Adolescents In Botswana Research Articles

Prevalence and predictors of suicidal behaviours among primary and secondary school going adolescents in Botswana.

There is a scarcity of studies on the prevalence and predictors of suicide behaviors among primary and secondary school going adolescents aged 10-19 years in Botswana hence, this study would fill that gap. This study used cross-sectional secondary data from Botswana Youth Risk Behavior and Biological Surveillance Survey (BYRBBSS), 2010. Multivariable binary logistic regression models were used to investigate the predictors of suicide behaviours. The study shows that 51.5% of the respondents reported having ever contemplated suicide while 40.1% of the respondents attempted suicide in the last 12 months before the survey. The study found that male learners (AOR = 0.61, 95% CI = 0.44-0.83), learners who were not attacked or threatened or injured by someone (AOR = 0.35, 95% CI = 0.17-0.72), who were not bullied (AOR = 0.22, 95% CI = 0.13-0.39), and who were confident of themselves (AOR = 0.55, 95% CI = 0.39-0.76) were less likely to contemplate suicide. Whereas learners with primary school level education were more likely to contemplate suicide (AOR = 2.12, 95% CI = 1.14-3.95). Males were less likely than their female counterparts to attempt suicide (AOR = 0.68, 95% CI = 0.47-0.97). Regarding attempt, learners who had self-confidence (AOR = 0.35, 95% CI = 0.24-0.50), not being bullied (AOR = 0.20, 95% CI = 0.11-0.35), not being attacked or threatened or injured by someone (AOR = 0.35, 95% CI = 0.18-0.69), not engaging in a physical fight that led to injury (AOR = 0.34, 95% CI = 0.19-0.61) were less likely to attempt suicide. Whereas being at primary school (AOR = 5.29, 95% CI = 2.58-10.86), and missing classes once or more in a week (AOR = 1.70, 95% CI = 1.05-2.76) were associated with increased likelihood of suicide attempt. The study shows that suicide behaviours as big challenges in Botswana among primary and secondary school going adolescents aged 10-19 years. Thus, the study recommends policy interventions aiming at including education on peer bullying or fighting or attack at primary and secondary education levels if not already in existence. There should also be interventions aiming at educating guardians and teachers on consequences of bullying or fighting so that they should consistently remind their children not to bully and for them to open up if they are being bullied. The study further recommends that schools and communities at large should have a psychosocial system for bullying or fighting reporting, follow-up, and appropriate corrective interventions for the offenders. There should also be self-confidence instilling education as well as sex/gender-specific interventions for instance girls can be given platform (private if necessary) to express peculiar problems to them that need specific help.

Psychoactive Substance Use Disorder in HIV-Infected Adolescents in Botswana: A Comparison Between the Congenitally Infected and Behaviorally Infected Adolescents.

Substance use is a major obstacle to preventing and managing HIV among adolescents, who account for 30% of new infections in many parts of the world, including Botswana. Unfortunately, there is a paucity of data on adolescent substance use, especially in the region. Therefore, this study aimed to determine the pattern of psychoactive substance use in adolescents living with HIV (ALWHIV). It also aimed to compare and explore the pattern of substance use disorders and associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs). Six hundred and thirty-four ALWHIV were interviewed using a sociodemographic questionnaire, the WHO drug questionnaire, and DSM-5 criteria for substance use disorder. The participants' mean age (SD) was 17.69 (1.6) years, with a male predominance (n = 336, 53%), and the majority (n = 411, 64.8%) were CIAs. Alcohol was the most used substance among the participants, with 15.8% admitting to its current use. The BIAs were more likely to have SUD (χ2 = 17.2, P < .01), use more than one substance (χ2 = 20.3, P < .01), and more likely to use all psychoactive substances except for inhalants. In the CIAs, regular participation in religious activities was negatively associated with SUD (AOR = 0.36; 95% CI: 0.17-0.77), while struggling with HIV status acceptance was positively associated with SUD (AOR = 2.54; 95% CI: 1.15-5.61) in the BIAs. This study showed a huge burden and similar pattern of substance use disorders among the ALWHIV in Botswana, as reported elsewhere. It also identified the dissimilarities between the BIAs and CIAs regarding substance-related issues and suggested the need for differentiated care.

