Mental health, sexual and reproductive health, substance use and connectedness among adolescents in the overseas Caribbean territories

OBJECTIVE: To analyse mental health, sexual and reproductive health (SRH) and substance use behaviours and outcomes among adolescents in the overseas Caribbean territories and their association with family and school connectedness. SUBJECTS AND METHOD: The data were collected through aschool-based survey administered to secondary school students in Aruba, British Virgin Islands (BVI), Cayman Islands, Montserrat, St Eustatius and St Maarten. Multi country analysis was conducted through pooling and weighting of the data from the six territories. Data analysis included descriptive analysis and odds ratios to examine associations between family and school connectedness and mental health, SRH and substance use. RESULTS: Data on 4883 respondents in the age group 15–19years were used for the analysis, equally divided in males(49%) and females (51%). More than half (58.8%) of the girls reported feelings of sadness or hopelessness for more than a day and 31.2% seriously considered suicide. Approximately one-third (34.9%) made a suicide plan and 70.6% of these girls attempted suicide at least once. A quarter (23.2%) of the girls and 30.1% of the boys initiated sex before age 15 years; 58.2% of the females and 57.7%of the males used alcohol in the past 30 days and 44% ofthe boys got very drunk at least once. More than half of the adolescents reported lifetime marijuana use. Statistically significant associations were found between low family and school connectedness, and feeling sad or hopeless, suicidal thought, sexual initiation before age 15years, pregnancy, alcohol and substance use. CONCLUSIONS: The results highlight the critical importance of connectedness for adolescents to be healthy and thrive.

Are women the main victims of violence within relationships? prevalence, type and frequency of intimate partner violence and aggression by sex in Barbados, Jamaica and Trinidad and Tobago

OBJECTIVE: In the Caribbean, studies of intimate partner violence and aggression (IPVA) have rarely incorporated the experiences of men. In this study we compare the sexes in examining types, frequency and prevalence of IPVA. DESIGN AND METHODS: Data were from a population-based study of 15–30 year olds in Barbados, Jamaica and Trinidad and Tobago. The Revised Conflict Tactics Scales (CTS2) were used to measure incidence levels of IPVA in the 12-months preceding the survey. IPVA was defined as the combination of three subscales: physical violence, sexual coercion and psychological aggression. Physical injury was measured. RESULTS: Of 3,401 participants, more than half had experienced IPVA (53.0%), comprising physical violence (22.1%), sexual coercion (14.5%) and psychological aggression (43.5%). There were no significant differences by sex in IPVA or any contributing subscale. More women experienced injury (odds ratio 1.52; 95% confidence interval 1.07 - 2.15) and women experienced significantly greater frequency of physical violence. Physical violence and psychological aggression were lowest in Trinidad, and sexual coercion was highest in Jamaica with no other statistically significant country-level differences. CONCLUSION: Most of our results do not support the idea that women are the main victims of IPVA. Studies should examine a variety of potential risk factors beyond the sex of victims and perpetrators, as suggested by country differences, with further attention to IPVA frequency. Services should respond to the range of risks. Longitudinal studies and age group comparisons should identify whether these results signify shifts in gender relations within couples.

HIV Gateway: expanding access to Caribbean HIV research via a website

BACKGROUND/OBJECTIVES: Evidence-based HIV programming and policy in the Caribbean is hampered by limited access to existing research and other information about HIV in the region. A website was developed to facilitate such access. DESIGN AND METHODS: The HIV Gateway is a repository of publications and reports on HIV in the Caribbean searchable via a public website (www.hivgateway.com). Eligibility criteria were developed and used for searches to identify content on databases such as PubMed and Scopus. HIV researchers were approached to recommend and submit items, including unpublished research. Infographic tools were developed. RESULTS: By November 2014, the HIV Gateway contained over 5,500 journal publications, reports, conference abstracts, posters and slide presentations on HIV in the Caribbean, including over 250 documents not previously published or available online. All references include abstracts and web addresses (URLs) or PDFs providing access to original publications. Infographic tools enable users to analyse content by keyword, author and country. CONCLUSION: HIV Gateway provides opportunities for researchers and practitioners to build evidence-based approaches and to collaborate based on knowledge of who is working on issues and topics. Since it is publicly accessible, it facilitates the informed involvement of Caribbean people, including vulnerable populations, in the HIV response. Healthcare professionals can contribute articles or reports to continually expand and update the database and make this the website of choice for anyone wanting to find out about HIV in the Caribbean.

