Objectives To stem the HIV epidemic among adolescent girls and young women (AGYW, 15–24 years), prevention programs need to reach AGYW who are most at risk. We examine whether individual- and household-level factors could be used to define HIV vulnerability for AGYW. Methods We surveyed out-of-school AGYW in urban and peri-urban Kenya (N = 1014), in urban Zambia (N = 846), and in rural Malawi (N = 1654) from October 2016 to 2017. LCA identified classes based on respondent characteristics, attitudes and knowledge, and household characteristics. Multilevel regressions examined associations between class membership and HIV-related health outcomes. Results We identified two latent classes—high and low HIV vulnerability profiles—among AGYW in each country; 32% of the sample in Kenya, 53% in Malawi, and 51% in Zambia belonged to the high vulnerability group. As compared to AGYW with a low-vulnerability profile, AGYW with a high-vulnerability profile had significantly higher odds of HIV-related outcomes (e.g., very early sexual debut, transactional sex, sexual violence from partners). Conclusions Out-of-school AGYW had differential vulnerability to HIV. Interventions should focus on reaching AGYW in the high HIV vulnerability profiles.

Introduction: India has the largest adolescent population in the world. However, many unprivileged Indian adolescents are still unable to complete schooling. Hence, there is a need to understand the reasons for school dropout among this population. The present study is an attempt to understand the determinants of school dropout among adolescents and identify the factors and reasons that contribute to it. Material and methods: Longitudinal survey data- Understanding Adults and Young Adolescents (UDAYA) for Bihar and Uttar Pradesh has been used to identify the determinants of school dropout among adolescents aged 10–19. The first wave of the survey was conducted in 2015–2016, and the follow-up survey in 2018–2019. Descriptive statistics along with bivariate and multivariate analysis was used to observe school dropout rates and factors associated with it among adolescents. Results: Results show that the school dropout rate was highest among married girls aged 15–19 years (84%), followed by unmarried girls (46%), and boys (38%) of the same age group. The odds of school dropout among adolescents decreased with an increase in household wealth status. School dropout was significantly less likely among adolescents whose mothers were educated as compared to mothers who had no education. Younger boys [AOR: 6.67; CI: 4.83–9.23] and girls [AOR: 2.56; CI: 1.79–3.84] who engaged in paid work were 6.67 times and 2.56 times more likely to drop out of school than those who were not. The likelihood of school dropout was 3.14 times more likely among younger boys [AOR: 3.14; CI: 2.26–4.35], and it was 89% more likely among older boys [AOR: 1.89; CI: 1.55–2.30] who consumed any substances as compared to those who did not consume any substances. Both younger [AOR: 2.05; CI: 1.37–3.05] and older girls [AOR: 1.30; CI: 1.05–1.62] who acknowledged at least one form of discriminatory practice by parents were more likely to drop out of school than their counterparts. Lack of interest in studies/education not necessary (43%) was the predominant reason among younger boys for school dropout, followed by family reasons (23%) and paid work (21%). Conclusions: Dropout was prevalent among lower social and economic strata. Mother’s education, parental interaction, participation in sports and having role models reduce school dropout. Conversely, factors such as being engaged in paid work, substance abuse among boys, and gender discriminatory practices towards girls, are risk factors for dropout among adolescents. Lack of interest in studies and familial reasons also increase dropout. There is a need to improve the socio-economic status, delay the marital age of girls, and enhance the government incentives for education, give rightful work to girls after schooling, and provide awareness.

Introduction: The societal norm in India is such that adolescents are expected to respect and follow traditional values and view early sexual debut as undesirable and deviant from the social mores. However, a dramatic shift in attitudes towards sex before marriage has been observed in India. We in this study, aim to study the factors associated with early sexual debut among unmarried adolescents. Materials and methods: The study used data from the Understanding the lives of adolescents and young adults (UDAYA) survey conducted in 2016 with 15,388 adolescents aged 10–19 years from two Indian states. Bivariate and logistic regression analyses were performed to determine the associated factors. Results: Adolescent boys (9%) were more prone to early sexual debut compared to girls (4%). Both boys (17.2%) and girls (6%) who were school dropouts had significantly higher chances of early sexual debut. Boys who had rare [OR: 2.28; CI: 1.12–4.64] or frequent media exposure [OR: 2.70; CI: 1.36–5.32] were significantly more likely to report early sexual debut than those who had no media exposure. Further, the likelihood of early sexual debut was significantly higher among boys [OR: 3.01; CI: 2.34–3.87] and girls [OR: 1.87; CI: 1.12–3.12] who had exposure to pornography compared to their counterparts. The odds of early sexual debut were higher among boys [OR: 1.89; CI: 1.19–3.01] and girls [OR: 1.77; CI: 1.30–2.41] who had moderately-severe/severe depressive symptoms compared to their counterparts. Conclusions: The results highlight that Indian unmarried adolescents demand the appropriate knowledge to promote safer sexual behavior and lead a responsible and healthy lifestyle. The preventive efforts must be multifaceted with involvement at the individual and parental levels. Especially, interventions appear advantageous to be parents-focused emphasizing family life education that can prevent risky sexual behaviors among adolescent boys and girls. And the public programs should focus on sexual health promotion considering the physical and psychosocial changes during early ages of sex life.