Test-Retest Reliability of a Computerized Neurocognitive Battery in School-Age Children with HIV in Botswana.

Human immunodeficiency virus (HIV) infection is prevalent among children and adolescents in Botswana, but standardized neurocognitive testing is limited. The Penn Computerized Neurocognitive Battery (PennCNB) attempts to streamline evaluation of neurocognitive functioning and has been culturally adapted for use among youth in this high-burden, low-resource setting. However, its reliability across measurements (i.e., test-retest reliability) is unknown. This study examined the test-retest reliability of the culturally adapted PennCNB in 65 school-age children (age 7-17) living with HIV in Botswana. Intraclass correlation coefficients (ICCs) for PennCNB summary scores (ICCs > 0.80) and domain scores (ICCs = 0.66-0.88) were higher than those for individual tests, which exhibited more variability (ICCs = 0.50-0.82), with the lowest reliability on memory tests. Practice effects were apparent on some measures, especially within memory and complex cognition domains. Taken together, the adapted PennCNB exhibited adequate test-retest reliability at the domain level but variable reliability for individual tests. Differences in reliability should be considered in implementation of these tests.

Substantial Increase in Transactional Sex and HIV Risk Among Adolescents During the COVID-19 Pandemic: Results From a Repeated Cross-Sectional Study in Botswana.

The COVID-19 pandemic and resulting public health response has disrupted the lives of adolescents and their families worldwide. We evaluated the impact of the pandemic on attitudes, beliefs, and sexual risk behavior among adolescents in Botswana. Participants were recruited using household-based sampling across residential districts (blocks) in and around Gaborone, Botswana, and completed surveys on laptop computers at a private, central location. We compared baseline survey data from 380 adolescents who completed the survey pre-pandemic (n = 139) to those who completed the survey intra-pandemic (n = 241). Participants had a mean age of 15.2 years; 58.6% were girls and 41.4% were boys. Intra-pandemic, participants reported greater engagement in transactional sex (38.1% compared to 13.6% pre-pandemic, p <. 05), more favorable attitudes toward transactional sex with sugar daddies and sugar mommies (p <. 05), greater intentions to remain sexually active in the future (29.2% vs.13.6%, respectively, p <.05), and lower self-efficacy in handling risky sexual situations (p < .01). Public health interventions that lessen these concerning shifts in attitudes and behaviors will be key to protecting the sexual health of adolescents and to supporting their safe transition to adulthood.

Psychiatric disorders and associated risk factors in a sample of adolescents in Gaborone, Botswana: a cross-sectional study

BackgroundDespite the high proportion of adolescents living with mental health issues in low- to middle-income countries (LMICs), especially in Botswana, there is a significant deficit of local research to guide an increase in prevention and treatment. We, therefore, aimed to assess the prevalence and associated risk factors of psychiatric disorders (PD) in a sample of secondary school students in Botswana.MethodsThis cross-sectional study included 750 students from the 13 public secondary schools in Gaborone using a multi-stage sampling technique. The Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was used to screen for PDs.ResultsThe participant’s mean age was 15.26 and SD 1.57 years, with 53.6% being female. Approximately 34% had a PD, with depression being the commonest, of whom 35% were neither receiving treatment nor aware of the available services. Perinatal complications (AOR = 4.29; 95%CI: 1.04–17.70), a family history of mental illness (AOR = 2.19; 95%CI: 1.17–4.11) and substance-related problems (AOR = 1.80; 95% CI:1.22–2.65) predicted the likelihood of developing PD.ConclusionsOur findings revealed that adolescents in Botswana have many mental health issues which may affect their developmental phases. A multi-sectoral collaboration is needed for the timely detection of identified risk factors and initiation of the necessary prevention and treatment measures.

