20th International AIDS Conference - Melbourne, Australia


MOAC01 Young People: Epidemiology and Prevention Strategies
  Oral Abstract Session : Track C
Venue: Melbourne Room 2
Time: 21.07.2014, 16:30 - 18:00
Co-Chairs: Udi Davidovich, Netherlands
Megan Lim, Australia

16:30
MOAC0101
Abstract
Powerpoint
Webcast
Disparities and trends in AIDS mortality among adolescents living with HIV in low- and middle-income countries
T. Porth, C. Suzuki, A. Gillespie, S. Kasedde, P. Idele
UNICEF, New York, United States

16:45
MOAC0102
Abstract
Powerpoint
Webcast
Strengthening sexual health promotion for young people: a comprehensive assessment of barriers to condom use and HIV/STI testing for program development
P.C.G. Adam1, C. Treloar1, J. Bryant1, T. Lea1, J. Holden2, T. Duck2, C. Power2, C.P. Bourne3, C. Murray3, B. Shepherd3, J. Howard4, J.B.F. de Wit1
1Centre for Social Research in Health, The University of New South Wales, Sydney, Australia, 2HIV and STI Branch, New South Wales Health, North Sydney, Australia, 3New South Wales Sexually Transmissible Infections Programs Unit, Southeast Sydney Local Health District, Sydney, Australia, 4National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia

17:00
MOAC0103
Abstract
A videogame increases HIV risk-related knowledge in adolescents
L. Fiellin1,2, K. Hieftje1,2, T. Fakhouri1, L. Duncan1,3, T. Kyriakides2
1Yale play2PREVENT Lab, New Haven, United States, 2Yale University, New Haven, United States, 3McGill University, Montreal, Canada

17:15
MOAC0104
Abstract
Powerpoint
Webcast
Combination social protection halves HIV-risk behavior incidence amongst female and male South African adolescents
L. Cluver1, M. Orkin2, M. Boyes3, L. Sherr4
1Oxford University & University of Cape Town, Social Policy and Intervention, Cape Town, South Africa, 2University of the Witwatersrand, School of Public and Development Management, Johannesburg, South Africa, 3Curtin University, School of Psychology and Speech Pathology, Perth, Australia, 4University College London, Royal Free and University College Medical School, London, United Kingdom

17:30
MOAC0105
Abstract
Powerpoint
Webcast
Associations between gay community venue network position and HIV Risk and protective factors among young men who have sex with men in Los Angeles county
I.W. Holloway1, M.D. Kipke2,3
1University of California, Department of Social Welfare, Los Angeles, United States, 2Children's Hospital Los Angeles, Department of Pediatrics, Los Angeles, United States, 3University of Southern California, Department of Preventive Medicine, Los Angeles, United States

17:45
MOAC0106
Webcast
Moderated discussion

Powerpoints presentations
Disparities and trends in AIDS mortality among adolescents living with HIV in low- and middle-income countries - Tyler Porth
Disparities and trends in AIDS mortality among adolescents living with HIV in low- and middle-income countries - Tyler Porth

Strengthening sexual health promotion for young people: a comprehensive assessment of barriers to condom use and HIV/STI testing for program development - Philippe Christian Guy Adam

Combination social protection halves HIV-risk behavior incidence amongst female and male South African adolescents - Lucie Cluver

Associations between gay community venue network position and HIV Risk and protective factors among young men who have sex with men in Los Angeles county - Ian W. Holloway



Rapporteur reports

Track C report by Elizabeth Bukusi


T. Porth presented data from LMICs where PMTCT and ART has increased for children, mortality among them has decreased and they are living longer.  Adolescents, however, are counted with adults as being 15 years and older.  The analysis focused on adolescents 10-19 years where new infections decreased by 37%, but mortality increased by 189%, especially among those age 15-19 years who survived from being perinatally infected in the 2000-2005 peak years. Mortality among adolescents differs by sex because 60% of girls are newly infected (and still healthy) as adolescents and deflates mortality risk and 80% of mortality is among boys who are part of the perinatally infected birth cohort and that those perinatally infected have lower access to ART and suboptimal ART adherence, thereby requiring more new and invigorated attention to perinatally infected adolescents. 

