Knowledge, Utilisation, and Preferences of Reproductive Health Services Among Youth Whose Parents Are Receiving Care at Knh; a Comparative Cross-sectional Study

Abstract

Introduction: In Kenya, 13% of people living with HIV (PLWHA) in 2017 were youthsaged 15-24 years. Youths also account for 39% of new HIV infections, while the prevalence of STI and unwanted pregnancies is estimated to be 27.1% and 18.0% respectively. Even though discrepancies in knowledge and utilization of HIV, STI, and pregnancy prevention strategies have been touted as a predictor for such outcomes, this area has not been studied sufficiently. For instance, even though the HIV status of parents has been reported to influence decision- making of youths, the level to which it influences knowledge of HIV, STI, and pregnancy prevention and preference and utilization of strategies for HIV, STI, and pregnancy prevention by youths is not well understood. Our aim will be to try and fill this knowledge gap. Broad Objective: To compare the knowledge, utilization, and preferred strategies for HIV, STIs, and pregnancy prevention among youths whose parents are seeking HIV-related care and non-HIV related care at the Kenyatta National Hospital (KNH), Kenya. Methodology: A cross-sectional study done between August and September 2019. 264 parents were screened (143 HIV negative and 121 living with HIV) yielded 188 youths (94 with HIV negative parents and 94 parents living with HIV) who were enrolled. Pre-tested questionnaires were used to capture data on the demographic characteristics of youths and parents, knowledge of HIV, STI, and pregnancy prevention strategies by youth, and preferred strategies for HIV, STI, and pregnancy prevention. The demographic characteristics of parents and youth were explored and crude and adjusted analyses using the Chi-square test and logistic regression done to evaluate the differences in knowledge, utilization, and preferences of HIV, STI, and pregnancy prevention strategies by youths with HIV negative and positive parents. The Statistical Package for Social Scientists (SPSS) version 21 was used for analysis at 95% confidence level. Results: Most baseline characteristics of parents were similar between the two groups. Majority of the parents of the participating youth were 40 years or older (68% for HIV negative and 73% for parents living with HIV, and majority were females (82.9% and 87.2%, respectively). However, parents who were HIV positive were more likely to be employed (59.6% and 40.0%, p<0.01). Slightly more than half of youths with HIV negative parents and parents living with HIV were male (55.3% and 52.1%,), while only16.0% and 25.6% of youths with HIV negative parents and HIV positive parents respectively were age group 16-20 (p=0.02) and had a secondary education. After adjusting for the age of youth, the education level of parents, and the education of youths, knowledge of HIV, STI, and pregnancy prevention was similar among youths with HIV negative and positive parents. The school was the commonest source of information (70.2% and 64.9% respectively) while the adjusted odds for sexual exposure was significantly lower among youths with HIV negative parents [AOR (95% CI) =0.35(0.13-0.94), p=0.03]. Condom use was modest (62.5% and 47.7%) and comparable between youths with HIV negative and positive parents. Abstinence, condoms, faithfulness were most preferred modes of HIV, STI, and pregnancy prevention irrespective of the HIV status of parents. Conclusion: There was no association between HIV status of parents or guardians and the knowledge of HIV, STI, and pregnancy prevention by youth. The youth were more knowledgeable about the traditional strategies of HIV, STI and Pregnancy prevention as compared to the novel strategies and the level of knowledge was adequate and comparable between the two groups of youth. The utilization of the different strategies was comparable among the youth from both groups and the traditional strategies were more utilised as compared to the novel strategies. The youth preferred the traditional strategies, hospital and school as the source of information and services on HIV, STI and pregnancy prevention. Recommendations: Since there is no difference in knowledge between youths with HIV negative parents and parent living with HIV, we should use the same approach but teach the youth more about the novel strategies, work on ensuring that the services are offered under one roof also known as combined strategy.