Kenya National AIDS Control Council
First National Biennial HIV and AIDS Research Conference
17–20 May 2011
"A population at risk: Emerging issues among married adolescent girls (MAG) in Nyanza Province and implications for HIV prevention"
The purpose of the study was to provide a baseline for assessing the combined effect of interventions to promote the uptake of comprehensive HIV and RH/FP information and services among married adolescent girls (MAG).
Findings presented are from a baseline study conducted in Homa Bay and Rachuonyo Districts of Nyanza Province. The National Ethical Review Committee of the Kenya Medical Research Institute, the Kenya National Council for Science and Technology, and the Institutional Review Board of the Population Council provided ethical and research clearance for the study. A household survey was carried out in 2010 using structured questionnaires administered by trained research assistants.
Based on calculations from the 2003 Kenya Demographic and Health Survey, a total of 18 sublocations were randomly selected in both of the districts for inclusion in the study. The Kenya National Bureau of Statistics provided the list of sublocations in the two districts for sampling purposes. With the assistance of the provincial administration (chiefs, assistant chiefs, and village heads), lists of all villages in the sampled sublocations were obtained. From these lists, five villages were randomly selected in each sublocation. All households in each of the selected villages were visited and a household listing questionnaire was administered to the household head. Information was collected on age, sex, relationship to household head, and marital status for all household members aged 14 years and above. Those who satisfied the following criteria were eligible for individual interviews:
- Female household member aged 14–19 years and married to any member of the household. In households with more than one female member satisfying this criterion, all were interviewed.
- Male household member, regardless of age, married to a female household member aged 14–19 years. In households where a male member was married to more than one wife aged 14–19 years, the interview questions referred to the youngest wife.
A total of 721 MAG (aged 14–19 years) and 392 of their partners took part in the survey. The principal procedure for data analysis involved descriptive statistics on each variable at baseline.
HIV serostatus was self-reported by all study participants who had been tested for HIV and who were willing to disclose their status. HIV prevalence among MAG aged 15–19 was found to be high (Homa Bay 5%; Rachuonyo 4%) compared to girls in the same age range nationally (2.7%). A third of HIV-positive MAG did not access prevention of mother-to-child (PMTCT) services during their last pregnancy, and 44% of the children born as a result had not been tested for HIV. Ninety-one percent of MAG attended antenatal care (ANC) clinics at least once during their last pregnancy, but 41% delivered at home. Spousal (physical and sexual) violence among MAG aged 15–19 is remarkably high in Homa Bay in particular. In Homa Bay, 45% of MAG had ever been slapped or had an object thrown at them by their partners, compared to 27% of MAG in Rachuonyo, and 27% of all girls aged 15–19 nationally who have ever experienced sexual violence. Forty-one percent of MAG had ever been physically forced to have sex with their partner, compared to 8% of their peers in Rachuonyo, and 11% of all girls aged 15–19 nationally who had ever experienced physical violence since the age of 15. For the vast majority of MAG, their experience of spousal physical and sexual violence had occurred in the past year. Nearly half of the partners of married adolescent girls were in the 20–24-year-old age range.
Given the dangerous and complex relationship between HIV/AIDS and SGBV, and the prevalence of both among MAG in Homa Bay District, married adolescent girls face unique health risks which merit attention. Married adolescent/youth couples are an important population to consider in HIV programming.
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