Building Capacity to Study the Intersection Between COVID-19 and HIV-Related Stigma among Adolescents in Western Kenya

Project Summary/Abstract Kenya has one of the world's largest HIV and AIDS epidemics, with about 1.6 million people living with HIV and 25,000 people dying from AIDS in 2018. Adolescents, especially girls, are particularly vulnerable to HIV. In western Kenya, over 50% of adolescents had sexual intercourse before the age of 18; however, youth between the ages of 15-19 have low rates of condom use and HIV testing. Stigma negatively affects HIV prevention behaviors, including condom use and HIV testing. In Kenya, complex interactions between social capital, religiosity, and gender norms shape societies' discriminating attitudes towards youth perceived to be infected with HIV (i.e., HIV-related stigma), which, in turn, affects HIV prevention. Our parent award aims to study the relationship between social capital, religiosity, gender norms, and HIV-related stigma among adolescents (ages 15-19) and its impact on HIV prevention in western Kenya. With the advent of the COVID-19 pandemic, the Kenyan government enacted mitigation strategies, including lockdowns. Although these policies are important to limit the spread of COVID-19, they have many unintended consequences among adolescents, such as increased risk of HIV. Additionally, people living with HIV have increased psychosocial burdens emanating from stress, isolation, and stigma due to COVID-19. These outcomes are compounded by a lack of social relationships, especially among youth. Therefore, this supplement will use a mixed-methods approach to assess the effects of COVID-19 mitigation measures on changes in social relationships (i.e., social capital, religiosity, gender norms), stigma, and HIV prevention among youth in western Kenya by addressing the following specific aims: (1) Examine trends in social capital, religiosity, gender norms, stigma, and HIV preventive behaviors before and after the COVID-19 lockdown among adolescents in western Kenya; and (2) Elucidate the drivers of change in social relationships, the experience of stigma, and the changes in HIV preventive behaviors during the COVID-19 lockdown in western Kenya. In Aim 1, we will employ two surveys to explore social relationships, stigma, and HIV prevention among 765 boys and girls ages 15-19 years. The two surveys will ask youth to recall their experiences and perceptions before and during the COVID-19 pandemic. In Aim 2, we will conduct 18 focus groups discussions with boys and girls ages 15-19 years, healthcare providers, parents, teachers, and religious leaders to explore their perceptions of how COVID-19 has changed the lives of young people, especially youth living with HIV. This supplement will illuminate the unintended consequences of COVID-19 disease control efforts in relation to HIV preventive behaviors among adolescents in Kenya. Additionally, this study will extend research capacity at Tangaza University College and Gynocare Women's and Fistulas Hospital around studying the intersection between COVID-19 disease control efforts, stigma, and HIV prevention in Kenya.