Combination Social Protection for Reducing HIV-Risk Behavior Among Adolescents in South Africa.
Combination Social Protection for Reducing HIV-Risk Behavior Among Adolescents in South Africa.
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DOI：
10.1097/qai.0000000000000938
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发表时间：
2016-05-01
期刊：
影响因子：
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通讯作者：
Sherr L
中科院分区：
文献类型：
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作者：
Cluver LD;Orkin FM;Yakubovich AR;Sherr L
社会保障（即现金转移、免费学校、父母支助）具有预防青少年艾滋病毒的潜力。我们的目的是确定哪些社会保障干预措施最有效，以及综合社会保障在南非是否有更大的影响。在这项前瞻性纵向研究中，我们在2009年至2012年期间采访了3516名10-18岁的青少年。我们在南非两个省的四个城市和农村地区随机选择的人口普查区对所有有青少年居民的家庭进行了抽样。我们测量了家庭接受14种社会保障干预措施和艾滋病毒风险行为的发生率。使用性别分类的多元逻辑回归和边际效应分析，我们评估了干预措施和潜在的组合效应各自的贡献。以儿童为中心的赠款、免费教育、学校供餐、教师支持和父母监督与艾滋病毒风险行为发生率降低独立相关（OR 0.10-0.69）。综合社会保障显示出强大的效果，艾滋病毒风险行为累积减少。例如，在没有干预措施的情况下，女孩去年因经济原因发生性行为的预测发生率从11%下降到2%，其中有儿童补助金，免费学校和良好的父母监督。同样，女孩无保护/随意性行为或多性伙伴的发生率从没有干预措施的15%下降到父母监督或学校供餐的10%，再下降到两种干预措施的7%。在现实世界的高流行率条件下，“综合社会保障”显示出对青少年艾滋病毒预防的强大效果，并可最大限度地加强预防工作。
Social protection (i.e. cash transfers, free schools, parental support) has potential for adolescent HIV-prevention. We aimed to identify which social protection interventions are most effective and whether combined social protection has greater effects in South Africa. In this prospective longitudinal study, we interviewed 3516 adolescents aged 10-18 between 2009 and 2012. We sampled all homes with a resident adolescent in randomly-selected census areas in four urban and rural sites in two South African provinces. We measured household receipt of fourteen social protection interventions and incidence of HIV-risk behaviors. Using gender-disaggregated multivariate logistic regression and marginal-effects analyses, we assessed respective contributions of interventions and potential combination effects. Child-focused grants, free schooling, school feeding, teacher support, and parental monitoring were independently associated with reduced HIV-risk behavior incidence (OR 0.10-0.69). Strong effects of combination social protection were shown, with cumulative reductions in HIV-risk behaviors. For example, girls’ predicted past-year incidence of economically-driven sex dropped from 11% with no interventions, to 2% amongst those with a child grant, free school and good parental monitoring. Similarly, girls’ incidence of unprotected/casual sex or multiple-partners dropped from 15% with no interventions to 10% with either parental monitoring or school feeding, and to 7% with both interventions. In real-world, high-epidemic conditions, ‘combination social protection’ shows strong HIV-prevention effects for adolescents and may maximize prevention efforts.