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Linking at-risk South African girls to sexual violence and reproductive health services: A mixed-methods assessment of a soccer-based HIV prevention program and pilot SMS campaign.

ABSTRACT: Grassroot Soccer developed SKILLZ Street-a soccer-based life skills program with a supplementary SMS platform-to support adolescent girls at risk for HIV, violence, and sexual and reproductive health challenges. We conducted a mixed-methods assessment of preliminary outcomes and implementation processes in three primary schools in Soweto, South Africa, from August to December 2013. Quantitative methods included participant attendance and SMS platform usage tracking, pre/post questionnaires, and structured observation. Qualitative data were collected from program participants, parents, teachers, and a social worker during 6 focus group discussions and 4 in-depth interviews. Of 394 participants enrolled, 97% (n?=?382) graduated, and 217 unique users accessed the SMS platform. Questionnaires completed by 213 participants (mean age: 11.9, SD: 3.02 years) alongside qualitative findings showed modest improvements in participants' perceptions of power in relationships and gender equity, self-esteem, self-efficacy to avoid unwanted sex, communication with others about HIV and sex, and HIV-related knowledge and stigma. The coach-participant relationship, safe space, and integration of soccer were raised as key intervention components. Implementation challenges were faced around delivery of soccer-based activities. Findings highlight the relevance and importance of programs like SKILLZ Street in addressing challenges facing adolescent girls in South African townships. Recommendations for future programs are provided.

SUBMITTER: Merrill KG

PROVIDER: S-EPMC6613633 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Linking at-risk South African girls to sexual violence and reproductive health services: A mixed-methods assessment of a soccer-based HIV prevention program and pilot SMS campaign.

Merrill Katherine G KG Merrill Jamison C JC Hershow Rebecca B RB Barkley Chris C Rakosa Boitumelo B DeCelles Jeff J Harrison Abigail A

Evaluation and program planning 20180430

Grassroot Soccer developed SKILLZ Street-a soccer-based life skills program with a supplementary SMS platform-to support adolescent girls at risk for HIV, violence, and sexual and reproductive health challenges. We conducted a mixed-methods assessment of preliminary outcomes and implementation processes in three primary schools in Soweto, South Africa, from August to December 2013. Quantitative methods included participant attendance and SMS platform usage tracking, pre/post questionnaires, and ...[more]

PMID: 29890449

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Project description:BackgroundThe international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to both sexual and reproductive health (SRH) services and HIV/AIDS prevention, treatment, care and support. Recently, there has been increasing awareness and discussion of the possible benefits of linkages between SRH and HIV programmes at the policy, systems and service delivery levels. However, the evidence for the efficacy of these linkages has not been systematically assessed.MethodsWe conducted a systematic review of the evidence for interventions linking SRH and HIV. Structured methods were employed for searching, screening and data extraction. Studies from 1990 to 2007 reporting pre-post or multi-arm evaluation data from SRH-HIV linkage interventions were included. Study design rigour was scored on a nine-point scale. Unpublished programme reports were gathered as "promising practices".ResultsOf more than 50,000 citations identified, 185 studies were included in the review and 35 were analyzed. These studies had heterogeneous interventions, populations, objectives, study designs, rigour and measured outcomes. SRH-HIV linkage interventions were generally considered beneficial and feasible. The majority of studies showed improvements in all outcomes measured. While there were some mixed results, there were very few negative findings. Generally, positive effects were shown for key outcomes, including HIV incidence, sexually transmitted infection incidence, condom use, contraceptive use, uptake of HIV testing and quality of services. Promising practices (n = 23) tended to evaluate more recent and more comprehensive programmes. Factors promoting effective linkages included stakeholder involvement, capacity building, positive staff attitudes, non-stigmatizing services, and engagement of key populations.ConclusionsExisting evidence provides support for linkages, although significant gaps in the literature remain. Policy makers, programme managers and researchers should continue to advocate for, support, implement and rigorously evaluate SRH and HIV linkages at the policy, systems and service levels.

Project description:IntroductionIn 2013, the WHO published the first global and regional estimates on physical and sexual intimate partner violence (IPV) and non-partner sexual violence (NPSV) based on a systematic review of population-based prevalence studies. In this protocol, we describe a new systematic review for the production of updated estimates for IPV and NPSV for global monitoring of violence against women, including providing the baseline for measuring Sustainable Development Goal to eliminate all forms of violence against women and girls.Methods and analysisThe systematic review will update and extend the previous search for population-based surveys (either nationally or subnationally representative) conducted among women aged 15+ years that measured the prevalence of physical, sexual, psychological and physical and/or sexual IPV, NPSV or sexual violence by any perpetrator up to December 2019. Data will be extracted separately for all age groups, setting (urban/rural), partnership status (currently partnered/ever partnered/all women) and recall period (lifetime prevalence/past 12 months). Studies will be identified from electronic searches of online databases of EMBASE, MEDLINE, Global Health and PsycInfo. A search of national statistics office homepages will be conducted for each country to identify reports on population-based, national or subnational studies that include data on IPV or NPSV published outside academic journals. Two reviewers will be involved in quality assessment and data extraction of the review. The review is planned to be updated on a continuous basis. All findings will undergo a country consultation process.Ethics and disseminationFormal ethical approval is not required, as primary data will not be collected. This systematic review will provide a basis and a follow-up tool for global monitoring of the Sustainable Development Goal Target 5.2 on the elimination of all forms of violence against women and girls.Prospero registration numberCRD42017054100.