Mediation Analysis of a Theory-Based Culture and Age-Appropriate HIV/STI Prevention.

Few studies have investigated mediator effects of HIV prevention interventions on adolescents in sub-Saharan Africa. Herein, we report on a secondary analysis of an intervention that increased intentions to use condoms, abstain from sexual intercourse, and seek safe male circumcision among adolescents in Botswana. In a study conducted in Botswana, 806 grade 9 students from 21 public Junior Secondary Schools were randomly assigned to either the OWN THE FUTURE: Pulling Together We Will" ( PTWW) intervention group or a health promotion control group. Both conditions consisted of 12 1-h modules, with two modules delivered during each of the six sessions on six consecutive school days. The students in both groups completed confidential computer-based surveys at several time points: pre-, immediately post-, 3, 6, and 12months post-intervention. Mediation was assessed using the product-of-coefficients approach in a generalized estimating equations (GEE) framework. The analyses showed that condom use beliefs were significant mediators of the intervention effect on the intention to consistently use condoms over time. Also, negative socio-cultural beliefs, prevention beliefs, and HIV/STI knowledge were significant mediators of the intervention's effects on the intention to abstain from sex. Additionally, normative beliefs, prevention beliefs, parental negotiation, and circumcision knowledge were significant mediators of the intervention's effect on intention to seek safe male circumcision. The mediation analysis delineated a theoretical model and isolated activities that positively impact condom use, abstinence from sex, and circumcision intentions of Batswana middle school adolescents.

Building a Community Based Mental Health Program for Adolescents in Botswana: Stakeholder Feedback.

When planning interventions for adolescents, adult interventions should not be used 'as is' in youth settings. Stakeholder engagement can help understand the overall adolescent mental health ecosystem and adapt existing evidence-based interventions for the youth. To understand the overall mental health needs of adolescents in Botswana and the necessary adaptations required for an adolescent lay counselor based intervention in the country. We used the theory of change model and the nominal group technique in five stakeholder meetings. Meetings were held to discuss the mental health needs of youth in Botswana and identify priorities for a lay counsellor based intervention modelled after the Friendship Bench intervention, an existing mental health intervention for adults. The root causes of mental health problems among Botswana's youth identified by stakeholders included limited mental health knowledge among the youth and the community, family problems, poor communication, low self-esteem, the rapid growth of technology, and biological/genetic predisposition. Structurally barriers included: mental illness-related stigma, lack of psychosocial support, incomplete follow up for health services, cultural beliefs about mental illness, and fragmented mental health services. The stakeholders envisage a program that could empower adolescents and youth counselors to address mental health concerns for a healthier community. The group identified and prioritized several key elements of an effective lay counselor intervention. A diverse group of community stakeholders can illustrate critical mental health needs and elements that countries could use to adapt and contextualize a lay counsellor based mental health intervention for new populations such as the youth.

Acceptability of a Computerized Neurocognitive Battery to Identify Cognitive Impairments Among Children and Adolescents in Botswana

