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Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068)

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Abstract

Individual economic resources may have greater influence on school-enrolled young women’s sexual decision-making than household wealth measures. However, few studies have investigated the effects of personal income, employment, and other financial assets on young women’s sexual behaviors. Using baseline data from the HIV Prevention Trials Network (HPTN) 068 study, we examined the association of ever having sex and adopting sexually-protective practices with individual-level economic resources among school-enrolled women, aged 13–20 years (n = 2533). Age-adjusted results showed that among all women employment was associated with ever having sex (OR 1.56, 95 % CI 1.28–1.90). Among sexually-experienced women, paid work was associated with changes in partner selection practices (OR 2.38, 95 % CI 1.58–3.58) and periodic sexual abstinence to avoid HIV (OR 1.71, 95 % CI 1.07–2.75). Having money to spend on oneself was associated with reducing the number of sexual partners (OR 1.94, 95 % CI 1.08–3.46), discussing HIV testing (OR 2.15, 95 % CI 1.13–4.06), and discussing condom use (OR 1.99, 95 % CI 1.04–3.80). Having a bank account was associated with condom use (OR 1.49, 95 % CI 1.01–2.19). Economic hardship was positively associated with ever having sex, but not with sexually-protective behaviors. Maximizing women’s individual economic resources may complement future prevention initiatives.

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Acknowledgements

The authors wish to thank the study participants, community stakeholders, and staff from the HPTN 068 South African study site; the MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt), School of Public Health at University of the Witwatersrand in South Africa; and the HPTN collaborators at the University of North Carolina (UNC) Gillings School of Public Health and the Johns Hopkins Bloomberg School of Public Health, and the HPTN Scholars Program leaders.

Funding

This study was funded by Award Numbers UM1 AI068619 (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center) from the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health and the National Institute on Drug Abuse of the National Institutes of Health. The Wellcome Trust, United Kingdom, provided vital core funding for the Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit including the Agincourt Health and Socio-Demographic Surveillance System (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z). The primary author’s work on this manuscript was supported through resources from the HPTN Scholars Program (Grant UM1 AI068619: NIAID, NIMH, NIDA) and through services provided by the Johns Hopkins University Center for AIDS Research (Grant 1P30AI094189: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA

    Larissa Jennings

  2. Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA

    Audrey Pettifor & Amanda Selin

  3. FHI360, Science Facilitation, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA

    Erica Hamilton

  4. Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St., Charleston, SC, 29425, USA

    Tiarney D. Ritchwood

  5. Medical Research Council Wits Rural Public Health and Health Transitions Research Unit, Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Audrey Pettifor, F. Xavier Gómez-Olivé, Catherine MacPhail & Kathleen Kahn

  6. INDEPTH Network, Accra, Ghana

    F. Xavier Gómez-Olivé & Kathleen Kahn

  7. School of Health, University of New England, Armidale, 2351, NSW, Australia

    Catherine MacPhail

  8. Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa

    Catherine MacPhail

  9. Fred Hutchinson Cancer Research Center, Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, WA, USA

    James Hughes

  10. Department of Biostatistics, University of Washington, Seattle, WA, USA

    James Hughes

  11. Centre for Global Health Research, Umeå University, Umeå, Sweden

    Kathleen Kahn

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  1. Larissa Jennings
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  2. Audrey Pettifor
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Correspondence to Larissa Jennings.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Jennings, L., Pettifor, A., Hamilton, E. et al. Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068). AIDS Behav 21, 665–677 (2017). https://doi.org/10.1007/s10461-016-1435-5

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