Evidence on delay in sexual initiation, multiple partnerships and condom use among young people: review of Caribbean HIV behavioural studies / Evidencias sobre la demora en la iniciación sexual, las parejas múltiples, y el uso del condón entre los jóvenes: revisión de estudios de conducta en relación con el VIH en el Caribe

OBJECTIVE: To develop a Caribbean regional profile of youth sexual behaviour associated with risk of HIV. DESIGN AND METHODS: A review of sexual behaviour surveys with youth aged 15-24 years was conducted as part of the Pan American Health Organization (PAHO) HIV Caribbean Office's Review and Gender Analysis of Caribbean HIV Behavioural and Seroprevalence Studies. Studies with internationally recommended indicators were prioritized. Studies were sought via database searches and contact with researchers and National AIDS Programmes. RESULTS: Inter-country comparisons and longitudinal analyses were limited by lack of uniformity in study age groups and indicators. Data were sufficient to identify the following among 15-24-year olds: * More males than females report sexual intercourse before the age of 15 years. * More than half of sexually active youth report sex before age 16 years. * First sexual encounter is usually with someone older, with age differences larger for females. * More males than females report multiple partnerships, with 20%-76% of males reporting this in the past year. * Condom use varies widely, with no clear pattern by gender. CONCLUSION: There are substantial levels of early sexual initiation, intergenerational sex among females and multiple partnerships among males, while condom use is inconsistent. Efforts to promote delay in sexual initiation, partner reduction and consistent condom use should be supplemented with initiatives against harmful gender norms, child abuse and transactional sex and skills to negotiate safe sex. Standardization of survey methods to facilitate cross-study comparisons should continue and encompass additional risk factors such as transactional sex, gender-based violence, drug use and HIV treatment adherence.

OBJETIVO: Desarrollar un perfil regional caribeño del comportamiento sexual de la juventud en relación con el riesgo de VIH. DISEÑO Y MÉTODOS: Se realizó una revisión de los estudios del comportamiento sexual de jóvenes entre 15 y 24 años, como parte del Estudio de la Oficina de VIH de la Organización Panamericana de la Salud (OPS) para el Caribe, y el Análisis de Género de los Estudios de Seroprevalencia y Conducta en relación con el VIH en el Caribe. Se le dio prioridad a los estudios con indicadores recomendados internacionalmente. Se obtuvieron estudios mediante búsquedas de bases de datos y contactos con los investigadores y los programas nacionales de SIDA. RESULTADOS: Los análisis longitudinales y las comparaciones entre países estuvieron limitados por la falta de uniformidad en los grupos etarios y los indicadores de los estudios. Los datos fueron suficientes para identificar lo siguiente entre los jóvenes de 15 a 24 años de edad: * Más varones que hembras reportaron relaciones sexuales antes de los 15 años de edad. * Más de la mitad de los jóvenes sexualmente activos reportaron relaciones sexuales antes de los 16 años. * El primer encuentro sexual suele ser con alguien de más edad, siendo las diferencias de edad mayores para las mujeres. * Más varones que hembras reportaron relaciones de parejas múltiples; 20%-76% de los hombres reportaron este tipo de relación en el último año. * El uso del condón varía ampliamente, sin un patrón claro por género. CONCLUSIÓN: Hay niveles considerables de iniciación sexual temprana, sexo intergeneracional entre las hembras, y múltiples parejas entre los varones, mientras que el uso del preservativo es inconsistente. Los esfuerzos por promover la demora en la iniciación sexual, la reducción de parejas, y el uso sistemático del condón deberían complementarse con las iniciativas contra las normas de género perjudiciales, el abuso infantil, el sexo transaccional, y las habilidades para negociar sexo seguro. La estandarización de los métodos de encuesta para facilitar las comparaciones transversales debe continuar y abarcar otros factores de riesgo, tales como el sexo transaccional, la violencia de género, el uso de drogas, y el cumplimiento con el tratamiento del VIH.