Background: A range of socio-demographic, biological, and behavioral factors are associated with HIV incidence among AGYW. Multi-sectoral HIV prevention efforts, like DREAMS, take a comprehensive approach to address multiple vulnerabilities. We assess shifts in biological and behavioral factors related to HIV acquisition among AGYW in Kenya.
Methods: AGYW enrolled in DREAMS programs aged 15-24 were surveyed in 2016 and 2018 across two sites in Kenya (n=736). Surveys captured knowledge, attitudes, practices, and participation in DREAMS safe space (SS) interventions that provide life skills and address HIV, STI, violence-prevention, and sexual and reproductive health. Bivariate and age-stratified multiple logistic regression analyses?adjusting for site, marital status, schooling, and orphanhood?examine change over time in STI experiences, sexual behaviors, partnership characteristics, violence experiences, and HIV testing among AGYW.
Results: At follow-up, mean age of respondents was 20 years and 14% had lost both parents. Over time fewer were enrolled in school (60% vs.53%), more were sexually active (60% vs. 67%) or been married (23% vs. 26%). Over 90% of adolescent girls (AG, 15-19 years) and young women (YW, 20-24 years) had participated in the SS interventions. Over time, HIV testing increased significantly among AG (AdjOR: 6.35 [3.29, 12.24]) and YW (AdjOR:1.26 [0.55, 2.89]), and AG and YW had significant reductions in sexual violence from intimate partners (AdjOR: 0.35 [0.19, 0.65], AdjOR: 0.37 [0.22, 0.60], respectively). YW also had significant reductions in sexual violence from non-partners (AdjOR:0.34 [0.23, 0.50]). There were no significant shifts in other risk factors (i.e. number of sexual partners in the last year, consistent condom use, and STI experience). Both AG and YW reported increases in transactional relationships with a main partner (AdjOR: 2.89 [1.71, 4.89], 2.54 [1.70, 3.80], respectively) and YW reported increased transactional sex with casual partners (AdjOR: 1.86 [1.01, 3.40]).
Conclusions: We show mixed effects of DREAMS program engagement on outcomes related to HIV acquisition among AGYW. Over time, there were notable reductions in experiences of sexual violence and increases in HIV testing, yet there were increases in transactional relationships and sex. There is a need to re-double efforts to reduce high-risk sexual behaviors among AGYW.