Climate Change-Related Factors and HIV Vulnerabilities Among Very Young Adolescents in Kenya: Multi-Method Qualitative Findings

Background and Purpose: There is growing evidence of linkages between climate change-related factors, such as water insecurity, and HIV vulnerabilities. Yet knowledge gaps persist regarding climate change and HIV prevention needs, and climate experiences among very young adolescents ages 10-14. Yet very young adolescents comprise half of the world's 1.2 billion adolescent population and are at a key developmental phase. We conducted a multi-method study to explore climate change-related factors and linkages with HIV vulnerabilities among very young adolescents in climate-affected Kenyan regions.

Methods: This multi-method study in 6 sites (Nairobi, Naivasha, Kisumu, Isiolo, Kilifi, Kalobeyei refugee settlement) involved: n=12 focus groups (FG) with elders, n=60 very young adolescent walk-along interviews, and n=12 two-day participatory mapping workshops with very young adolescents. We developed a strengths-based approach to participatory mapping that combined user-friendly geographic information system technology with arts-based methods (dance, drawing, music, video). We conducted thematic analysis informed by the resource insecurity framework, and integration with a mixed-methods matrix.

Results: Participants (N=297) included: elders (n=119; mean age: 60.6 years, standard deviation [SD]: 7.9; men: 48.7%, women: 51.3%), youth walk-along interviewees (n=60; mean age: 13.4, SD: 1.5; boys: 51.4%, girls: 48.6%), and youth participatory mapping participants (n=118; mean age: 12.1, SD: 1.33; boys: 50.8%, girls: 49.2%). Participant narratives revealed climate-related changes (e.g., drought, extreme heat, flooding) increased food insecurity, water insecurity, and sanitation insecurity. Each resource insecurity in turn was linked with unique and overlapping HIV vulnerabilities. Food insecurity was associated with youth running away, and transactional sex and exploitative relationships for food, which contributed to early, unplanned and/or unwanted pregnancy. Water insecurity was associated with: menstruation hygiene management challenges (which in turn, reduced educational attendance); sexual violence risks travelling far and/or at night for water; and transactional sex and exploitative relationships to access water. Sanitation insecurity was associated with: sexual violence risks accessing showers, toilets, and garbage disposal sites; and transactional sex for menstruation products, which elevated early pregnancy risks. Heavy rains and floods were raised as particularly dangerous for young women and girls due to infrastructure damage to roads and bridges, and subsequent sexual harassment and sexual violence exposure while travelling via different routes. While sanitation insecurity was common across sites, water and food insecurity were raised most frequently in Kalobeyei (refugee settlement) and Isiolo (nomadic and pastoralist community).

Conclusions and Implications: Together findings signal water, food, and sanitation insecurity are social drivers of HIV vulnerability, and poorer sexual and reproductive health outcomes at large, among very young adolescents in Kenya. Strengths-based interventions that apply a gender-transformative approach, and participatory research that amplifies voices of very young adolescents, hold the potential to disrupt the inequitable power dynamics underpinning violence and exploitation that are exacerbated by climate change and related resource insecurities. Climate-informed interventions can consider seasonality influences, contextual differences, gender equity, and target mechanistic pathways at interpersonal (e.g., transactional sex/exploitative relationships), community (e.g., gender inequitable norms), and structural (e.g., sanitation infrastructure, poverty) levels to promote sexual and reproductive health, and advance HIV prevention, with very young adolescents in Kenya.