Assessment of HIV Prevention Needs of West Kenyan Adolescents: Implications for Intervention Adaptation

Thesis (Ph.D.)--University of Washington, 2013University of Washington Abstract Assessment of HIV Prevention Needs of West Kenyan Adolescents: Implications for Intervention Adaptation Amelia S. Knopf Chair of the Supervisory Committee: Professor Elaine Adams Thompson Department of Psychosocial and Community Health, School of Nursing Purpose: The purpose of this dissertation study was to examine early sexual partnerships of west Kenyan adolescents and their sociocultural context in order to shape an HIV prevention program to meet their needs. The impetus for this dissertation research came from a previous study conducted with Kenyan adults in North Nyamware, a village in Nyanza Province, which is an epicenter of the global HIV epidemic. This dissertation describes three studies (Chapters 2 through 4), which were conducted to address the following goals: 1. Describe the characteristics of rural west Kenyan adolescents' sexual debut and the patterns of sexual partnerships in adolescence and young adulthood. 2. Examine the prevalence of concurrent, or temporally overlapping, sexual partnerships in west Kenyan adolescents. 3. Assess the feasibility and acceptability of the first component of the KYN concurrency reduction intervention for use with adolescents aged 13 to 17. Methods: In the first study (Chapter 2) data from two household surveys of Kenyan adolescents and adults were acquired from the United States Centers for Disease Control and Prevention (CDC). The Asembo Baseline Cross-Sectional Study (Asembo BCS) and Gem Baseline Cross-Sectional Study (Gem BCS) were used to describe the features of sexual debut and to cluster respondents by features of their sexual debut. In the second study (Chapter 3) the Asembo BCS and Gem BCS data were examined to estimate the prevalence of concurrent, or temporally overlapping, sexual partnerships among rural Nyanza adolescents aged 13 to 19. In the third study, (Chapter 4) qualitative data were collected from adult and adolescent stakeholders to assess the feasibility and acceptability of a concurrency reduction intervention called Know Your Network (KYN). The data were analyzed using a thematic approach to content analysis, and the results used to inform the adaptation of KYN for use with adolescents aged 13 to 17. Results: The results from study one indicate 20% of adolescents reached sexual debut before age 13, and the median debut age for males and females was relatively young (14 years, 15 years, respectively), underscoring the importance of targeting young adolescents for pre-risk HIV prevention efforts. Features of sexual debut can be used to cluster groups of respondents into distinct groups with different typologies of debut. Study two results estimate the point prevalence of concurrency on the date of interview was 2.2% among the entire sample of adolescents, and 4.4% for sexually experienced adolescents. Study three results reveal rural Nyanza adults and adolescents are concerned about HIV among youth and find current resources insufficient for addressing their concerns. KYN elements were difficult for 13 to 14 year olds to understand but were feasible and acceptable for use with 15 to 17 year olds. Conclusions: This study has several important implications for HIV prevention. First, efforts to prevention HIV infection in rural Nyanza must target very young adolescents for effective primary prevention. Second, multiple features of sexual debut can be used to more fully describe a complex, multidimensional experience. Third, adults expressed interest in getting HIV prevention messages to youth, and youth expressed interest in hearing such messages, but both agreed the current informational resources are inadequate. Finally, the KYN intervention offers information older youth find interesting and relevant to their lives and the lives of other youth. Taken together, the studies in this dissertation can be used to inform HIV prevention efforts for Nyanza youth, whose healthy transition to adulthood is critical to Kenya's success in the battle against HIV and AIDS

Mobilizing a Medical Home to Improve HIV Care for the Homeless in Washington, DC

African Americans face a higher burden of HIV infection, morbidity, and mortality than other ethnic groups in the United States. As an organization that exists to serve the homeless and impoverished of Washington, DC, So Others Might Eat (SOME) works diligently to address this disparity. SOME's clients are primarily African Americans who often face obstacles to HIV care because of low socioeconomic status, mistrust of the medical establishment, and fear of being identified as HIV positive. We relate the lessons we learned at SOME's medical clinic while trying to better address the needs of our clients living with HIV/AIDS. Chief among those lessons was the need to shift from considering our patients “noncompliant” with their HIV-related care to recognizing they had needs we were not addressing