Human immunodeficiency virus (HIV) infection and in utero exposure increase the risk of neurocognitive deficits, but comprehensive neurocognitive screening is unavailable in settings with high HIV prevalence (e.g., Sub-Saharan Africa). The Penn Computerized Neurocognitive Battery (PennCNB) was culturally adapted and translated for use among children and adolescents in Botswana. To prepare for the implementation process, this study assessed perceptions of acceptability, a leading indicator of implementation success, of the adapted PennCNB among a cohort of HIV+ and HIV-exposed-uninfected (HEU) young people (N = 155, aged 7–17 years) in Gaborone, Botswana. Immediately following completion of the PennCNB, participants completed a three-point Likert scale survey eliciting perspectives of acceptability of the overall PennCNB and the 13 individual subtests and provided open-ended responses to elaborate upon acceptability ratings. Descriptive statistics were calculated, and predictors (age, sex, and PennCNB performance) of unacceptable response were evaluated using logistic regressions. A content analysis was completed on the open-ended responses. Participants reported high acceptability of the overall PennCNB (98%). Of the subtests, the Penn Trailmaking Test, Part A (measuring sensorimotor/processing speed) received the highest acceptability rating (82%), while the Penn Face Memory test (measuring episodic memory) was the least acceptable (40% unacceptable). Age and performance on the PennCNB were associated with an unacceptable response for Fractal N-Back (OR 0.873) and the Penn Line Orientation Test (OR 0.620), respectively. Themes about the content of the cognitive assessment, features of the tests, and participant characteristics were articulated as reasons for reporting the PennCNB subtests as acceptable or unacceptable. Overall, this research offers promise for successful implementation of the PennCNB for use among pediatric populations in Botswana.

Contraceptive literacy among school-going adolescents in Botswana.

AimTo examine adolescent contraceptive literacy and condom knowledge in Botswana.BackgroundIn Botswana, adolescent HIV infection rates remain high and unintended pregnancies are the predominant reason girls drop out of school. Despite a national mandate for comprehensive sexuality education and youth‐friendly health services, access to accurate sexual and reproductive health information for adolescents remains limited.MethodsTwo hundred forty adolescents attending secondary schools in Maun, Botswana, completed cross‐sectional surveys in 2020. Bivariate and logistic regression examined factors associated with contraceptive literacy and self‐reported condom knowledge.FindingsAlthough 90% of students were aware of one or more forms of contraception, only 67% could name a method for which they knew a source and only half of sexually active respondents had used birth control during their last sexual experience. Respondents reported that teachers and family members were the most important sources of information; only 8.2% of respondents identified health professionals in that role. Adolescents who consulted nurses had eight times greater odds of reporting correct condom‐use knowledge than those who consulted teachers.Implications for Nursing PolicyThe positive association between adolescents’ condom‐use knowledge and nurses as information resources supports a call to expand nurses’ role in health education in secondary schools and clinics in Botswana. Education and training programs for health professionals that build communication skills for working with adolescents should be promoted as an essential step in youth‐friendly service provision.ConclusionContraceptive literacy among adolescents in Botswana is low and may contribute to risk behaviors that drive rates of HIV and pregnancies in this population. Interventions to reduce adolescent HIV risk behaviors and unintended pregnancy may prove more effective if they involve nurses as communicators and educators.

Explicating factors that explain condom use intention among in-school adolescents in Botswana: a structural equation modelling approach

ABSTRACT Knowledge with respect to adolescents’ intentions to engage in protective sexual behaviours is still deficient in numerous countries around the world, particularly in Sub-Saharan Africa (SSA) where HIV prevalence is the highest. Increasing cross-sectional research suggests that the theory of planned behaviour (TPB) is robust in predicting condom use intentions. This study used secondary, baseline data from a study involving 794 in-school adolescents. A structural equation model was applied to the data. Latent variables were used to validate the applicability of the TPB in HIV/AIDS prevention among adolescents in the Botswana context. The predictors of interest were all derived from the TPB. The results revealed that the TPB predictors, apart from affective and instrumental attitude, were predictive of condom use intention among Batswana adolescents. The independent variables explained 57% of the variance in the model. These results suggest that the TPB is recommended as a framework to establish the predictors of condom use intention among Batswana in-school adolescents. Policy makers working on developing HIV education programmes or interventions targeted at adolescents should improve the intention to use condoms via promotion of positive instrumental attitudes, subjective norms and perceived behavioural control beliefs of condom use.

Detection of Inducible Replication-Competent HIV-1 Subtype C Provirus Despite Long-Term Antiretroviral Treatment in Perinatally Infected Adolescents in Botswana.

