Bhushan Nivedita L, Stoner Marie C D, Groves Allison K, Kahn Kathleen, Pettifor Audrey E
Center for Communication Science, RTI International, Research Triangle Park, North Carolina.
Women's Global Health Imperative, RTI International, San Francisco, California.
J Adolesc Health. 2022 Jul;71(1):63-69. doi: 10.1016/j.jadohealth.2022.02.003. Epub 2022 Mar 31.
In South Africa, adolescent mothers have a three times higher risk of HIV acquisition than nonadolescent mothers. Yet, limited evidence exists regarding how early childbearing may affect HIV risk. A better understanding of adolescent mothers' partnership dynamics and sexual behaviors is critical to tailoring interventions to prevent new infections.
Data are from HIV Prevention Trials Network 068, a longitudinal study of adolescent girls and young women (AGYW) aged 13-20 in South Africa who were followed annually for up to 6 years. Log-binomial regression models were used to assess whether adolescent motherhood was associated with partnership dynamics (intimate partner violence, gender inequitable norms, low relationship power, no HIV prevention communication) and if the association between partnership dynamics and sexual behaviors (unprotected sex and transactional sex) varied by adolescent motherhood. Generalized estimating equations, with an exchangeable correlation structure, were used to account for nonindependence.
Adolescent mothers were more likely than nonadolescent mothers to be in partnerships characterized by intimate partner violence, low relationship power, gender inequitable norms, and no HIV prevention communication. A higher proportion were also more likely to experience these dynamics, as well as engage in transactional sex, after giving birth. Poor partnership dynamics put AGYW at a higher risk for unprotected sex and transactional sex, regardless of adolescent motherhood status.
Engaging adolescent mothers in interventions post birth and developing interventions that address power imbalances in AGYW's sexual partnerships have the potential to reduce engagement in HIV-related sexual behaviors and HIV risk in the long term.
在南非，青春期母亲感染艾滋病毒的风险是非青春期母亲的三倍。然而，关于早育如何影响艾滋病毒感染风险的证据有限。更好地了解青春期母亲的伴侣关系动态和性行为对于制定预防新感染的干预措施至关重要。
数据来自艾滋病毒预防试验网络068，这是一项对南非13至20岁的青春期女孩和年轻女性（AGYW）进行的纵向研究，对她们进行了长达6年的年度随访。使用对数二项回归模型评估青春期母亲身份是否与伴侣关系动态（亲密伴侣暴力、性别不平等规范、低关系权力、无艾滋病毒预防沟通）相关，以及伴侣关系动态与性行为（无保护性行为和交易性行为）之间的关联是否因青春期母亲身份而异。使用具有可交换相关结构的广义估计方程来考虑非独立性。
与非青春期母亲相比，青春期母亲更有可能处于以亲密伴侣暴力、低关系权力、性别不平等规范和无艾滋病毒预防沟通为特征的伴侣关系中。更高比例的青春期母亲在分娩后也更有可能经历这些动态，以及从事交易性行为。无论青春期母亲身份如何，不良的伴侣关系动态都会使AGYW面临更高的无保护性行为和交易性行为风险。
让青春期母亲参与产后干预，并制定解决AGYW性伴侣关系中权力不平衡问题的干预措施，有可能长期减少与艾滋病毒相关的性行为参与和艾滋病毒感染风险。
