The Effect of Family-Based Economic Empowerment Intervention and Family Factors on Sexual Risk-Taking Attitudes Among Adolescents Living with HIV in Uganda

Background and Purpose: Previous studies demonstrated the effect of a family-based economic strengthening intervention on sexual risk-taking attitudes among adolescents orphaned by HIV and AIDS. Additionally, perceived caregiver support mediated the role between economic strengthening and sexual risk-taking attitudes. However, little is known about the impact of such interventions, on sexual risk-taking attitudes among adolescents living with HIV (ALHIV). Yet, ALHIV are particularly vulnerable to engaging in risky sexual behaviors –increasing the risk of HIV transmission and superinfections. Moreover, given the increasing HIV prevalence rates among adolescents in sub-Saharan Africa, strategies to address sexual risk-taking behaviors are critical. This study examined the effect of a family-based economic empowerment intervention, known as Suubi+Adherence, and role of family level factors on sexual risk-taking attitudes among ALHIV in rural Uganda.

Methods: This study utilized data from the Suubi+Adherence study, a longitudinal cluster randomized clinical trial, funded by National Institute for Child Health and Human Development. The study examined an innovative family-based economic empowerment intervention on ART adherence among perinatally HIV-infected adolescents in southern Uganda, a region heavily affected by HIV/AIDS. Adolescents were eligible to participate if they were: 1) 10–16 years old, 2) HIV-positive and know their HIV status, 3) prescribed antiretroviral therapy, 4) living within a family, not an institution, and 5) enrolled in one of the 39 health clinics providing ART to ALHIV in the study area. Clinics were randomly assigned to either the control group (n=344) receiving bolstered standard of care, or the intervention group (n=358) receiving a family-based economic empowerment intervention consisting of a child development savings account, and microenterprise workshops. We utilized data collected at baseline, 12 and 24-months post intervention initiation. Mixed-effects models were used to examine the effect of the intervention as well as family factors (as measured by family communication, cohesion, and support) on sexual risk-taking attitudes.

Results: Overtime, adolescents in both the intervention and control groups reported significantly lower scores in sexual-risk-taking attitudes. After adjusting for sociodemographic and family factors, there was no significant difference in sexual risk-taking attitudes among adolescents in the intervention and control group. However, age (ß=0.05, 95% CI: 0.02, 0.06), frequency of family communication (ß=0.21, 0.13, 0.29) and caregiver social support (ß=-0.19, 95% CI: -0.35, -0.04) were significant predictors of sexual-risk taking attitudes. The effect of social support on sexual risk-taking attitudes was significantly moderated across time points. Adolescents reporting higher levels of caregiver social support also reported a significant decrease in sexual-risk-taking attitudes at 12-months follow up (ß=-0.34, 95%CI: -0.57, -0.11).

Conclusions and Implications: Attitudes towards sexual risk-taking decreased for ALHIV throughout the study period. The study findings demonstrate that a supportive family environment can promote positive attitudes related to sexual risk-taking behaviors. The effectiveness of sexual risk reduction interventions and strategies would be enhanced by engaging families and strengthening supportive relationships between adolescents and their caregivers. Public health and social work researchers and programmers should consider leveraging on existing family social networks while developing and implementing interventions to promote and sustain positive health outcomes among ALHIV.