Using implementation science to strengthen HIV prevention for ...

Using implementation science to strengthen HIV prevention for ...

Emerging evidence on AGYW HIV risk and prevention from the DREAMS partnership: the role of gender Julie Pulerwitz, ScD and Sanyukta Mathur, DrPH MHS Girl uninterrupted: Evidence, implementation and agency No conflicts of interest to disclose Context Should address the context in which AGYW live, to improve health & development outcomes Gender-based power dynamics underpins many relationships Power in sexual

relationships* linked with violence, condom use, HIV incidence, untreated STIs, etc High HIV risk and incidence rates among *Pulerwitz, J, Gortmaker, SL, & DeJong, W. (2000) Measuring relationship power in HIV/STD Research. Sex Roles. 42(7/8); McMahon, JM, Volpe, EM, Klostermann, K, Trabold, N, & Xue, Y. (2015) A Systematic Review of the Psychometric AGYW (esp. Southern and Properties of the Sexual Relationship Power Scale in HIV/AIDS Research. Arch Sex Behav; 44(2): 267294. DREAMS partnership as case study Mobilize Communitie s for change

Reduce risk of Male sexual partners Empower Adolescent Girls & Young Women (AGYW) and reduce risk Adapted from: Preventing HIV in Adolescent Girls and Young Women: Guidance for PEPFAR Country Teams on the DREAMS Partnership, March 2015

Strengthen Families Generating evidence around DREAMS 3 cross-cutting themesfocused on unique features; country priorities Assessing reach and effectiveness of community-based girl-centered programming Characterizing male partners of adolescent girls and young women, and use of HIV services Introducing oral PrEP among adolescent girls and young women Vulnerability profiles of out-of school AGYW, Kisumu, Kenya

Preliminary findings from latent class analysis (15-24yrs, n=1,014) Double orphans Sometimes hungry Not connected to adult in HH Sexual debut 14 Limited HIV knowledge LOWER VULNERABILIT Y 71% of sample HIGHER VULNERABILT

Y 29% of sample Acknowledge inequitable gender norms AGYWs relationship power in Kenya 21-24 years 18-20 years 15-17 years (n=1,101) My partner has more say than I do about important decisions that affect us.* If my partner wants to have sex, he would expect me to agree*

When my partner and I disagree, he gets his way most of the time* *p < 0.05 0 20 40 60 80 100 Pulerwitz, Mathur, and Woznica. (2018) How empowered are girls/young women in their sexual relationships?: relationship power, HIV risk, and partner violence in Kenya. PLoS ONE. 13(7): e0199733.doi:10.1371/journal.pone.0199733 Relationship power, sexual violence & HIV risk Having relationship power strongly associated with: Less sexual and physical violence More condom use at last sex

More knowledge of partners HIV status Sexual violence experience in the last 12 months 19% 21% From partners (n=597) From nonintimate partners (n=1,778) AGYW who experienced sexual violence were 2x as likely to report an STI symptom, and anxiety and depression

Pulerwitz, Mathur, and Woznica. (2018) How empowered are girls/young women in their sexual relationships?: relationship power, HIV risk, and partner violence in Kenya. PLoS ONE. 13(7): e0199733. doi: 10.1371/journal.pone.0199733; Mathur, Okal, Musheke, et al. Forthcoming (PLoS ONE). High rates of sexual violence by both intimate and non-intimate partners experienced by adolescent girls and young women in Kenya and Zambia: Findings around violence and other Conflict & miscommunication characterize relationships Study site: Uganda (n=94 IDIs with male partners PrEP power dynamics in the health care setting Factors associated with providers willingness to prescribe PrEP (n=316) Adj. IRR1 (95% CI)

Negative attitudes toward AGYW sexuality 0.81 (0.66 0.99)* Behavioral 0.89 Disinhibition (0.79 1 Adjusted for provider demographics, prior PrEP scale 0.99)* knowledge,

other facility factors (e.g., Some of us are very critical and judgmental. We just judge someone, Ooh you came again? Last time you had gonorrhea, did you do it again? Service provider, age 32 stockouts) *p<0.05 Pilgrim, N. et al. (2018) Provider perspectives on PrEP for adolescent girls and young women in Tanzania: The role of provider biases and quality of care. PLoS ONE 13(4): e0196280. doi:

Framework for PrEP introduction to AGYW Mathur, S, Pilgrim N, and Pulerwitz, J. (2016) PrEP introduction for adolescent girls & young women. The Lancet HIV 3(9): e406-e408. 11 Implications/next steps Gender-related dynamics accentuate HIV risk and inhibit service use Unpacking these relationships can provides useful insights for strengthening program/policy Should be more consistently measured in programs Phase 2 DREAMS Implementation Science

will explore program effects What worked, when, for whom, and why? 2018 The Population Council. All rights reserved. Use of these materials is permitted only for noncommercial purposes. The following full source citation must be included: Pulerwitz, Julie and Sanyukta Mathur. 2018. Addressing adolescent girl and young womens risk and empowerment: Emerging lessons from the DREAMS Partnership. Presented at 22nd International AIDS Conference (AIDS 2018), Amsterdam, The Netherlands, 24 July. This presentation may contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed. The Population

Council conducts biomedical, social science, and public health research. We deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world.

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