Sexual Relationship Typologies, Multilevel Determinants, and HIV Among Adolescent Mothers in Eastern and Southern Africa
A Multilevel Latent Class Analysis
Bibliographic Data
| ID | 15336992 |
|---|---|
| Authors | Luwam T Gebrekristos (0000-0002-2721-9382, Drexel University, corresponding author), Allison K Groves (0000-0003-4520-3963, Drexel University), Marie C D Stoner (0000-0002-7189-8669, RTI International), Alex Ezeh (0000-0002-1309-4697, Drexel University), Ezeh Alex (Drexel University), Félice Lê-Scherban (0000-0003-1920-724X, Drexel University) |
| Year | 2026 |
| Volume | 30 |
| Issue | 7 |
| Pages | 1996-2011 |
| Publication date | 2026-01-16 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | AIDS and Behavior (JOURNAL) |
| Journal identifiers | ISSN: 1090-7165 • E-ISSN: 1573-3254 |
| Publisher | Springer Science+Business Media (PUBLISHER • DE) |
| DOI | 10.1007/s10461-025-05024-y |
| PMID | 41543669 |
| OpenAlex | W7124422879 |
| Language | EN |
| References cited | 63 |
In Eastern and Southern Africa (ESA), there is heterogeneity within adolescent mothers' (AMs') sexual relationships. However, existing studies focus on single relationship characteristics, even though these characteristics do not operate in isolation. Moreover, no studies have examined multilevel predictors of AMs' relationships. Identifying and characterizing typologies by multilevel factors can inform targeted interventions to lower HIV risk. Data are from the Population-based HIV impact Assessment (PHIA) Project on AMs (15-19 years) from 9 ESA countries (N = 2,761). We conducted multilevel latent class analysis to identify relationship typologies at the AM and community (PHIA cluster) levels, multinomial logistic regression to characterize typologies by multilevel predictors, and multivariable generalized estimating equations (GEE) log-binomial regression to calculate prevalence ratios of HIV for relationship typologies. There were 3 typologies: married with minimal transactional sex (61%), unmarried peer partnership (30%), and working and high transactional sex (9%). Individual-level (i.e., age, school enrollment, low-wealth household, number of sexual partners) and community-level factors (i.e., urbanicity and proportion of low-wealth households) were associated with typologies. Married with minimal transactional sex was associated with a 51% lower HIV prevalence compared to the unmarried peer partnership (adjusting for multilevel factors). We also identified 2 PHIA cluster-level classes: high age-disparate marriage (49%) and low marriage (51%). Low-wealth communities had higher odds of being high age-disparate marriage communities. Results suggest that AMs' relationships fall into 3 distinct typologies and 2 community-level classes. Further, HIV prevalence varies across relationship typologies. Utilizing tailored approaches could optimize interventions that reduce AMs' HIV risk in ESA
Health psychology · Latent class model · Logistic regression · Multilevel model · Multinomial logistic regression · Odds · Psychological intervention · Public health · Transactional analysis · Transactional sex · Adolescent Sexual and Reproductive Health · HIV/AIDS Research and Interventions · Poverty, Education, and Child Welfare
Age-disparate and intergenerational sex in southern Africa
Transactional sex and risk for HIV infection in sub‐Saharan Africa
Pregnancy and childbirth outcomes among adolescent mothers
Intimate partner violence and HIV infection among women
Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa
Multilevel Latent Class Analysis
A latent class analysis of young women’s co-occurring health risks in urban informal settlements in Durban, South Africa
Gender, Power, and Health
IPV victimization in pregnancy increases postpartum STI incidence among adolescent mothers in Durban, South Africa
Skinning the goat and pulling the load
When marriage is the best available option
Trends in adolescent first births in sub-Saharan Africa
Correlates of intimate partner violence among married women in Uganda
My partner was not fond of using condoms and I was not on contraception”
They say that I have lost my integrity by breaking my virginity”
The relational dynamics of hegemonic masculinity among South African men and women in the context of HIV
Management of non-marital fertility in two South African communities
Revisiting the understanding of “transactional sex” in sub-Saharan Africa
Estimating the Association between Latent Class Membership and External Variables Using Bias-adjusted Three-step Approaches
Latent Class Modeling with Covariates
Multilevel Latent Class Models
The Simultaneous Decision(s) about the Number of Lower- and Higher-Level Classes in Multilevel Latent Class Analysis
| Highly cited | No |
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