Nyaboe Edward, Larsen Anna, Sila Joseph, Kinuthia John, Owiti George, Abuna Felix, Kohler Pamela, John-Stewart Grace, Pintye Jillian
Kenya Medical Research Institute, Nairobi, Kenya.
Department of Epidemiology, University of Washington, Seattle, WA, United States.
Front Reprod Health. 2021 Jul 21;3:667413. doi: 10.3389/frph.2021.667413. eCollection 2021.
Understanding HIV risk behaviors among adolescent girls and young women (AGYW) seeking contraception could help inform integrating HIV prevention services within family planning (FP) clinics. From 10/2018 to 04/2019, we conducted a survey at 4 FP clinics in Kisumu, Kenya to evaluate risk behaviors among AGYW without HIV infection seeking contraception. All AGYW aged 15-24 were invited to participate following receipt of FP services. Adolescent girls and young women initiating or refilling contraception were included in this analysis. Long-acting reversible contraceptives (LARC) included intrauterine devices, implants, or injectables. Non-LARC methods included oral contraceptive pills (OCP) or condoms. We used an empiric risk score to assess HIV risk behaviors; HIV risk scores of ≥5 (corresponding to 5-15% HIV incidence) defined "high" HIV risk. Overall, 555 AGYW seeking FP were included. Median age was 22 years [interquartile range (IQR) 20-23], median completed education was 12 years (IQR 10-12); 23% of AGYW had HIV risk scores of ≥5. The most frequent form of contraception was injectables (43%), followed by implants (39%). After adjustment for education, prior pregnancy, and marital status, LARC users more frequently engaged in transactional sex than non-LARC users [6 vs. 0%, adjusted prevalence ratio (PR) = 1.17, 95% CI 1.09-1.29, < 0.001]; LARC use was not associated with HIV risk scores ≥5. Among LARC users, AGYW using injectables more frequently had condomless sex compared to AGYW using other LARC methods (85 vs. 75%, adjusted PR = 1.52, 95% CI 1.09-2.10, = 0.012); injectable use was not associated with HIV risk scores ≥5. Adolescent girls and young women seeking contraception frequently had high HIV risk, emphasizing the importance of integrating HIV prevention within FP. Multipurpose technologies for contraception and HIV prevention could particularly benefit AGYW.
了解寻求避孕措施的青春期女孩和年轻女性（AGYW）中的艾滋病毒风险行为，有助于为在计划生育（FP）诊所内整合艾滋病毒预防服务提供信息。2018年10月至2019年4月，我们在肯尼亚基苏木的4家计划生育诊所进行了一项调查，以评估寻求避孕措施的未感染艾滋病毒的AGYW中的风险行为。所有年龄在15 - 24岁的AGYW在接受计划生育服务后被邀请参与。开始或重新使用避孕措施的青春期女孩和年轻女性被纳入本分析。长效可逆避孕方法（LARC）包括宫内节育器、植入剂或注射剂。非LARC方法包括口服避孕药（OCP）或避孕套。我们使用经验风险评分来评估艾滋病毒风险行为；艾滋病毒风险评分≥5（对应5 - 15%的艾滋病毒发病率）定义为“高”艾滋病毒风险。总体而言，555名寻求计划生育服务的AGYW被纳入。中位年龄为22岁[四分位间距（IQR）20 - 23]，中位完成教育年限为12年（IQR 10 - 12）；23%的AGYW艾滋病毒风险评分≥5。最常用的避孕方式是注射剂（43%），其次是植入剂（39%）。在对教育程度、既往怀孕情况和婚姻状况进行调整后，使用LARC的人群比未使用LARC的人群更频繁地参与性交易[6%对0%，调整患病率比（PR）= 1.17，95%置信区间1.09 - 1.29，< 0.001]；使用LARC与艾滋病毒风险评分≥5无关。在使用LARC的人群中，与使用其他LARC方法的AGYW相比，使用注射剂的AGYW更频繁地发生无保护性行为（85%对75%，调整PR = 1.52，95%置信区间1.09 - 2.10，= 0.012）；使用注射剂与艾滋病毒风险评分≥5无关。寻求避孕措施的青春期女孩和年轻女性经常有较高的艾滋病毒风险，这凸显了在计划生育中整合艾滋病毒预防的重要性。用于避孕和艾滋病毒预防的多功能技术可能会使AGYW特别受益。
