Table 1 Summary of Aims, Methods, Participants, and Key Findings of Studies Included in the Review
Authors | Year of publication | Country | Aims/purpose | Methodology | Study population | Key findings |
|---|---|---|---|---|---|---|
Ankunda et al. | 2016 | Uganda | Describe sexual risk behaviors and factors associated with abstinence among YLWH in Uganda | Cross-sectional | 338 youth Mean age: 19 | Many participants were abstaining from sexual intercourse. Only a third of youth in relationships had disclosed their status to their partners. Less than half of the youth reported condom use in their last sexual encounter. 50% of participants reported preferring a HIV-negative partner. Tailored interventions that address disclosure and consistent condom use are needed to prevent HIV transmission |
Arikawa et al. | 2016 | Côte d’Ivoire | Measure the incidence of pregnancy and its associated factors in ALWH | Retrospective Analysis | 266 female adolescents Mean age: 12.8 years | Median age at first pregnancy was 17.7 years. All of the adolescents did not intend or plan to be pregnant, and the incidence of pregnancy was almost the same as adult cohorts in sub-Saharan Africa. There is an urgent need to provider adolescent-friendly reproductive health services |
Bakeera-Kitaka et al. | 2008 | Uganda | Assess sexual and reproductive health needs and sexual risk taking among young people living with HIV | Qualitative Study: Focus group discussions | 75 adolescents Mean age: 16 years | Adolescents had misconceptions about transmission and sexual and reproductive health. Fear of unintended consequences and hope for the future were the motivations for using protection during sexual encounters. Stigma, poverty, peer pressure, and ignorance of partners were some of barriers to using preventative measures. The study highlights the need for age-appropriate interventions to help youth adopt safe sexual habits |
Birungi et al. | 2009 | Uganda | Understand the sexual and reproductive health needs of perinatally infected YLWH | Mixed methods: survey and in-depth interviews | 732 adolescents Mean age: 17 years | Many adolescents were sexually active and desired to be in relationships. Majority (60%) of the youth who desired to be with HIV-negative partners wanted to avoid HIV re-infection. Only a third of those in relationships disclosed their status to their partner, and only one-third reported always using condoms |
Birungi et al. | 2011 | Kenya | Examine the use of maternal health services among HIV-positive female adolescents | Cross-sectional: quantitative surveys | 359 adolescent girls Age range: 15–19 | Use of PMTCT services was lower than use of pre-natal services among HIV-positive adolescents. There was low utilization of skilled attendance in post-natal care for pregnancies that ended in miscarriage, abortion, or stillbirth. Pregnant YLWH need maternal services that integrate PMTCT and there is a need to implement PMTCT services tailored to HIV-positive adolescent mothers |
Busza et al. | 2013 | Tanzania | Examine how adolescent experience their sexuality within the context of a home-based care program | Qualitative | 14 adolescents (age 15–19) 10 caregivers 12 home-based care providers | Adolescents did not feel comfortable discussing sex and sexuality with their providers and caregivers. They also reported being discouraged from sexual activity. Adolescents expressed concerns with disclosure and infecting others and reported limited access to information on reproductive health. Caregivers and providers reinforced negative views ALWH engaging in sexual activity |
Dago- Akribi et al. | 2004 | Côte d'Ivoire | Describe the psychosexual development of youth enrolled in the Yopougon Child Program | Qualitative | 19 youth (age 13–17 years) | Youth were concerned with bodily development, getting married, and having children. There is a need for programs that support youth in their sexual development |
Hodgson et al. | 2012 | Zambia | Explore and document the informational, psychosocial, sexual and reproductive health (SRH) needs of adolescents (aged 10–19 years) living with HIV in Zambia, and identify gaps between these needs and existing services | Qualitative: semi-structured interviews and focus group discussions | 111 adolescents (10–19 years) 59 key informants (health care workers n = 38 and parents/guardians n = 21) | Social networks have significant impact on treatment adherence and assist adolescents in coming to terms with an HIV diagnosis. Service providers do not adequately meet the adolescents’ needs for SRH information Adolescents living with HIV require effective, targeted and sustainable HIV services to navigate safely through adolescence |
Horwood et al. | 2013 | South Africa | Compare the characteristics of adolescent mothers and adult mothers, including HIV prevalence and MTCT rates | Quantitative: questionnaires | 4485 adolescent mothers (12–19 years 14,608 adult mothers (20–39 years) 7800 infants (< = 16 weeks) | Despite high levels of antenatal clinic attendance among pregnant adolescents in KwaZulu-Natal, the MTCT risk is higher among infants of HIV-infected adolescent mothers compared to adult mothers. Adolescent mothers were less likely to receive the recommended PMTCT regimen. Access to adolescent-friendly family planning and PMTCT services should be prioritized for this vulnerable group |