Purpose: South Asian region is a focal point owing to its vulnerabilities to climate-sensitive diseases, dependence on climate-sensitive livelihoods, projected levels of crop decline in the region, and high rates of poverty and malnutrition. Women are particularly vulnerable to climate change and this affects women disproportionately during different extreme events. The purpose of this paper is to understand the issue of climate change and its impact, and climate resilience among women in South Asia. Further, it also identifies the gaps and suggests future policy implications.Design/methodology/approach: Climate change is increasingly being recognised as an alarming issue and the present review is important when South Asian countries are facing the brunt of climate change impacts. This paper tries to understand the issue by review of the literature and conceptual framework methodology. To understand women’s vulnerability due to climate change and its aftermath, the authors conducted both offline and online desk reviews for this study.Findings: The findings of this study show a clear linkage between climate change and women’s vulnerabilities in South Asia. Climate change has significant socio-economic impacts on women, and it affects them disproportionately in various domains of agriculture, livelihood, food security, both physical and mental health, water and sanitation in the South Asia region.Practical implications: The paper also highlights that the programmes that aim at combating the effects of climate change require a gender-sensitive approach so that climate change does not obstruct the development and reduction of poverty in the region.Social implications: The findings of this paper will add value in helping families to come out of poverty by undertaking adaptive measures with proactive assistance from the government and grassroots level organisations.Originality/value: The present study also advocates for more gender- and climate-sensitive measures from governments, and implementation of intervention- and evidence-based research in the South Asian countries.

Introduction: The role of gender norms in shaping education and work opportunities, distribution of power and resources, and health and wellbeing is well recognised. However, rigorous studies in low- and middle-income countries on when and how norms change over time and what factors shape adolescents’ and young adult’s gender attitudes are limited. This paper explores the factors that determine adolescents’ gender attitudes, as well as patterns in gender attitude shifts over time among younger and older adolescent boys and girls in India. Data and methods: Data presented in this paper were drawn from a unique longitudinal study of adolescents aged 10–19 (Understanding the lives of adolescent and young adults–UDAYA study) in the states of Bihar and Uttar Pradesh in India, conducted during 2015–2016 (wave 1) and 2018–2019 (wave 2). The analysis presented in this paper drew on data from 4,428 boys and 7,607 girls who were aged 10–19 and unmarried at wave 1 and interviewed at both rounds of the survey. We used univariate and bivariate analyses to examine changes in adolescents’ gender role attitudes over time and the association between explanatory variables and gender role attitudes. We also used linear fixed effects regression models to identify factors that shape adolescents’ gender role attitudes. Results: Gender role attitudes became more egalitarian over time among boys and girls, except among the older cohort of boys in our study. Among both younger and older cohorts, girls/young women held more egalitarian views than boys/young men and this pattern held over time for both cohorts. Factors that influenced gender role attitudes differed for younger and older adolescents, particularly among boys. While some predictors differed for boys and girls, there were substantial similarities as well. Gender attitudes were affected by factors at the individual, family, peer, and societal levels, as well as by community engagement. Conclusions: Our findings show that it is possible to shift gender attitudes toward greater equity and, in so doing, contribute to improved health and rights.

Background The relationship between mobility, violence and mental health has largely been unexplored in developing countries. This study screens for signs of major depression, and assesses its association with mobility and violence among female sex workers (FSWs) in southern India. Methods Data (N=2400) for this study were used from a cross-sectional Behavioral Tracking Survey (BTS-2014) conducted among FSWs from a southern state of India as part of the Avahan programme. Major depression of FSWs was assessed using the Patient Health Questionnaire-2 depression scale. Descriptive statistics, frequency, bivariate, interaction effect and multivariate logistic regression techniques were used for the analysis. Results More than one-fourth of FSWs (29%) screened positive for major depression. The likelihood of screening positive for major depression was 6 times higher among FSWs who were both mobile for sex work outside their district of residence and had experienced any violence (combined association) during the past 1 year (62% vs 19%, adjusted OR 6.1, 95% CI 4.4 to 8.6) compared with those who reported neither. The individual association results show that FSWs who reported being mobile outside the district, and FSWs who were beaten or raped in the past 1 year, were 3 times more likely to screen positive for major depression. Conclusions The findings indicate that violence and mobility are independently associated with major depression among FSWs. The combined association of mobility and violence poses a greater risk to the mental health of FSWs than their independent association. These results point to the need for creating an enabling environment for FSWs to enhance existing efforts to reduce the spread of HIV and mental health problems. The study highlights that HIV prevention efforts among FSWs in India require evidence-based research and integrated programme approaches to address mental health issues.