Comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in sub-Saharan Africa.

James Boadu Frimpong,Bright Opoku Ahinkorah,Aliu Mohammed,Abdul-Aziz Seidu,Justice Kanor Tetteh,Eugene Budu,Collins Adu

doi:10.1017/s0021932021000493

Abstract

Globally, HIV/AIDS remains a public health issue, especially in sub-Saharan Africa (SSA). Despite the increased advocacy and dissemination of comprehensive HIV/AIDS information in SSA, it appears that little progress has been made to reduce the incidence of HIV/AIDS in the sub-region. This study, therefore, examined the association between comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in SSA. Data were taken from the Demographic and Health Surveys conducted between 2010 and 2019 in 30 countries in SSA. The study sample comprised 37,364 adolescent girls and young women aged 15-24. A multivariable binary logistic regression analysis was done to test the hypothesis that there is a positive association between comprehensive HIV/AIDS knowledge and safer sex negotiation. Adolescent girls and young women who had comprehensive knowledge on HIV/AIDS were more likely to negotiate for safer sex compared with those who had no comprehensive knowledge on HIV/AIDS (AOR=1.31, 95% CI: 1.22-1.41). At the country level, the positive association between comprehensive knowledge on HIV/AIDS and safer sex negotiation was significant in Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi. On the other hand, in Togo, adolescent girls and young women who had comprehensive HIV/AIDS knowledge were less likely to negotiate for safer sex. These findings can inform policies and programmes on the crucial role of comprehensive HIV/AIDS education and knowledge in increasing safer sex negotiation among adolescent girls and young women in SSA. The study recommends that Togo needs to address certain practices such as intimate partner violence against adolescent girls and young women, which prevent them from negotiating for safer sex, despite their higher knowledge on comprehensive HIV/AIDS. Lessons can be learnt from Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi about the scale-up of programmes and interventions targeted at young women.

Highlights

HIV/AIDS remains a public health concern in sub-Saharan Africa (SSA) (World Health Organization [WHO], 2018)
Adolescent girls and young women (AGYW) in SSA are at higher risk of contracting HIV than their male peers as a result of early marriage, which predisposes them to HIV acquisition (Mavhu et al, 2018)
As shown in Model II, women who had comprehensive knowledge on HIV/AIDS were more likely to have safer sex negotiation compared with those who had no comprehensive knowledge on HIV/AIDS (AOR=1.31, 95% confidence intervals (CIs): 1.22–1.41)

Summary

Introduction

HIV/AIDS remains a public health concern in sub-Saharan Africa (SSA) (World Health Organization [WHO], 2018). In SSA, AGYW’s ability to negotiate for safer sex has been a major problem associated with HIV incidence since men are regarded as being more influential and domineering when it comes to sexuality decision-making (Saul et al, 2018; Darteh, 2020). In SSA, interventions such as comprehensive sex education, the promotion of condom use, Determined, Resilience, Empowered, AIDS-free, Mentored and Safe (DREAMS), among others, aim to enhance AGYW’s control in reproductive issues and these efforts are making some progress (Saul et al, 2018). Several socioeconomic and cultural factors, including place of residence, marital status, age and educational level, have been found to be associated with AGYW’s ability to negotiate for safer sex (Exavery et al, 2012; Darteh et al, 2014; Ameyaw et al, 2017). The findings of the study could help inform policy formulation in the sub-region in order to reduce the incidence of HIV/AIDS and unintended pregnancies

Methods

Findings

Discussion