Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort.

OBJECTIVE: To investigate whether the incidence of HIV infection is higher among sexually active women using depot medroxyprogesterone acetate (DMPA) or noresthisterone enanthate (NET-EN) injections for contraception than among women using nonhormonal or no contraception. METHODS: Five hundred and fifty-one initially HIV-negative women were followed up for a total of 491 person-years. Participants were interviewed, counselled, examined, tested for HIV and other STIs, and treated, at three monthly intervals for 1 year. RESULTS: There was no significant association between progestin contraceptive use and HIV infection (rate ratio 1.1, 95% CI 0.5 to 2.8; log-rank test, p=.73). In proportional hazards regression, the only significant hazard ratios for HIV acquisition were prevalent Neisseria gonorrhoea (5.2; 95% CI 1.1 to 23.7, p=.035) and Trichomonas vaginalis (4.8; 95% CI 1.0 to 22.8, p=.049); bacterial vaginosis was marginally significant (2.8; 95% CI 1.0 to 8.3, p=.057). The adjusted hazard ratios for NET-EN and DMPA were 1.76 (95% CI 0.64 to 4.84) and 0.46 (95% CI 0.06 to 3.79), respectively, relative to nonuse. Five hundred and twelve of 551 women had one or more confirmed STIs during the study. CONCLUSIONS: There is no evidence of an association between HIV infection and injectable contraceptives. Due to the limited power of this study and because similar studies have not included young women using NET-EN, we recommend that further research be carried out to focus on the use of NET-EN and HIV acquisition in high risk groups

Assessment of Service Availability and Health Care Workers' Opinions about Young Women's Sexual and Reproductive Health in Soweto, South Africa

Young women in South Africa experience high HIV and unintended pregnancy rates. Health care workers' (HCWs') opinions about sexual and reproductive health (SRH) issues impact young women's ability to access SRH services. We explored HCW opinions through interviews with a purposive sample of 29 HCWs in three primary health clinics in Soweto, South Africa and examined service availability through facility assessments. Most HCWs believed young women should not have sex before marriage and thought that young women ignore information they receive about HIV and pregnancy prevention. HCWs acknowledged outside factors influencing young women's ability to protect themselves. Most thought injectables were the most appropriate contraception for young women; all recognized the importance of condoms for dual protection. Some services were only reported to be provided to those over 18 years. HCWs may benefit from workshops providing technical and policy information and values clarification exercises highlighting the impact of opinions on service provision (Afr J Reprod Health 2012 (Special Edition); 16[2]: 283-293).Les jeunes femmes en Afrique du Sud connaissent de taux élevés du VIH et de grossesse non voulues. Les opinions des membres du personnel soignant (MPS) sur les problèmes de la santé sexuelle et de reproduction (SSR) influencent la capacité des jeunes femmes d'avoir accès aux services de la SSR. Nous avons exploré les opinions des MPS à travers les interviews en profondeur avec un échantillon calculé de 29 MPS dans trois cliniques de santé primaire à Soweto, Afrique du Sud et nous avons examiné la disponibilité des services à travers les évaluations des établissements. La plupart des MPS ont cru que les jeunes ne devraient pas avoir des rapports sexuels avant le mariage et ont cru que les jeunes femmes ignorent les informations concernant le VIH et la prévention de la grossesse. Les MPS ont reconnu les facteurs extérieurs qui influent sur la capacité des jeunes femmes de se protéger. La plupart croyaient que les injectables constituaient la contraception la plus appropriée pour les jeunes femmes ; toutes les femmes reconnaissaient l'importance des préservatifs pour une double protection. Certains services ont été rendus aux femmes qui avaient plus de 18 ans. Les MPS peuvent profiter des ateliers qui donnent des informations sur les techniques et la politique ainsi que les exercices sur la clarification de valeurs qui ne mettent pas en lumière les influences des opinions sur l'assurance des services (Afr J Reprod Health 2012 (Special Edition); 16[2]: 283-293).)

Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention

Youth trauma exposure is associated with syndemic HIV risk. We measured lifetime prevalence, type, and correlates of trauma experience by gender among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa. Methods Using data from the Botsha Bophelo Adolescent Health Survey (BBAHS), prevalence of “ever” experiencing a traumatic event among adolescents (aged 14–19) was assessed using a modified Traumatic Event Screening Inventory-Child (TESI-C) scale (19 items, study alpha = 0.63). We assessed self-reported number of potentially traumatic events (PTEs) experienced overall and by gender. Gender-stratified multivariable logistic regression models assessed independent correlates of ‘high PTE score’ (≥7 PTEs). Results Overall, 767/830 (92%) participants were included (58% adolescent women). Nearly all (99.7%) reported experiencing at least one PTE. Median PTE was 7 [Q1,Q3: 5-9], with no gender differences (p = 0.19). Adolescent men reported more violent PTEs (e.g., “seen an act of violence in the community”) whereas women reported more non-violent HIV/AIDS-related PTEs (e.g., “family member or someone close died of HIV/AIDS”). High PTE score was independently associated with high food insecurity among adolescent men and women (aOR = 2.63, 95%CI = 1.36-5.09; aOR = 2.57, 95%CI = 1.55-4.26, respectively). For men, high PTE score was also associated with older age (aOR = 1.40/year, 95%CI = 1.21-1.63); and recently moving to Soweto (aOR = 2.78, 95%CI = 1.14-6.76). Among women, high PTE score was associated with depression using the CES-D scale (aOR = 2.00, 95%CI = 1.31-3.03,) and inconsistent condom use vs. no sexual experience (aOR = 2.69, 95%CI = 1.66-4.37). Conclusion Nearly all adolescents in this study experienced trauma, with gendered differences in PTE types and correlates, but not prevalence. Exposure to PTEs were distributed along social and gendered axes. Among adolescent women, associations with depression and inconsistent condom use suggest pathways for HIV risk. HIV prevention interventions targeting adolescents must address the syndemics of trauma and HIV through the scale-up of gender-transformative, youth-centred, trauma-informed integrated HIV and mental health services.Non UBCMedicine, Faculty ofReviewedFacult

Additional file 1: of Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention

Comparison of potentially traumatic event items assessed within the Botsha Bophelo Adolescent Health Survey and TESI-C items. (DOCX 101 kb