TUAC0204
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Background: HIV prevention efforts are increasingly addressing social/structural factors associated with adolescent girls'' HIV vulnerability. However, there is limited evidence whether interventions that go beyond the health sector can decrease HIV risk among adolescent girls in high-incidence settings. We delineate the layered effects of social protection, education, and economic interventions on HIV-risk among urban adolescent girls in Zambia.
Methods: Surveys?conducted March-May 2018?captured knowledge, attitudes, practices, program experiences, and HIV service uptake of 15- to 19-year-old women (n=487) enrolled in the DREAMS program in Lusaka and Ndola. We focus on 4 layers of program exposure: (1) Participated in some safe space/social asset building interventions (SSI), (2) Completed all SSIs and received a certificate (SSC), (3) Completed all SSIs and received educational support (SSC+Ed), and (4) Completed all SSIs and received educational support and cash transfer (SSC+Ed+CT). Poisson regressions assess association between program exposure and HIV-risk outcomes (HIV knowledge, consistent condom use, transactional sex, and intimate partner sexual violence).
Results: Among respondents, 30% received only some SSIs, 32% completed all SSIs (SSC), 17% received SSC+Ed, and 21% received SSC+Ed+CT. There were no differences in HIV-risk outcomes between SSI and SSC groups, except that the SSC group was more likely to engage in transactional sex [IRR:1.05 (0.74-1.47)]. Compared to SSI only, respondents who received the SSC+Ed were significantly more likely to have comprehensive knowledge about HIV (Incidence-Rate Ratio [IRR:1.09, [1.02-1.15]) and report consistent condom use (IRR:4.80 [3.35-6.87]) and less likely to experience sexual violence (IRR:0.31, [0.15-0.65]). Similar significant findings were found for respondents receiving SSC+Ed+CT. Respondents who received SSC+Ed+CT were significantly less likely to engage in transactional sex (IRR: 0.59, [0.43-0.80]), compared to the SSI group.
Conclusions: We provide empirical evidence of the value of going beyond the health sector for HIV prevention efforts. Safe space interventions alone did not seem to influence HIV-risk and findings around transactional sex warrant further investigation. Layering educational and economic interventions on top of safe spaces/social asset-building activities reduced HIV-risk among urban adolescent girls in Zambia.


 Program uptake %HIV knowledge IRR (95% CIConsistent condom use IRR (95% CI)Transactional sex IRR (95% CI)Sexual violence IRR (95% CI)
Participated in some Safe Space interventions only (SSI)30%refrefrefref
Completed all Safe Space interventions only (SSC)32%1.05 (0.97-1.13)1.45 (0.58-3.59)1.14 (1.03-1.27)1.05 (0.74-1.47)
Completed all safe space interventions & received education support (SSC+Ed)17%1.09 (1.02-1.15)4.80 (3.35-6.87)(low power)0.31 (0.15-0.65)
Completed all safe space interventions & received education support & cash transfer (SSC+Ed+CT)21%1.15 (1.09-1.20)4.66 (4.35-5.00)0.59 (0.43-0.80)0.62 (0.48-0.80)
[Table 1. IRRs between program exposure and key HIV-risk factors]