obala A, vanden Broeck D, Sidle J, Operario D. Factors associated with HIV testing among men who have sex with men in Western Kenya: A cross-sectional study. Int J STD AIDS, 2016: [epub ahead of print].

HIV diagnosis is an important step in the HIV cascade of prevention and treatment. However, men who have sex with men in low- and middle-income countries have limited access to HIV care services. We examined factors associated with prior HIV testing among men who have sex with men in western Kenya. We recruited 95 men who have sex with men aged 18 years and older, and who reported at least one sexual contact with a man in the past 6 months; however, this analysis is restricted to 89 participants who completed questions on HIV testing. Logistic regression model was used to determine factors associated with HIV testing in the past one year. Results indicate that 23 (26%) had not been tested in the past 12 months. Bivariate analyses demonstrated that condomless anal sex (odds ratio = 3.29, 95% confidence interval = 1.18-9.17) and comfort with healthcare providers (odds ratio = 1.15, 95 % CI = 1.05-1.26) were associated with higher odds of HIV testing in the past 12 months. Experiencing social stigma was associated with lower odds of HIV testing in the last 12 months (odds ratio = 0.91, 95% confidence interval = 0.84-0.94). In multivariable models, social stigma remained significantly associated with lower odds of HIV testing in the last 12 months odds ratio = 0.90, 95% confidence interval = 0.82-0.99) after inclusion of sexual risk and individual level variables. Development of men who have sex with men-sensitive HIV-testing services, addressing stigma, and training healthcare workers to provide culturally sensitive services may assist in effectively engaging men who have sex with men in the HIV treatment cascade.

  • Swartz A, Harrison A, Colvin CJ. The Cape Town Boyfriend and the Joburg Boyfriend: Women’s sexual partnerships and social networks in Khayelitsha, Cape Town. Social Dynamics, 2016: DOI: 10.1080/02533952.2016.1194591.

In South Africa, young people’s “multiple” or “concurrent” partnerships have been increasingly prominent in public health discourses – as drivers of HIV transmission. Multiple partnerships are typically framed in moralising, negative terms and depicted primarily as male-driven, within a broader framework of women’s vulnerability and use of sex for survival and material gain. Based on ethnographic fieldwork with adolescents and young adults in Khayelitsha township near Cape Town, this article investigates young women’s partnerships by exploring their complex interpersonal and social dynamics. We unpack women’s multiple motivations for, and careful management strategies of, both sexual and social relationships in a broader context of socio-economic exclusion, threats to health and well-being, social obligations and relationships of care. The meanings and practices associated with young people’s relationships are more than the sum of individual sexual behaviours, rigid cultural scripts or simply a locus of “risk.” The data presented here highlight some of the limitations of “prevention” approaches that do not take into account this nuanced and multilayered view of such relationships. The affective and empathetic dimensions of young peoples’ relationships, as well as the socio-economic contexts in which they occur should also be considered. Without accounting for this context, standard “prevention” approaches are less likely to succeed.

  • Wainwright M. Case Study 5.1: Rebellion and co-morbidity (Chapter 5: Bodily resistances). In: The Routledge. 2016.

[no abstract available]





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