P. Adams presented data from New South Wales, Australia to help inform sexual health regarding condom use and HIV/STI testing for young adults aged 16-26, recruited through Facebook and administered an online survey.   Comprehensive barriers to testing were evaluated. Of the 754, only the 502 sexually active young adults were included who were equally 20 or younger, more female (60.4%), and heterosexual (75.1%).  Overall, HIV/STI knowledge was moderate (6.18 out of 10) and highest for transmission (7.64) and lowest for consequences (5.10). Most (62.2%) reported unprotected sex and 44% had ever been tested for any STI. Social cognitive correlates of HIV/STI testing included better knowledge of STI/ HIV, perceived behavioral control (confidence they can use condoms when they want to), and subjective norms (their best friends believe they should use condoms).  Overall, 67.1% had been exposed to STI testing campaigns, which was significantly associated with past and future planned STI testing. Association of frequency of exposure to STI/HIV testing campaigns with social-cognitive correlates of STI testing were similar to past STI testing and included increased STI/HIV knowledge, perceived behavioural control and subjective norms.  Independent correlates of unprotected sex were positive attitudes towards condom use and subject norms (i.e. supported by their friends). Exposure to STI campaigns, however, was not associated with either unprotected sex or intention to use condoms with casual or regular partners.  Findings from this study suggests that sexual health campaigns must move beyond knowledge and promote positive attitudes and perceived advantages of sexual health behaviours and address perceived disadvantages. 

L. Fiellin presented data applicable to adolescents in high-income countries who have access to iPads.  Using an RCT, 333 teens (data presented only for 198) in the US age 11-14 years adolescents were randomized either to 6-weeks exposure to a “serious” video game where they selected a character (aspirational avatar) where they were faced with a series of risks and consequences using message framing or other non-serious video content (e.g., “angry birds”).  Significant improvements in HIV-related knowledge occurred during the intervention and was sustained for 3 and 6 months.  A direct correlation was made between the amount of time exposed to playing the game and HIV knowledge scores. Avatars were unable to interact with each other (i.e., multiple players) or allowed to address “real-life” skill negation, which should be incorporated into the next generation of interventions.

L. Cluver presented real-world data from South African that builds on evidence that conditional cash transfers (incentives) improves behavioral outcomes, but that cash alone is insufficient to reduce HIV risk behaviors and should be complimented with teacher support, improved parenting and better care (cash + care).  The rationale for the program is that community violence, school dropouts and hunger are additional drivers of HIV risk.  In a longitudinal study of 3515 teenagers in South Africa, unconditional cash transfer (uniforms, food parcels, transportation, etc) was compared with those who also got care (positive parenting, school counselors, free school meals if they attended school, teacher support, participated in a food garden).  The program worked differently for boys and girls.  For boys, cash alone had no impact on HIV risk behaviors, but cash+care reduced them by 50%.  For girls, cash alone reduced risk by 37%, but cash+care reduced it by 45%. There was an incremental impact on HIV incidence reduction for each additional “care” component of teacher support and better parenting. The issues are complex in each context and the amount of money or the “type” of care should be tailored to the unique community needs. 

I. Holloway examined 10-year old data of healthy young MSM (YMSM) in LA County and the venues that they attend.  Important findings from this study is that YMSM social spaces are highly interconnected (may attend multiple places in one evening) and core venues in the community were associated with higher drug use, a recent STI diagnosis, and recent HIV testing. Integrating treatment and prevention services into these cultures, including working with venue owners, may be an innovative way to more effectively engage YMSM to promote better choices.  Questions were raised about whether the “social space” has changed in more recent years with the increase in online venues, shifting of physical space of venues, and whether risky sex was a result of these venues or vice versa. 




Youth report by Joanna Williams


This oral abstract session highlighted the heterogeneity of epidemiological research in the area of HIV and adolescents. Research attention to this group is essential in the context of a 157% increase in new infections over the past decade. This age group also accounts for an increased proportion of new infections suggesting that while progress has been made in other age groups, this remains a neglected area.

The presenters highlighted that health services should focus on allowing adolescences to ‘thrive’ as opposed to ‘keeping [them] alive’. Based on the first priority of preventing new infections, most presentations focused on prevention by decreasing the odds of an adolescent engaging in risky sexual behaviours. One study in South Africa found that when certain socio-cognitive support and structural enablers, such as unconditional cash transfers, teacher support and positive parenting were applied simultaneously, the odds ratio of young people engaging in risky sexual behaviour decreased by 50%. When only unconditional cash transfers were provided without socio-cognitive support, a decrease in the odds ratio was only noted in adolescent females. This finding is significant given that in Sub-Saharan Africa females are disproportionately affected by HIV.

The session highlighted the potential for the community to use innovative methods of health promotion – such as venue-based interventions and the use of ‘serious computer games’ – to decrease risk taking behaviour in adolescents. Whilst current research suggest that these methods are accepted by their target audience and lead to changes in young people’s knowledge and attitudes, further research is being conducted to assess whether they influence risk-taking behaviours.




   

    The organizers reserve the right to amend the programme.