Gender Differences in HIV/HSV-2: Evidence from a School Support Randomized Controlled Trial Among Orphaned Adolescents in Kenya

Abstract

Women and girls are disproportionately affected by HIV and other sexually transmitted infections (STIs) such as Herpes Simplex Virus type-2 (HSV-2) in Sub-Saharan Africa (SSA). Given this gender disparity and women's vulnerability to HIV/STIs, prevention efforts often target women, but relatively little attention has been paid to compare whether HIV interventions produce equal program effects across gender. The purpose of this study is to examine whether the school support intervention had equal program effects on study outcomes and biomarkers by gender among orphaned adolescents in Kenya. A randomized controlled trial was conducted to test whether keeping orphaned boys and girls in school reduced risky sexual behaviors and prevented HIV/HSV-2 infection in Kenya (N = 835). We collected four annual surveys and biomarkers measures of HIV and HSV-2 at Time 1 and Time 4. Regression analysis and multi-level linear mixed models were conducted, and t test with Satterthwaites' method for each regression coefficients was used to compare program effects by gender. There were substantial gender differences on risky sexual behaviors, HSV-2 infection, and gendered ideologies prior to intervention implementation. The school support intervention had significant gender-specific program impacts on HSV-2. The intervention females experienced a 36% increase in HSV-2 infection while intervention males experienced a 23% decrease after 3 years of program implementation. Differential program effects by gender on attitudes toward abstaining from sex were also found. More scientific research is needed to test whether HIV interventions produce equal program impacts by gender. Prevention programs should recognize gender-specific program effects and address individual, relational, and contextural factor that reinforce the gender disparity in HIV/HSV-2 risk.