Although antiretroviral therapy (ART) effectively suppresses HIV replication, the latent reservoir remains the barrier to HIV eradication. It remains unknown whether long-term ART impacts levels of inducible replication-competent provirus. To address this knowledge gap, we assessed the proviral reservoir in HIV-1 perinatally infected adolescents having received ART for >13 years. We recruited 15 vertically infected adolescents living with HIV in Botswana. Historical viral load, CD4+ T cell count, and treatment data were retrieved from their outpatient medical records. Inducible replication-competent proviruses from cryopreserved peripheral blood mononuclear cells were quantified using a TZM-bl based assay (TZA). Total proviral DNA copies were quantified using droplet digital PCR. The mean age of study participants was 16 years (standard deviation = 0.7) and median CD4+ T cell count at enrollment was 784 [interquartile range (IQR) = 728.8-1,288] cells/mm3. Median age at ART initiation was 8 (IQR = 6-12) months. Fourteen (93%) participants had HIV-1 RNA <400 copies/mL at the time of enrollment in the study. A median of 19 (IQR = 18-27) HIV-1 RNA measurements were available per participant. Six (40%) participants displayed viral suppression at all clinic visits since initiating ART, whereas the remaining 9 (60%) had one or more clinic visits with detectable HIV-1 RNA. The median inducible replication-competent provirus count was 7.4 infectious units per million cells (IQR = 6.7-19.2), and did not differ significantly by either complete or incomplete viral suppression (7.2 vs. 7.4, p = .86), or by age at ART initiation (7.4 if <12 months, 11.2 if >12 months, p = .85). The median total HIV DNA count was 129.1 copies per million cells (IQR = 18.9-212.3). Our data suggest that long-term ART initiated within the 1st year in perinatally infected infants did not eliminate proviral DNA or inducible replication-competent proviruses.

Prevalence of hypertension and selected cardiovascular risk factors among adolescents in selected rural and urban secondary schools in Botswana.

Adolescent hypertension and other cardiovascular risk factors tend to track into adulthood. Consequently, there is a need to determine the prevalence of hypertension and pre-hypertension, and its co-existence with glycaemia, obesity, tobacco and alcohol use among senior secondary school students in Botswana. A cross-sectional study was undertaken between December 2015 and March 2016 among students in selected rural and urban senior secondary schools in Botswana. Data were collected through a self-administered questionnaire, measurements and fasting blood glucose testing. Participants were asked about cigarette smoking, alcohol use and levels of physical activity. Body weight, height, waist circumference, blood pressure and fasting blood glucose levels were measured. Hypertension, pre-hypertension, overweight and obesity were defined based on gender, age and height from normative tables. A total of 252 students with a mean age (standard deviation) of 17.1 (0.9) years participated in the study. Rural students were older than urban students (17.5 vs 16.7 years; p < 0.001). The prevalence of hypertension and prehypertension were 13.1 and 15.5%, respectively. Physical inactivity (37.7%), overweight/obesity (10.3%) and alcohol intake (9.1%) were also prevalent. Cigarette smoking was rare (2.0%). Impaired fasting glucose levels were found in 1.6% of participants, and none had diabetes mellitus. Hypertension ( p < 0.001) and cigarette smoking (p = 0.019) were more prevalent among male than female participants. Female students were more likely to be overweight or obese than male students ( p < 0.001). There were no urban-rural differences in hypertension, pre-hypertension and smoking. Urban students were more likely to drink alcohol than rural students (p = 0.008). Hypertension, overweight/obesity and alcohol intake were common among these adolescents in Botswana. Strategies to reduce the risk factors of cardiovascular diseases should be urgently developed and implemented to prevent cardiovascular disease-related morbidity and mortality in the future.

The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana.

