Kenya Medical Research Institute, Center for Microbiology Research, P.O. Box 19669-40123, Kisumu, Kenya.
Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, USA.
BMC Public Health. 2021 Nov 6;21(1):2028. doi: 10.1186/s12889-021-12051-6.
Food insecurity is an important underlying driver of HIV risk and vulnerability among adolescents in sub-Saharan Africa. In this region, adolescents account for 80% of all new HIV infections. The primary purpose of this analysis is to understand perceived mechanisms for how a multisectoral agricultural intervention influenced sexual risk taking among HIV-affected adolescents in southwestern Kenya.
We conducted semi-structured, individual interviews with 34 adolescent-caregiver dyads who were participants in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in the Shamba Maisha trial (NCT01548599), a multi-sectoral agricultural and microfinance intervention. Interviews were audiotaped, transcribed, translated, and analyzed using framework and interpretive description analysis methods.
Adolescents receiving the Shamba Maisha intervention described no longer needing to engage in transactional sex or have multiple concurrent sexual partners as a way to meet their basic needs, including food. Key mechanisms for these effects include greater sexual agency among adolescent girls, and increased confidence and self-efficacy in overcoming existing reciprocity norms and sexual relationship power inequity; as well as staying in school. The intervention also increased caregiver confidence in talking about adolescent sexual reproductive health issues. In contrast, driven primarily by the need for food and basic needs, girls in the control arms described engaging in transactional sex, having multiple sexual partners, being unable to focus in school, getting pregnant or becoming HIV infected.
These findings emphasize the need to address food insecurity as a part of structural interventions targeting adolescent HIV risk in low-resource countries. We recommend that future interventions build upon the Shamba Maisha model by combining sustainable agricultural production, with household level interventions that deliberately target gender norms that contribute to unequal power dynamics.
在撒哈拉以南非洲，粮食不安全是青少年感染艾滋病毒风险和脆弱性的一个重要潜在驱动因素。在该地区，青少年占所有新感染艾滋病毒人数的 80%。本分析的主要目的是了解多部门农业干预措施如何影响肯尼亚西南部受艾滋病毒影响的青少年的性风险行为，从而理解感知机制。
我们对半结构、个体访谈进行了分析，受访者为 34 对青少年-照顾者，他们是 Adolescent Shamba Maisha（NCT03741634）的参与者，这是 Adolescent Shamba Maisha 试验（NCT01548599）的一个子研究，该试验是一项多部门农业和小额供资干预措施，有一个家庭的成员参加。访谈使用框架和解释性描述分析方法进行录音、转录、翻译和分析。
接受 Shamba Maisha 干预的青少年表示，不再需要通过性交易或拥有多个同时进行的性伴侣来满足基本需求，包括食物。这些效果的关键机制包括青少年女孩有更大的性自主权，以及增加克服现有互惠规范和性关系权力不平等的信心和自我效能；以及留在学校。该干预措施还增强了照顾者谈论青少年性生殖健康问题的信心。相比之下，由于主要是为了满足食物和基本需求，对照组的女孩描述了从事性交易、拥有多个性伴侣、无法专注于学业、怀孕或感染艾滋病毒的情况。
这些发现强调需要解决粮食不安全问题，作为针对低收入国家青少年艾滋病毒风险的结构性干预措施的一部分。我们建议未来的干预措施在 Shamba Maisha 模式的基础上进行改进，将可持续农业生产与旨在针对导致不平等权力动态的性别规范的家庭层面干预措施相结合。
