title: School, Supervision and Adolescent-Sensitive Clinic Care: Combination Social Protection and Reduced Unprotected Sex Among HIV-Positive Adolescents in South Africa.
abstract: Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited. This study quantitatively tests whether social protection is associated with reduced unprotected sex among 1060 ART-eligible adolescents from 53 government facilities in South Africa. Potential social protection included nine 'cash/cash-in-kind' and 'care' provisions. Analyses tested interactive/additive effects using logistic regressions and marginal effects models, controlling for covariates. 18 % of all HIV-positive adolescents and 28 % of girls reported unprotected sex. Lower rates of unprotected sex were associated with access to school (OR 0.52 95 % CI 0.33-0.82 p = 0.005), parental supervision (OR 0.54 95 % CI 0.33-0.90 p = 0.019), and adolescent-sensitive clinic care (OR 0.43 95 % CI 0.25-0.73 p = 0.002). Gender moderated the effect of adolescent-sensitive clinic care. Combination social protection had additive effects amongst girls: without any provisions 49 % reported unprotected sex; with 1-2 provisions 13-38 %; and with all provisions 9 %. Combination social protection has the potential to promote safer sex among HIV-positive adolescents, particularly girls.
authors.affiliation: Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK. elona.toska@spi.ox.ac.uk.|AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, 4.26 Leslie Building, Private Bag Rondebosch, Cape Town, Western Cape, 7701, South Africa. elona.toska@spi.ox.ac.uk.
authors.forename: Elona
authors.identifier: http://orcid.org/0000-0002-3800-3173
authors.initials: E
authors.lastname: Toska
authors.affiliation: Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.|Department of Psychiatry and Mental Health, Groote Schuur Hospital, University of Cape Town, J-Block, Observatory, Cape Town, 7925, South Africa.
authors.forename: Lucie D
authors.initials: LD
authors.lastname: Cluver
authors.affiliation: Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Boyes
authors.affiliation: Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Isaacsohn
authors.affiliation: AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, 4.26 Leslie Building, Private Bag Rondebosch, Cape Town, Western Cape, 7701, South Africa.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hodes
authors.affiliation: University College London, London, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006679:HIV Seropositivity; D006801:Humans; D016015:Logistic Models; D008297:Male; D010290:Parents; D011640:Public Policy; D012309:Risk-Taking; D012574:Schools; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000208:ethnology / Q000706:statistics & numerical data*
keywords: HIV-positive adolescents; Secondary prevention; Social protection; South Africa; Unprotected sex