Behavioral intentions (motivational factors), attitudes, subjective norm (social pressures), and perceived behavioral control promote or discourage smoking behavior among adolescents. To assess students' behavioral intentions, attitudes, subjective norms and perceived behavioral control on smoking using the Theory of Planned Behavior. The prevalence of smoking among the adolescents is also calculated. In this cross-sectional study, structured self-administered questionnaires were used to collect data from adolescents in primary and secondary schools. Data on demographics, behavioral intentions, attitudes, subjective norms, and perceived behavioral control towards smoking were collected. Pearson product moment correlations and logistic regression models were used to determine factors associated with current smoking. A total sample of 2554 (mean age = 15; Range = 12-18 years) students participated in the study. Twenty-nine percent (n = 728) of the students had tried smoking at least once. Smoking was predicted by attitudes, subjective norms, perceived behavioral control and intention.There was a strong association between having a parent or guardian, caregiver or close friend who smoked (p < 0.001) and being a smoker. The majority of students (57%) conveyed that adults talked to them about the harmful effects of cigarette smoking and 50% had discussed smoking concerns with their friends. Students who had positive attitudes towards smoking like "smoking makes you confident" were more likely to be current smokers (OR: 1.63, 95% CI: 1.03-2.59). The feeling or conviction that they could refuse a cigarette if offered was an impediment from smoking (OR: 0.18, 95% CI: 0.13-0.26). Attitudes, subjective norms, and perceived behavioral control contributed significantly to the students' smoking. Right attitudes must be cultivated and behavioral control must be strengthened for early effective interventions to curtail smoking among adolescents.

Factors associated with first heterosexual sex; sexual coercion and sexual risk behaviors among adolescents in Botswana

Although early sexual debut is highly prevalent in Botswana, its link to sexual risk practices has not been explored at the national level. The aim of this paper was to investigate the association between age-at-first-sex, experience of sexual coercion and subsequent sexual practices. We used data derived from the 2013 Botswana AIDS Impact Survey (BAISIV)—a fourth and latest in a number of nationally representative, population-based surveys meant to measure the sociodemographic and other effects of the HIV/AIDS epidemic in Botswana. A sample of 3796 adolescents in ages 10–24 years who had successfully completed BAISIV individual questionnaire were selected and included for analysis. Data was analyzed using descriptive and multivariate statistical methods. All comparisons were considered statistically significant at p < 0.05. Mean age at first sex for the sampled adolescents was 17.9 years. Using binary logistic regression analysis, results indicate that females (AOR1.16, CI = 1.08–1.63), adolescents who did not belong to any religious affiliation (AOR = 1.71, CI = 1.03–2.86) and those who started sexual activity earlier (AOR = 1.53, CI = 1.02–2.56) were more likely to report to have experienced sexual coercion. Moreover, the odds of reporting multiple sexual partnerships were significantly high among adolescents who started sexual activity earlier (AOR = 1.71, CI = 1.03–2.86) and those who resided in cities/towns (AOR = 1.61, CI = 1.08–2.38). There is need for adolescent HIV policies and programs to address circumstances around young people’s initiation into sexual intercourse, as well as the psychosocial, and cultural norms pertaining to initiation of sex.

Patterns and correlates of health risk behaviours among adolescents in Botswana: 2001-2013

ABSTRACT Monitoring of patterns and correlates of health behaviours among adolescents serves to provide strong evidence to guide adolescent interventions and programs. Using data derived from the four Botswana AIDS Impact surveys (2001–2013), this study assesses patterns and correlates of health risk behaviours among adolescents in Botswana. Samples of adolescents were drawn from each survey and used for data analysis. Estimates of adolescents’ health risk behaviours generally showed fluctuating patterns across all the four surveys. After sex disaggregation, inconsistent condom, multiple sexual partnerships and alcohol & substance use increased overtime among males while among females all health risk behaviours still showed a fluctuating pattern. Multivariate results indicated that the odds of reporting inconsistent condom use were significantly high male adolescents who reported multiple sexual partnerships between 2001–2013 surveys (e.g.in 2001, AOR = 1.02, C.I. = 1.00–2.30; 2004, AOR = 1.07, C.I. = 1.01–3.72; 2008, AOR = 2.46, C.I. = 1.03–4.10; 2013, AOR = 2.59, C.I. = 1.16–4.23). Moreover, males who reported alcohol and substance use were more likely to report inconsistent condom use, and the odds of inconsistent condom use among these males were highest in 2004 (AOR = 5.5, C.I. = 1.18–15.9). Among females, the odds of reporting inconsistent condom use and multiple sexual partnerships were significantly high among those who reported alcohol and substance use. All the comparisons were statistically significant at 5% level. These results highlight the need to strengthen adolescent’s behavioural programs in order to reduce health-damaging behaviours among adolescents.

