Exploratory analysis of the ecological variables associated with sexual health profiles in high-risk, sexually-active female learners in rural KwaZulu-Natal.

Hilton Humphries,Quarraisha Abdool Karim,Lucia Knight,Farzana Osman

doi:10.1371/journal.pone.0195107

Abstract

PurposeYoung women are at high risk for negative sexual health outcomes. Despite their high risk, many sexually-active women never experience negative sexual health outcomes. This study explored the ecological risk factors associated with the risk profiles of sexually-active female high school-learners in rural KwaZulu-Natal, South Africa.MethodsUsing baseline data from N = 596 sexually-active school-going women, we explored the ecological factors associated with being sexually-active and managing risk successfully [SARS] or unsuccessfully [SARU]. Generalised estimated equations (GEE) were applied to data collected at multiple levels while adjusting for school and other included variables. GEE were used to calculate probability of being SARU.ResultsAmongst SARU learners, 21.9% had HIV, 38.6% had HSV-2, 12.5% were pregnant, 28.7% self-reported STI symptoms and 51.9% reported a previous pregnancy. Individual-level factors had the greatest impact on being SARU. Univariate and multivariate analysis highlighted several important partner factors associated with SARU. Age was significantly associated with the risk profiles (p<0.0001), a greater proportion of SARU learners were 18 or older compared to the SARS learners. The odds of being SARU decreased when ≥18 years (aOR = 0.2577, 95% CI 0.1462–0.4542) or if not falling pregnant was important (aOR = 0.6343, 95% CI 0.4218–0.9538). Having >1 HIV test (aOR = 2.2161, 95% CI 1.3964–3.5169) increased the odds a SARU profile.ConclusionIndividual and partner level factors are important for the sexual health profile of an adolescent female. While the exploratory findings require further research; managing multiple sexual health outcomes, tailoring responses around a risk profile and including partners is essential for successful interventions.

Highlights

Adolescents are at high risk of experiencing negative sexual health outcomes (HIV infection, STI infection and early pregnancy)[1,2]
Age was significantly associated with the risk profiles (p
The odds of being SARU decreased when !18 years or if not falling pregnant was important

Summary

Introduction

Adolescents are at high risk of experiencing negative sexual health outcomes (HIV infection, STI infection and early pregnancy)[1,2]. The prevalence of negative sexual health outcomes is unacceptably high, with young women bearing the highest burden[2,3,4,5]. Recent data suggests that 10–20% of young people aged 15–24 years old in sub-Saharan Africa are sexually active and potentially at risk of a negative sexual outcome[1]. Despite the high-risk context of South Africa, only some sexually active young women experience negative SRH outcomes. There has been less investigation into the differences between sexually active young women, and why despite similar high-risk settings, some manage to avoid negative SRH outcomes while others do not. An understanding of why some young women manage their SRH risk better than others is critical for designing contextualised and localised prevention interventions that better target high-risk adolescents

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Results

Conclusion