Landolt et al. | 2017 | Thailand | Assess strategies to improve safe-sex practices in sexually active female adolescents living with HIV, through linking reproductive health (RH) care with HIV care | Single arm prospective study | 77 sexually active young women (12 – 24 years) Median age: 19 years | At baseline, two-thirds had disclosed their sero-status to their partner, and 68% reported condom use during the first intercourse/ Majority of participants showed improvement in knowledge of safe sex practices at post follow-up visits. Individual counseling was often rated as the most helpful source of information. Offering continuous reproductive care linked with HIV care resulted in increased uptake of hormonal contraception for dual protection |
Lolekha et al. | 2015 | Thailand | Assessed the knowledge, attitudes, and practices of perinatally HIV-infected youth and youth reporting sexual risk behaviors receiving care at two tertiary care hospitals in Bangkok, Thailand | Cross-sectional: audio self-assisted interview | 197 adolescents (11–18 years) Median age: 14 years | Most youth could correctly answer questions about HIV transmission and ARV adherence, but more than half lacked knowledge on family planning, STI health, and reproductive health Low condom use was reported in sexually active youth. The study highlighted the need for interventions and resources to improve knowledge on reproductive health and reduce engagement in risky behavior among HIV-infected youth in Thailand |
Loos et al. | 2013 | Kenya Uganda | Assess the impact of HIV and related contextual conditions on identity formation of adolescents living with HIV/AIDS (ALH) in the domains of physical, cognitive, social, and sexual development | Qualitative: focus group discussions | 119 adolescents (10–19 years) 54 care givers 55 service providers | Youth experimented with their sexuality as a means to discover their social identity. For many youths, sex served as a way of becoming “special” and coping with emotional pain of living with HIV |
Mbalinda et al. | 2015 | Uganda | Explore the correlates of ever had sex among perinatally HIV-infected (PHIV) adolescents | Cross-sectional: survey | 624 adolescents (10–19 years) Mean age: 16.2 years old | About three-fourths of participants reported not using condoms consistently and almost half did not use condoms in their last sexual encounter. Almost 50% of participants did not know the HIV status of their partners. Risk reduction interventions are required to minimize unplanned pregnancies, STI, and HIV transmission |
Mburu et al. | 2013 | Zambia | Document psychosocial and sexual reproductive health care needs of ALHIV and identify gaps between those needs and currently available services for adolescents | Qualitative: in-depth interviews | 111 adolescents 21 parents 38 health providers | ALHIV wanted greater access to information about HIV, SRH, and protective measures. They wanted services that offer privacy and confidentiality, short wait times and youth-friendly., Parents and caregivers agreed that SRH services could be improved. Interventions are needed to prepare adolescents for disclosure |
McCarraher et al. | 2018 | Zambia | Advance our understanding of the reproductive health needs of ALHIV and to assess the extent to which these needs are being met | Mixed Methods: surveys and in-depth interviews | Surveys: 312 adolescents IDI: 32 adolescents 23 care givers 10 clinic staff | A fifth of participants reported having ever had sex and all desired to have children in the future. Adolescents reported low rates of disclosure. While adolescents knew about condom use, only half reported condom use at the last sexual encounter. Caregivers and service providers preferred to promote abstinence first followed by condom use. Half of the surveyed providers and caregivers supported offering contraceptive counseling at the ART clinic |
Mu et al. | 2015 | China | Assess SRH and HIV knowledge and perceptions among perinatally HIV-infected adolescents | Cross-sectional: survey | 124 adolescents (11–19 years) Median age: 15.6 | Only 5% correctly answered all questions regarding HIV knowledge and pregnancy 79% of participants had never discussed puberty development or sexuality with parents, and less than 50% had ever heard of condoms. A fifth of the participants did not know how to get information on SRH and HIV |
Mwalabu et al. | 2017 | Malawi | Explore the sex and relationship experiences of young women growing up with perinatally-acquired HIV in order to understand how to improve SRH care and associated outcomes | Qualitative- in-depth interviews | 42 participants 14 cases Each case- young woman (15–19 years), caregiver, service provider | Young women reported wanting to be normal and seeking romantic relationships to find love and acceptance. Caregivers and service providers wanted young women to practice abstinence. Young women living with HIV need more support from healthcare providers and caregivers on reproductive health |