Trends in HIV Treatment Adherence Before and After HIV Status Disclosure to Adolescents in Botswana

PurposeThis study aimed to determine if disclosure of HIV status to adolescents impacted their medication adherence and how medication autonomy might explain observed effects. MethodsThree hundred adolescents on HIV treatment using electronic medication monitors were followed for 24 months while undergoing routine care. One hundred six of the adolescents were HIV disclosure-naïve and HIV status disclosure in this group was assessed quarterly. Analyses included data from the 75 adolescents who experienced disclosure during the study providing adherence and autonomy data both predisclosure and postdisclosure. Segmented generalized estimating equations were used to examine the trend of adherence and autonomy predisclosure and postdisclosure. Covariates assessed include age at disclosure, sex, and orphan status. ResultsMedian age at study entry was 12.2 years (interquartile range 11.6–12.9). Incident disclosure occurred in 75 (71%) of the adolescents at a median age of 13.1 years (interquartile range 12.5–13.9). Adherence decreased by 11% (95% confidence interval [CI] 7–15, p < .001) during the predisclosure period and by 22% (95% CI 9–36, p = .001) during the postdisclosure period. Adolescents’ autonomy over their medication-taking increased over time, but disclosure did not impact the rate of increase in measured medication-taking autonomy. On a scale of 1–4 assessing autonomy (1 = receiving directly observed therapy and 4 = taking medicines mostly without supervision), autonomy increased by an average of .03 units/month (95% CI .02–.03, p < .001) predisclosure and by .05 units/month (95% CI −.01 to .11, p = .42) postdisclosure. ConclusionsThe findings suggest that, among perinatally HIV infected adolescents, HIV status disclosure may adversely impact treatment adherence. Postdisclosure support to HIV infected adolescents should be intensified.

An illustration of how responsive feedback in a social marketing tobacco control intervention in Ghana enabled managers to make decisions that increased intervention effectiveness.

This report illustrates how a feedback loop, set up to provide data and insights to a donor and designers/implementers of a social marketing tobacco prevention intervention in Ghana, helped adapt the original design of the intervention to one that was more suited to the social and media contexts of Ghana. The designers/implementers had previously, successfully implemented a tobacco control intervention with adolescents in Botswana. This experience had informed the initial intervention design in Ghana. As the feedback generated by evaluators started demonstrating just how different the Ghanaian social and media contexts were from the Botswanan one, implementers started making changes to their selection of channels, resulting in a design which was quite different from the original one. The close involvement of the donor in this process enabled implementers to make rapid changes to the design of the intervention. This illustration adds to a small but growing literature establishing the importance of feedback loops to improve the design and implementation of development interventions.

Association of Adolescent- and Parent-Reported Relationship Functioning with HIV Sexual Risk Among Adolescents in Botswana.

