Vulnerability profiles and prevalence of HIV and other sexually transmitted infections among adolescent girls and young women in Ethiopia: A latent class analysis.

Carly A Comins,Samuele A Abebe,Stefan Baral,Sheree R Schwartz,Andargachew Mulu,Katherine B Rucinski,Andrew R Dalby

doi:10.1371/journal.pone.0232598

Carly A Comins, Samuele A Abebe + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0232598

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Abstract

BackgroundAdolescent girls and young women (AGYW) aged 15–24 years have among the highest risk for HIV and other sexually transmitted infections (STI) across sub-Saharan Africa. A latent class analysis (LCA) was conducted to identify intersecting social- and structural-level determinants of HIV/STI acquisition among AGYW in Ethiopia.MethodsAGYW were recruited from venues using time-location sampling, completing an interviewer-administered behavioral survey and biological testing for HIV, syphilis, and chlamydia. LCA was used to identify distinct groups, defined by social- and structural-level determinants of HIV/STI risk, among AGYW. Prevalence ratios (PR) and 95% confidence intervals (CI) compared differences in HIV/STI prevalence by group.ResultsA total of 1,501 AGYW were enrolled across Addis Ababa (March–May 2018) and Gambella (June–July 2019). We identified three patterns of vulnerability defined by schooling status, migration history, food insecurity, orphan status, social support, and employment. We labeled these groups as “highly vulnerable” (representing ~21% of the population), “stable, out-of-school, migrated” (~42%), and “stable, in-school, never migrated” (~37%). STI prevalence was nearly two-fold higher among AGYW in the “highly vulnerable” group compared to AGYW in the “stable, in-school, never migrated” group (PR 1.93; 95% CI 1.33, 2.80).ConclusionsCharacterizing patterns of vulnerability among AGYW that reflect higher-level social and structural factors can help facilitate early identification of AGYW at the highest risk of HIV/STI acquisition, thus differentiating groups of AGYW who may most benefit from targeted HIV prevention interventions during adolescence and early adulthood.

Highlights

In countries across the continent of Africa, nearly 60% of people are under the age of 25 and it is the only continent in the world where the population of youth is growing [1, 2]
We identified three patterns of vulnerability defined by schooling status, migration history, food insecurity, orphan status, social support, and employment
sexually transmitted infections (STI) prevalence was nearly two-fold higher among AGYW in the “highly vulnerable” group compared to AGYW in the “stable, in-school, never migrated” group (PR 1.93; 95% confidence intervals (CI) 1.33, 2.80)

Summary

Introduction

In countries across the continent of Africa, nearly 60% of people are under the age of 25 and it is the only continent in the world where the population of youth is growing [1, 2]. A third of all new HIV infections in countries across sub-Saharan Africa occurred among youth aged 15–24 [3]. In Ethiopia, a country of more than 106 million, more than 610,000 people are living with HIV [3, 4] and HIV prevalence is estimated as 2.9% among those 15–49 years of age [5]. Similar to other countries in the region, women of reproductive age are twice as likely to be living with HIV [5] than men aged 15–49. Given that AGYW are thought to comprise more than half of all urban migrants in Ethiopia [9], there is an urgent need to prioritize and identify groups of AGYW who are most vulnerable to HIV and other STIs

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Conclusion