HIV prevention in Tanzania: the role of types of sexual partnerships, early sexual histories and community factors
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Epidemiology and Population Health
Abstract
Nature of proposed research
HIV prevention among young people is an urgent priority. Research has shown that prevention interventions such as sex education in schools can increase knowledge about HIV and sexual and reproductive health. However, such interventions have not been able to reduce the number of young people infected with HIV and other sexually transmitted infections (STI). There is a gap between knowledge of how to avoid HIV and other sexual risks among young people and actual behaviour change. We need to find effective ways to prevent HIV among young people in sub-Saharan Africa.
This research will use data collected during a recent survey of over 13,000 young people in rural Tanzania. Young people told us who they have sex with and described the type of relationship with each of their recent sexual partners. We can make a map to see if young people infected with HIV live in certain areas eg near to a major road or town. Analysing this information will help us to understand where and when a young person is most likely to take risks. The results of this research will be used to design interventions that will help young people to reduce their risk of being infected.
HIV prevention among young people is an urgent priority. Research has shown that prevention interventions such as sex education in schools can increase knowledge about HIV and sexual and reproductive health. However, such interventions have not been able to reduce the number of young people infected with HIV and other sexually transmitted infections (STI). There is a gap between knowledge of how to avoid HIV and other sexual risks among young people and actual behaviour change. We need to find effective ways to prevent HIV among young people in sub-Saharan Africa.
This research will use data collected during a recent survey of over 13,000 young people in rural Tanzania. Young people told us who they have sex with and described the type of relationship with each of their recent sexual partners. We can make a map to see if young people infected with HIV live in certain areas eg near to a major road or town. Analysing this information will help us to understand where and when a young person is most likely to take risks. The results of this research will be used to design interventions that will help young people to reduce their risk of being infected.
Technical Summary
Background
Young people are particularly vulnerable to HIV and other sexually transmitted infections (STI). Preventing HIV amongst young people is vital if the spread of the epidemic is to be halted. Since January 1999, in rural Tanzania, the MEMA kwa Vijana package of adolescent Sexual and Reproductive Health (SRH) interventions (teacher-led, in-school SRH education; youth-friendly health services; community activities; youth condom promotion and distribution) have been implemented in 10 randomly chosen intervention communities, with 10 similar communities acting as a comparison group. From May 2007 to July 2008, 13,814 youth aged 17-27 years from these 20 communities were surveyed. Results showed that SRH knowledge had been improved and retained, but that this intervention had little effect on reported behaviours and none on HIV/STI prevalence. These results suggest that an urgent rethink is needed to prevent HIV infection among young people. Integrating future youth interventions within intensive, community-wide programmes to reduce their risk and vulnerability may be more successful.
Aim:
To investigate factors associated with the prevalence of HIV/STI among youth in rural Tanzania in order to improve HIV prevention intervention design and evaluation.
Objectives:
(1) Investigate the association between sexual partner types and prevalence of STI and higher risk practices (2) Conduct spatial mapping of HIV/STI and determine whether cases are associated with proximity to health services, trading centres, roads and other geographical factors (3) Explore the relationship between exposures in early adolescence and later sexual risk behaviours (4) To investigate methodological issues (characteristics of those lost to follow-up, consistency in reporting of sexual behaviour) (5) Develop recommendations for future interventions to improve the SRH of young people.
Methods:
Secondary analysis of MEMA kwa Vijana Community Randomised Trial data. Individual demographic and SRH data including HIV/STI infection status are available for a cohort of over 9,500 youth (1998 to 2001/02) and in 2007/08 for a cross-sectional survey of over 13,500 youth. These data are of particular value due to the uniquely long length of follow-up and the biological outcome data. Detailed data on the last 3 sexual partners and GPS data, collected in 2007/08, will allow description of sexual partnerships and geographical mapping of sexual risk.
Opportunities:
The results of these new analyses, in combination with MEMA kwa Vijana trial results, its associated qualitative research and results of other intervention trials will be examined and recommendations made on potential future interventions in terms of content, target groups and evaluation design.
Young people are particularly vulnerable to HIV and other sexually transmitted infections (STI). Preventing HIV amongst young people is vital if the spread of the epidemic is to be halted. Since January 1999, in rural Tanzania, the MEMA kwa Vijana package of adolescent Sexual and Reproductive Health (SRH) interventions (teacher-led, in-school SRH education; youth-friendly health services; community activities; youth condom promotion and distribution) have been implemented in 10 randomly chosen intervention communities, with 10 similar communities acting as a comparison group. From May 2007 to July 2008, 13,814 youth aged 17-27 years from these 20 communities were surveyed. Results showed that SRH knowledge had been improved and retained, but that this intervention had little effect on reported behaviours and none on HIV/STI prevalence. These results suggest that an urgent rethink is needed to prevent HIV infection among young people. Integrating future youth interventions within intensive, community-wide programmes to reduce their risk and vulnerability may be more successful.
Aim:
To investigate factors associated with the prevalence of HIV/STI among youth in rural Tanzania in order to improve HIV prevention intervention design and evaluation.
Objectives:
(1) Investigate the association between sexual partner types and prevalence of STI and higher risk practices (2) Conduct spatial mapping of HIV/STI and determine whether cases are associated with proximity to health services, trading centres, roads and other geographical factors (3) Explore the relationship between exposures in early adolescence and later sexual risk behaviours (4) To investigate methodological issues (characteristics of those lost to follow-up, consistency in reporting of sexual behaviour) (5) Develop recommendations for future interventions to improve the SRH of young people.
Methods:
Secondary analysis of MEMA kwa Vijana Community Randomised Trial data. Individual demographic and SRH data including HIV/STI infection status are available for a cohort of over 9,500 youth (1998 to 2001/02) and in 2007/08 for a cross-sectional survey of over 13,500 youth. These data are of particular value due to the uniquely long length of follow-up and the biological outcome data. Detailed data on the last 3 sexual partners and GPS data, collected in 2007/08, will allow description of sexual partnerships and geographical mapping of sexual risk.
Opportunities:
The results of these new analyses, in combination with MEMA kwa Vijana trial results, its associated qualitative research and results of other intervention trials will be examined and recommendations made on potential future interventions in terms of content, target groups and evaluation design.