Globally, adolescents in sub-Saharan Africa are the youth most affected by HIV. Parent-adolescent relationships can be protective in child and adolescent development and may be implicated in lowered adolescent HIV sexual risk. However, the importance of parental and adolescent perceptions of their relationship andassessing the implications of family functioning in adolescents' risk for HIV or other sexually transmitted infectionsarenot well established in the research literature. This dyadic study simultaneously assessed both parents' and adolescents' perceptions of family functioning and their relationships with adolescent sexual behaviors in Botswana. Seventy-two parent-adolescent dyads completed audio computer-assisted self-interview surveys. Surveys, independently completed by parents and their adolescent, assessed multiple indicators of their relationship and is the first such study in Botswana to collect the perspectives of both the parents and their adolescents. The results highlight significantly discrepant views of their relationships and revealed that the magnitude of those discrepancies was associated with greater adolescent HIV sexual risk behavior across multiple measures of family relationships. Parents' inaccurate perceptions of their adolescents' sexual activity were also associated with greater adolescent sexual risk. These findings elucidate the importance of improving parent-adolescent communications and relationships, which may subsequently assist in lowering adolescents' sexual risk for HIV and other negative sexual health outcomes.

Prevalence and predictors of alcohol and drug use among secondary school students in Botswana: a cross-sectional study

BackgroundAlcohol and illicit drug use has been recognized as a growing problem among adolescents in Botswana. Little is known about factors affecting alcohol and drug use among Botswana’s secondary school students. To aid the design and implementation of effective public health interventions, we sought to determine the prevalence of alcohol and drug use in secondary school students in urban and peri-urban areas of Botswana, and to evaluate risk and protective factors for substance use.MethodsWe performed a 72-item cross-sectional survey of students in 17 public secondary schools in Gaborone, Lobatse, Molepolole and Mochudi, Botswana. The World Health Organization’s (WHO) Alcohol Use Disorder Identification Test (AUDIT) was used to define hazardous drinking behavior. Using Jessor’s Problem Behavior Theory (PBT) as our conceptual framework, we culturally-adapted items from previously validated tools to measure risk and protective factors for alcohol and drug use. Between-group differences of risk and protective factors were compared using univariate binomial and multinomial-ordinal logit analysis. Relative risks of alcohol and drug use by demographic, high risks and low protections were calculated. Multivariate ordinal-multinomial cumulative logit analysis, multivariate nominal-multinomial logit analysis, and binominal logit analysis were used to build models illustrating the relationship between risk and protective factors and student alcohol and illicit drug use. Clustered data was adjusted for in all analyses using Generalized Estimating Equations (GEE) methods.ResultsOf the 1936 students surveyed, 816 (42.1%) reported alcohol use, and 434 (22.4%) met criteria for hazardous alcohol use. Illicit drug use was reported by 324 students (16.7%), with motokwane (marijuana) being the most commonly used drug. Risk factors more strongly associated with alcohol and drug use were reported alcohol availability, individual and social vulnerability factors, and poor peer modeling. Individual and social controls protections appear to mitigate risk of student alcohol and drug use.ConclusionsAlcohol and illicit drug use is prevalent among secondary school students in Botswana. Our data suggest that interventions that reduce the availability of alcohol and drugs and that build greater support networks for adolescents may be most helpful in decreasing alcohol and drug use among secondary school students in Botswana.

Phenomenology of Substance Use Among School-Going Adolescents in Botswana

Background: Increased rates of alcohol and drugs abuse has been noted among secondary school students in Botswana. Objectives : We conducted nine student focus groups to elicit motivations for substance use as well as risk and mitigating factors. Methods: Participants were purposely sampled from among 2,227 secondary school students surveyed regarding drug/alcohol use in secondary schools. Students were selected for focus group participation based on their scores on the alcohol use and dependency inventory tool (AUDIT) and self-reported risk factors for alcohol/drug use. Results: Students reported that alcohol/drugs are readily available at school and at home. A prominent theme among substance users was inadequate support from parents, who they describe as uncomfortable and unwilling to talk about common issues faced during adolescence, including alcohol/drug use. Conclusions: We identified opportunities to improve the current situation such as renewing efforts to restrict alcohol availability and focusing on parent-child communication interventions.