Substantial Increase in Transactional Sex and HIV Risk Among Adolescents During the COVID-19 Pandemic: Results From a Repeated Cross-Sectional Study in Botswana.

The COVID-19 pandemic and resulting public health response has disrupted the lives of adolescents and their families worldwide. We evaluated the impact of the pandemic on attitudes, beliefs, and sexual risk behavior among adolescents in Botswana. Participants were recruited using household-based sampling across residential districts (blocks) in and around Gaborone, Botswana, and completed surveys on laptop computers at a private, central location. We compared baseline survey data from 380 adolescents who completed the survey pre-pandemic (n = 139) to those who completed the survey intra-pandemic (n = 241). Participants had a mean age of 15.2 years; 58.6% were girls and 41.4% were boys. Intra-pandemic, participants reported greater engagement in transactional sex (38.1% compared to 13.6% pre-pandemic, p <. 05), more favorable attitudes toward transactional sex with sugar daddies and sugar mommies (p <. 05), greater intentions to remain sexually active in the future (29.2% vs.13.6%, respectively, p <.05), and lower self-efficacy in handling risky sexual situations (p < .01). Public health interventions that lessen these concerning shifts in attitudes and behaviors will be key to protecting the sexual health of adolescents and to supporting their safe transition to adulthood.

Delivering Modern Global Health Learning Requires New Obligations and Approaches.

Introduction: The COVID-19 pandemic has forced a new look (or modernization) for both the obligations and approaches to achieve best-practices in global health learning. These best-practices have moved beyond traditional, face-to-face (F2F), classroom-based didactics to the use of innovative online, asynchronous and synchronous instructional design and the information and communication technology (ICT) tools to support it. But moving to this higher level of online in-service and pre-service training, key obligations (e.g., stopping neocolonialization, cultural humility, reversing brain drain, gender equity) must guide the modernization of instructional design and the supporting ICT. To positively impact global health training, educators must meet the needs of learners where they are. Purpose: We describe a set of multi-communication methods, e-Learning principles, strategies, and ICT approaches for educators to pivot content delivery from traditional, F2F classroom didactics into the modern era. These best-practices in both the obligations and approaches utilize thoughtful, modern strategies of instructional design and ICT. Approach: We harnessed our collective experiences in global health training to present thoughtful insights on the guiding principles, strategies, and ICT environment central to develop learning curricula that meet trainee needs and how they can be actualized. Specifically, we describe five strategies: 1. Individualized learning; 2. Provide experiential learning; 3. Mentor … Mentor … Mentor; 4. Reinforce learning through assessment; and 5. Information and communication technology and tools to support learning. Discussion: We offer a vision, set of guiding principles, and five strategies for successful curricula delivery in the modern era so that global health training can be made available to a wider audience more efficiently and effectively.