Ndongmo et al. | 2017 | Zambia | Explore the sexuality and SRH experience and needs of adolescents living with HIV | Cross-sectional; mixed methods | 148 adolescents (15–19 years) Mean age: 17 years | Majority of adolescents had sexual experience and expressed sexual desires and needs. Less than a fifth of participants had ever sought reproductive health services, and about half reported being able to discuss sexual issues with parents and caregivers. Over half had not disclosed their status to their sexual partners. Not being in school was a significant predictor, for knowing where to access information about sex |
Ngilangwa et al. | 2016 | Tanzania | Inform SRH programs and identify best approaches to reach marginalized youth | Cross-sectional mixed methods | 396 young people (10–24 years old) | 64% of YPLWH had knowledge of existing SRH policies, and less than half reported talking to their parents about various SRH topics. Peer educators were the leading source of information followed by parents and teachers. Young people value multiple sources of information |
Obare et al. | 2010 | Uganda | Explore policies for SRH in adolescents and identify barriers for SRH programming for adolescents | Qualitative: unstructured interviews | 23 key informants from bilateral institutions, civil society organizations, and NGO | While there are broad policies to address SRH in adolescents, there is a gap in policies that address SRH for ALWH. There is also a need to increase capacity of HIV providers to offer SRH services to ALWH |
Obare et al. | 2012 | Kenya | Examine factors associated with unintended pregnancies, poor birth outcomes and post-partum contraceptive use in Kenyan ALWH | Cross-Sectional Structured interviews | 394 adolescent girls (age 15–19) who had ever been pregnant | Girls who had begun childbearing had experienced multiple unintended pregnancies. There has been a lack of training for providers to counsel ALWH on SRH also existing programs focus on abstinence-based education. Poor birth outcomes were less likely in cases where the pregnancy occurred within a marital union. Post-partum contraceptive use was inconsistent |
Okawa et al. | 2018 | Zambia | Assess the sexual behaviors and SRH needs of ALWH in Zambia and identify any concerns with marriage and desire to have children | Cross-Sectional Self-administered structured questionnaire | 175 adolescents (15–19 years old) | One-third of youth did not use a condom during first intercourse. Most of the adolescents desired to have children, and about half were concerned about intimate relationships, disclosing their status and potential rejection after disclosure. Adolescents had an unmet need for SRH services and intimate relationships |
Rolland-Guillard et al. | 2019 | Thailand | Compare risky sexual behavior, planning for the future, and reproductive health between perinatally-infected youth and non-infected controls | Case control study, self-administered questionnaires | 571 adolescents (12–19 years old) | Sexual habits did not differ between PHIVA and their counterparts, but PHIVA tended to have less expectations for education and family formation. PHIVA experienced puberty later than adolescents in the general population. Need for psychosocial services and policies in place to foster future planning for PHIVA |
Vranda et al. | 2018 | India | Explore the SRH needs and concerns of ALWH in India | Qualitative in-depth interviews | 20 adolescents (13–18 years old) | Youth were worried about finding romantic partners and having children. Most youth had not discussed SRH with service providers, parents, guardians. There is a lack of adolescent-friendly services in India |
Vu et al. | 2017 | Uganda | Examine the effectiveness of the Link up Project- a peer led intervention that provided comprehensive care package of HIV and SRH services to Ugandan YLWH | Pre-post cohort study with 9-month follow-up Quantitative measures and IDIs | 473 youth (15–24 years old) | Linkage services increased uptake of HIV and SRH clinical services in the study population. At endline, youth demonstrated increased comprehensive knowledge on HIV transmission and other SRH topics. Youth also reported increase comfort and self-efficacy to discuss SRH topics with their providers |
Vujovic et al. | 2014 | South Africa | To describe the SRH opinions and concerns of very young adolescents in South Africa | Qualitative: In-depth interviews and FGD | 27 adolescents (10–14 years old) 9 healthcare providers | Adolescents knew little about their bodies but wanted to learn more about sexual and reproductive health issues. Healthcare providers were not confident about providing SRH services to ALWH and highlighted the need for capacity building health service staff. The study identified a need to address sexual and reproductive health in early adolescence and make sexual and reproductive health an integral part of youth health services |
Zamudio-Hass et al. | 2012 | Zimbabwe | Understand how young women living with HIV weigh disclosure in the context of forming partnerships and childbearing | Qualitative: in-depth Interviews | 28 young women (16–20 years old) | Disclosure played a big role in deciding childbearing or birth spacing because it was a turning point in romantic relationships. Women reported support and acceptance and abuse and rejection when they disclosed their HIV status to their partners. Women wanted healthcare providers to do more in helping them navigate disclosure |