Factors associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa

Abstract

1.Background In 2019, there were 1.7 million adolescents aged 10-19 living with HIV globally, with 1.5 million in sub-Saharan Africa and 360,000 in South Africa. Early sexual debut, defined as having first intercourse at or before age 14, has significant consequences for adolescents worldwide. While sexual activity during adolescence is normal, early sexual debut is linked to risky behaviours. While efforts have been made to understand HIV/AIDS knowledge among older adolescents and young adults, research often neglects younger adolescents aged 12-14 years old. Poor HIV knowledge among this age group may increase transmission risk, delay diagnosis and treatment, and fuel stigma. It's crucial to focus on this age group to eradicate the disease, although research is limited due to the sensitive nature of discussing HIV/AIDS with younger adolescents. 2.Objective The two set objectives of this study were firstly, to examine levels of HIV knowledge among younger adolescents aged 12-14 years old in South Africa. Secondly, to identify the demographic, socioeconomic and subjective norm characteristics associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa. 3.Methodology This study utilised secondary data acquired from the fifth South African National HIV, Behaviour and Health Survey of 2017 – this was the latest survey available data was analysed using STATA version 14. The South Africa National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM) is a national population-based survey conducted for surveillance of the HIV epidemic in South Africa. The sample for the study was younger adolescents aged 12-14 years old. The weighted sample of 927 861 was selected and used for analyses. The dependent variable in this study was HIV knowledge, defined as having accurate knowledge of all HIV-related questions from the survey. Eight questions assessing HIV and AIDS knowledge, perceptions, and stigma were used. Adolescents were asked about the curability of AIDS, reducing HIV risk by having fewer sexual partners, whether a healthy- looking person can have HIV, mother-to-child transmission, risk reduction by monogamy with an uninfected partner, HIV transmission through shared food, condom use, and male circumcision reducing HIV risk. The original response options were 'yes', 'no', and 'don't know', with 'don't know' responses excluded to ensure that the data accurately reflected the participants knowledge on HIV and AIDS. The dependent variable had three categories: low HIV knowledge (1-3 out of the eight questions answered correctly), average HIV knowledge (4-5 out of the eight questions answered correctly), and comprehensive HIV knowledge (6-8 questions answered correctly). A Multinomial Logistic Regression model was employed to analyse HIV knowledge. The data analysis was done in three phases. The first phase included descriptive analyses of utilised in the study through a ranked frequency and percentage distribution table and sex ratio which was used to explore the HIV knowledge levels based on sex. The second stage included Pearson’s chi-square test which were to measure the associations between the demographic, socioeconomic and subjective norms. The third stage included an unadjusted (bivariate) and adjusted (multivariate) Multinomial Logistic Regression which was employed to examine the demographic, socioeconomic and subjective norms associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa. 4.Results Less than half of younger adolescents (47.0%) had comprehensive HIV knowledge. The relative risk ratio shown in the multivariate Multinomial Logistic Regression model showed that the respondent’s age, sex, race, place of residence, province, grade, orphanhood status and subjective norms are significant predictors of HIV knowledge among younger adolescents aged 12-14 years old in South Africa. These associations indicated that non-African female adolescents are less likely to possess HIV knowledge compared to Black male adolescents, but generally, female adolescents have a slightly higher relative risk of possessing comprehensive HIV knowledge compared to their male counterparts (1.01, P<0.05; CI=0.99-1.03). Adolescents residing in rural areas have higher relative risks of possessing average and comprehensive HIV knowledge compared to those in urban areas, with relative risks increasing by 1.52 (P<0.05; CI=1.48-1.52) and 2.18 (P<0.05; CI=2.13-2.24), respectively. Additionally, willingness to share food with someone who has HIV/AIDS shows no significant difference in the relative risk of having average or comprehensive HIV knowledge (RRR:0.641; P<0.05; CI=0.62-0.65), while willingness to play with someone who has HIV/AIDS decreases the relative risks of having average and comprehensive HIV knowledge by factors of 0.32 (P<0.05; CI=0.32-0.33) and 0.13 (P<0.05; CI=0.12-0.13), respectively. Furthermore, adolescents uncomfortable discussing HIV/AIDS with at least one family member have decreased relative risks of possessing average and comprehensive HIV knowledge by factors of 0.27 (P<0.05; CI=0.27-0.28) and 0.30 (P<0.05; CI=0.29-0.30), respectively. These results highlight the importance of demographic and social factors in understanding HIV knowledge among young adolescents in South Africa. 5.Conclusion Despite significant efforts by the South African government to integrate HIV education into the national school curriculum and collaborate with NGOs and civil society groups, adolescents aged 12-14 still lack comprehensive HIV knowledge. Understanding HIV early plays a vital role in reducing stigma and discrimination associated with HIV/AIDS, fostering a supportive and inclusive atmosphere. It also promotes critical thinking among adolescents, empowering them to question myths and misunderstandings about the disease, thereby encouraging healthier behaviours and attitudes. The hypothesis for this research was that there is no association between demographic, socioeconomic and subjective norm characteristics and HIV knowledge among younger adolescents in South Africa. The multinomial logistic regression showed significant results. Therefore, the null hypothesis was rejected. Post the completion of the National Youth HIV Prevention Strategy (2022-205), it will become mandatory for the government to evaluate and refine the policy framework to include those under 15 years. Including those aged 12-14 years old will be crucial for fostering a generation equipped to safeguard their sexual health and make informed choices, thereby perpetuating the efficacy and relevance of HIV prevention efforts within the broader national agenda