Project description:BACKGROUND:Improved access to sexual and reproductive health (SRH) services and information is essential for supporting adolescents and youth in making informed decisions and optimizing each young person's outcomes related to their SRH, health and well-being and countries' current and future social and economic development. Mobile phones offer opportunities for young people to privately access SRH content and to be linked to SRH services. The objective of this study was to develop the content for an SMS (short message service or "text message") platform jointly with adolescents and youth in three regions in Peru (Lima, Ayacucho and Loreto) as part of the ARMADILLO (Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes) Study. METHODS:Content development was done in three stages. During Stage 1, we held community consultations with 13-17?year old adolescents, 18-24?year old youth and professionals who work with young people through the education and health sectors ("adult advisers") to identify and rate SRH topics of interest through group free- and guided-brainstorming activities and an individual written sharing activity. During Stage 2, the team developed the preliminary domains, sub-domains and content for the SMS platform. During Stage 3, we held focus groups with adolescents to validate the SMS content, including both individual scoring of and group feedback for each SMS. Group feedback asked about their general impressions and understanding and their thoughts about the language and usefulness of the SMS. RESULTS:A total of 172 adolescents and youth ages 13-24 and 20 adult advisers participated. Adolescents and youth brainstormed and rated SRH topics and sub-topics that led to the initial structure for the SMS platform, with 9 domains, 25 sub-domains and 146 draft SMS. Adolescents provided high scores for the SMS, with all sub-domains receiving average scores of 3.0 or higher (out of 4.0) for the SMS included. Adolescents also provided suggestions to optimize content, including improvements to unclear messages, resulting in SMS with adolescent-friendly content in simple, straightforward language. This process also revealed that adolescents lacked knowledge and had misconceptions related to contraceptive methods. CONCLUSION:This study details the systematic process used to develop relevant and accessible SRH information through a participatory approach. We document critical information about what young people know and how they think, enabling us to understand their perspective and literally speak their language. Results also provide future directions for programmatic, research and policy efforts with young people, in particular around gender norms, interpersonal violence, and access to SRH information and services, in similar settings.

Project description:BACKGROUND:Unintended pregnancy has dire consequences on the health and socioeconomic wellbeing of adolescent girls and young women (AGYW) (aged 15-24?years). While most studies tend to focus on lack of access to contraceptive information and services, and poverty as the main contributing factor to early-unintended pregnancies, the influence of sexual violence has received limited attention. Understanding the link between sexual violence and unintended pregnancy is critical towards developing a multifaceted intervention to reduce unintended pregnancies among AGYW in South Africa, a country with high teenage pregnancy rate. Thus, we estimated the magnitude of unintended pregnancy among AGYW and also examined the effect of sexual violence on unintended pregnancy. METHODS:Our study adopted a cross-sectional design, and data were obtained from AGYW in a South African university between June and November 2018. A final sample of 451 girls aged 17-24?years, selected using stratified sampling, were included in the analysis. We used adjusted and unadjusted logistic regression analysis to examine the effect of sexual violence on unintended pregnancy. RESULTS:The analysis shows that 41.9% of all respondents had experienced an unintended pregnancy, and 26.3% of those unintended pregnancies ended in abortions. Unintended pregnancy was higher among survivors of sexual violence (54.4%) compared to those who never experienced sexual abuse (34.3%). In the multivariable analysis, sexual violence was consistently and robustly associated with increased odds of having an unintended pregnancy (AOR:1.70; 95% CI: 1.08-2.68). CONCLUSION:Our study found a huge magnitude of unintended pregnancy among AGYW. Sexual violence is an important predictor of unintended pregnancy in this age cohort. Thus, addressing unintended pregnancies among AGYW in South Africa requires interventions that not only increase access to contraceptive information and services but also reduce sexual violence and cater for survivors.

Project description:IntroductionThere is a paucity of data on the impact of COVID-19 pandemic on girls and young women. The study examines the prevalence and correlates of violence and sexual and reproductive health (SRH) service disruption among girls and young women during COVID-19 restrictions and lockdown.MethodsAn interactive voice response survey was conducted among girls and women aged 18-24 years between 10th March to 24th April 2021. The survey enrolled 1314 participants. Descriptive analysis was used to assess prevalence of violence and SRH service disruption. Two sampled test of proportion was used to asses difference in prevalence of violence before and after the pandemic. Logistic regression was used to examine relationship between the outcome variables and socio demographic predictors.ResultsThe study did not find significant difference in prevalence of violence before and after the pandemic. Education was found to be protective against experience of both physical and sexual violence after the pandemic. Dalit participants were four times more likely to report physical violence after the pandemic than Brahmin/Chhetri participants (OR:3.80; CI:1.41-10.24). Participants from 22-24-year age group were twice as likely to experience sexual violence compared to girls and participants from 18-21year age group (OR:2.25; CI:1.04-4.84). Participants from urban municipalities were 29% less likely to report SRH services disruption than participants from rural municipalities (OR-0.71, 95% CI: 0.55-0.91). Participants with disability were twice as likely to report disruption than participants without disability (OR-2.35, 95% CI: 1.45-3.82).ConclusionsTo reduce violence against girls and women due to the pandemic, interventions should focus on Dalit women and on preventing education discontinuation among girls and women. SRH service during the pandemic needs to be improved for girls and women with focus on girls and women from rural municipalities and girls and women with disability.

Dataset Information

Linking at-risk South African girls to sexual violence and reproductive health services: A mixed-methods assessment of a soccer-based HIV prevention program and pilot SMS campaign.

Publications

Linking at-risk South African girls to sexual violence and reproductive health services: A mixed-methods assessment of a soccer-based HIV prevention program and pilot SMS campaign.

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