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Emerging evidence on AGYW HIV risk and prevention from the DREAMS partnership: the role Emerging evidence on AGYW HIV risk and prevention from the DREAMS partnership: the role

Emerging evidence on AGYW HIV risk and prevention from the DREAMS partnership: the role - PowerPoint Presentation

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Emerging evidence on AGYW HIV risk and prevention from the DREAMS partnership: the role - PPT Presentation

Julie Pulerwitz ScD and Sanyukta Mathur DrPH MHS Girl uninterrupted Evidence implementation and agency 24 July 2018 No conflicts of interest to disclose Context Should address the context in which AGYW live to improve health amp development outcomes ID: 781311

sexual hiv girls young hiv sexual young girls women violence power adolescent agyw risk amp relationship prep mathur partners

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Slide1

Emerging evidence on AGYW HIV risk and prevention from the DREAMS partnership: the role of gender

Julie Pulerwitz, ScD and Sanyukta Mathur, DrPH MHS Girl uninterrupted: Evidence, implementation and agency24 July 2018

Slide2

No conflicts of interest to disclose

Slide3

ContextShould address the context in which AGYW live, to improve health & development outcomes

Gender-based power dynamics underpins many relationshipsPower in sexual relationships* linked with violence, condom use, HIV incidence, untreated STIs, etcHigh HIV risk and incidence rates among AGYW (esp. Southern and Eastern Africa)

*Pulerwitz, J, Gortmaker, SL, & DeJong, W. (2000) Measuring relationship power in HIV/STD Research. Sex Roles. 42(7/8); McMahon, JM, Volpe, EM,

Klostermann

, K,

Trabold

, N, &

Xue

, Y. (2015) A Systematic Review of the Psychometric Properties of the Sexual Relationship Power Scale in HIV/AIDS Research. Arch Sex

Behav

; 44(2): 267–294.

Slide4

Adapted from:

Preventing HIV in Adolescent Girls and Young Women: Guidance for PEPFAR Country Teams on the DREAMS Partnership, March 2015DREAMS partnership as case study

Mobilize

Communities

for change

Reduce risk of

Male sexual partners

Empower

Adolescent Girls & Young Women (AGYW)

and reduce risk

Strengthen

Families

Slide5

Generating evidence around DREAMS3 cross-cutting themes—focused on unique features; country priorities

Assessing reach and effectiveness of community-based girl-centered programming

Introducing

oral

PrEP

among adolescent girls and young women

Characterizing male partners

of adolescent girls and young women, and use of HIV services

Slide6

Double orphans

Sometimes hungry

Not connected to adult in HH

Sexual debut ≤14

Limited HIV knowledge

Acknowledge inequitable gender norms

Vulnerability profiles of

out-of

school AGYW, Kisumu, Kenya

Preliminary findings from latent class analysis (15-24yrs, n=1,014)

LOWER

VULNERABILITY

71% of sample

HIGHER

VULNERABILTY

29% of sample

Slide7

AGYW’s relationship power in Kenya

*p < 0.05

Pulerwitz, Mathur, and Woznica. (2018) How empowered are girls/young women in their sexual relationships?: relationship power, HIV risk, and partner violence in Kenya.

PLoS

ONE. 13(7): e0199733.doi:10.1371/journal.pone.0199733

Slide8

Relationship power, sexual violence & HIV riskAGYW who experienced sexual violence were 2x as likely to report an STI symptom, and anxiety and depression

Pulerwitz, Mathur, and Woznica. (2018) How empowered are girls/young women in their sexual relationships?: relationship power, HIV risk, and partner violence in Kenya. PLoS ONE. 13(7): e0199733. doi: 10.1371/journal.pone.0199733; Mathur, Okal, Musheke, et al. Forthcoming (PLoS ONE). High rates of sexual violence by both intimate and non-intimate partners experienced by adolescent girls and young women in Kenya and Zambia: Findings around violence and other negative health outcomes.

Less sexual and physical violence

More condom use at last sex

More knowledge of partner’s HIV status

Having relationship power strongly associated

with:

Sexual violence experience in the last 12 months

From

partners

(n=597)

From

non-intimate partners

(n=1,778)

19%

21%

Slide9

Conflict & miscommunication characterize relationships

Study site: Uganda (n=94 IDIs with male partners of AGYW)

Slide10

PrEP power dynamics in the health care setting

Adj.

IRR

1

(95% CI)

Negative

attitudes toward AGYW sexuality

0.81

(0.66–0.99)*

Behavioral Disinhibition scale

0.89

(0.79

0.99)*

Pilgrim, N. et al. (2018) Provider perspectives on

PrEP

for adolescent girls and young women in Tanzania: The role of provider biases and quality of care.

PLoS ONE 13(4): e0196280. doi: 10.1371/journal.pone.0196280.

Some of us are very critical and judgmental. We just judge someone, “Ooh you came again? Last time you had gonorrhea, did you do it again?”

—Service

provider

,

age

32

Factors associated with providers’ willingness to prescribe

PrEP

(n=316)

1

Adjusted for provider demographics, prior

PrEP

knowledge, other facility factors (e.g., stockouts)

*p<0.05

Slide11

Framework for

PrEP introduction to AGYW

Mathur, S, Pilgrim N, and Pulerwitz, J. (2016)

PrEP

introduction for adolescent girls & young women.

The Lancet HIV

3(9): e406-e408.

Slide12

Implications/next steps

Gender-related dynamics accentuate HIV risk and inhibit service useUnpacking these relationships can provides useful insights for strengthening program/policyShould be more consistently measured in programs Phase 2 DREAMS Implementation Science will explore program effectsWhat worked, when, for whom, and why?

Slide13

Pulerwitz, Julie and Sanyukta Mathur. 2018. “Addressing adolescent girl and young women’s risk and empowerment: Emerging lessons from the DREAMS Partnership.” Presented at 22nd International AIDS Conference (AIDS 2018), Amsterdam, The Netherlands, 24 July.

Slide14

The

Population Council

conducts biomedical, social science, and public health research. We deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world.