Amsterdam 2015
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| Abstract #2273 - Needs and interventions for school-aged populations | ||||
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Session: 19.1: Needs and interventions for school-aged populations (Parallel) on Wednesday @ 16.30-18.00 in C103 Chaired by Mark Orkin, Larry Brown Authors: Presenting Author: Dr Franziska Meinck - University of Oxford, United Kingdom |
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| Additional Authors: | ||||
| Aim: Social protection interventions are important for mitigating HIV-risk behaviours in sub-Saharan Africa, and can be improved by an understanding of how, on the pathway from deprivation to risk, the interventions have effect. This paper applies structural equation modelling to a longitudinal sample of black female adolescents of school-going age in South Africa: to identify the indirect pathway that prevails from deprivation via mediators to HIV-risk behaviour and to establish where access to schooling first or second-order moderation effects on the pathway. | ||||
| Method / Issue: A prospective observational study of 3515 10-17 year olds (56.7% female) was carried out in rural and urban areas of two provinces in South Africa. In randomly sampled census enumeration areas with at least 30% HIV-prevalence, in all applicable households an adolescent was interviewed and followed-up a year later (n=3402, 97% retention, <2.5% refusal rate at baseline). Respondents reported on aspects of deprivation, internalizing psychological symptoms (measured with validated instruments for depression, anxiety and suicidality), externalizing adverse behaviours (measured as school out, delinquency, drug and alcohol use), and sexual health risks (measured as multiple partners, infrequent condom use, sex while drunk or on drugs), as well as socio-demographic factors. The analysis focused on “casual” sex among female adolescents aged 11+ (n=1498) (defined as infrequent condom use, multiple partners and sex drunk or on drugs). Following exploratory principal components analysis (PCA) to check the grouping of indicator variables on the latent constructs, structural equation modelling (SEM) was used to investigate longitudinal pathways from structural deprivation to the outcome construct, and moderation of these pathways by improved access to schooling. | ||||
| Results / Comments: The latent constructs for deprivation, internalizing psychological symptoms, externalizing adverse behaviours, and HIV-risk aspects of casual sex and, for the intervention, free access to schooling were confirmed by PCA. Secondly, the SEM indicated that baseline structural deprivation achieved its impact on HIV-risky casual sex at follow-up solely via a sequential double mediation, i.e. the pathway proceeded via internalising symptoms and then externalising behaviour (averaged between baseline and follow-up) to HIV-risk behaviour. There was no significant direct effect of structural deprivation on the outcome or on externalising behaviour. Thirdly, improved access to schooling moderated the segments of the pathway from structural deprivation to internalising symptoms and from internalising symptoms to externalising behaviour, but not from externalising behaviour to HIV-risky behaviours. | ||||
| Discussion: This study supports previous evidence on the importance of social protection to reduce HIV-risk behaviours, in the particular instances of improved access to schooling among female adolescents of school-going age. The intervention moderates two of the links in the causal chain from structural deprivation to HIV-risk sex behaviours, in addition to its beneficial first-order effects on the intervening variables and the outcome. Differentiated analysis of this kind may enhance the effective application of social protection in HIV prevention, and sheds light on the complex multiple pathways to risk as well as potential intervention points. | ||||
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