Jennings Larissa, Ssewamala Fred M, Nabunya Proscovia
a Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
b International Center for Child Health and Asset Development , Columbia University School of Social Work , New York , NY , USA.
AIDS Care. 2016;28(3):273-82. doi: 10.1080/09540121.2015.1109585. Epub 2015 Nov 7.
Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents' cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10-17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US12.32, ±1.12, p < .001) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group (p < .001). The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home (ΔT1-T0 = +14.9, p < .001), pursue vocational training (ΔT1-T0 = +8.8, p < .01), and start a business (T1-T0 = +6.7, p < .01). Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores (b = +0.19, ±0.09, p < .05), most commonly toward perceived risk of HIV (95.8%, n = 159), sexual abstinence or postponement (91.6%, n = 152), and consistent condom use (93.4%, n = 144). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score (OR = 2.017, 95%CI: 1.43-2.84). To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.
改善贫困青年的经济资源，可能会通过激发积极的未来规划以避免感染艾滋病毒的风险，以及改变导致感染艾滋病毒风险的经济环境，来改变他们参与性风险行为的意图。然而，尽管孤儿群体贫困率高且艾滋病毒感染率高，但很少有研究考察经济强化对孤儿青年经济和性行为的影响。本研究采用分层纵向回归分析，以检验一项以储蓄为主导的经济赋权干预措施——苏比-马卡项目，对孤儿青少年现金储蓄的变化，以及他们对储蓄和艾滋病毒预防措施的态度随时间推移所产生的影响。我们将346名年龄在10至17岁之间的乌干达青少年随机分为两组，对照组（n = 167）接受常规孤儿照料加辅导，干预组（n = 179）接受常规孤儿照料加辅导、金融教育，并获得匹配的储蓄账户。在基线、12个月和24个月时进行评估。结果表明，与对照组青少年相比，随着时间的推移，干预组青少年的现金储蓄显著增加（b = 12.32美元，±1.12，p < .001）。在基线后24个月时，92%的干预组青少年积累了储蓄，而对照组这一比例为43%（p < .001）。储蓄目标变化最大的是，干预组青少年中重视为买房储蓄的比例（ΔT1-T0 = +14.9，p < .001）、追求职业培训的比例（ΔT1-T0 = +8.8，p < .01）以及创业的比例（T1-T0 = +6.7，p < .01）。随着时间的推移，干预组青少年在艾滋病毒预防态度得分上也有显著的相对增加（b = +0.19，±0.09，p < .05），最常见的是对艾滋病毒感知风险的态度（95.8%，n = 159）、性禁欲或推迟性行为的态度（91.6%，n = 152）以及坚持使用避孕套的态度（93.4%，n = 144）。此外，干预组青少年获得最高艾滋病毒预防得分的几率显著高出2.017倍（OR = 2.017，95%CI：1.43 - 2.84）。为了在整个青少年和青年时期将艾滋病毒风险降至最低，需要长期策略将青年经济发展，包括储蓄和创收，与适合年龄的综合预防干预措施相结合。
