Measuring progress in reducing violence and HIV risk among children and young people
Authors: Chimaraoke O Izugbara, Mary O Obiyan
Journal: The Lancet Global Health (2021)

Violence against children and young people occurs worldwide. Annually, an estimated 1 billion people aged 18 years or younger experience one or more forms of violence.1Hillis S Mercy J Amobi A Kress H Global prevalence of past-year violence against children: a systematic review and minimum estimates.Pediatrics. 2016; 137e20154079Crossref Scopus (573) Google Scholar Young survivors of violence suffer multiple adverse social, behavioural, and health consequences, including protracted stress, low self-esteem, helplessness, anxiety, depression, risk taking, and poor learning outcomes. These individuals also frequently consider, attempt, or carry out suicide, show heightened insensitivity to future violence, are uncaring towards others, and tend, themselves, to become violent.2Hillis SD Mercy JA Saul JR The enduring impact of violence against children.Psychol Health Med. 2017; 22: 393-405Crossref PubMed Scopus (89) Google Scholar Adult survivors of childhood violence have heightened risks for substance dependence, sexual risk taking, poor mental health, criminality, abusive parenting, poor social functionality, and extended risks for subsequent polyvictimisation and revictimisation.3Riedl D Beck T Exenberger S et al.Violence from childhood to adulthood: the influence of child victimization and domestic violence on physical health in later life.J Psychosom Res. 2019; 116: 68-74Crossref PubMed Scopus (34) Google Scholar, 4Zierler S Feingold L Laufer D Velentgas P Kantrowitz-Gordon I Mayer K Adult survivors of childhood sexual abuse and subsequent risk of HIV infection.Am J Public Health. 1991; 81: 572-575Crossref PubMed Scopus (348) Google Scholar Violence and HIV in children weigh disproportionately on the disease burden in sub-Saharan Africa. Both violence and HIV are mutually reinforcing; violence against children and young people amplifies the risk for HIV in children, and HIV intensifies a child's risk for multiple forms of violence. Together, violence and HIV in children, if unaddressed, can create a large population of unhealthy and maladjusted people at risk for exclusion and lifelong poor health. In their Article in The Lancet Global Health, Francis Annor and colleagues5Annor FB Chiang LF Oluoch PR et al.Changes in prevalence of violence and risk factors for violence and HIV among children and young people in Kenya: a comparison of the 2010 and 201.Lancet Glob Health. 2021; (published online Nov 22.)https://doi.org/10.1016/S2214-109X(21)00457-5PubMed Google Scholar measured the change in the prevalence of violence and risk factors for violence and HIV among children and young people between 2010 and 2019 in Kenya. Their study is a straightforward contribution to efforts to gauge progress in the field of violence and HIV prevention in children. At a time of growing global clamour for data on and strategies to address violence and HIV in children and young people, the paper is timely. In many ways, the study fits within the context of current research and practice; it responds to the pressing need for policy-relevant evidence on urgent global health issues, offers insights on progress regarding the Sustainable Development Goals on violence and HIV in young people, and adds a strong data-driven voice to the importance of sustained political commitment in promoting population wellbeing. Annor and colleagues found significant declines in the prevalence of reported lifetime violence and in some risk factors for violence and HIV, as well as improvements in some indicators of service seeking. Among female participants, the prevalence of lifetime violence reduced from 2010 to 2019, from 36·2% to 25·2% for any sexual violence, 74·9% to 45·9% for any physical violence, and from 28·4% to 16·8% for any emotional violence. Considerably more female participants who had experienced sexual violence sought (11·3% in 2019 vs 4·6% in 2010) and received (10·0% in 2019 vs 3·0% in 2019) assistance from dedicated services. Substantially fewer females (61·8% in 2019 vs 75·1% in 2010) and males (47·8% in 2019 vs 59·2% in 2010) endorsed one or more inequitable gender attitudes. The authors broadly attribute these developments to the prioritisation of violence and HIV prevention and the response by the Kenyan Government and its development partners. Although important on their own, the findings of this study raise issues that merit further consideration. First, violence against children and young people is not merely limited to acts of sexual, physical, and emotional violence by intimate partners, parents, adult caregivers and relatives, or adults in the community. Robust data on the prevalence of violence against children and young people must include all abusive acts perpetrated by anyone, including strangers, and data on children who are victims of bullying, robbery, vandalism, or theft. Community and household violence, such as experiencing threatening situations, hearing gunshots, or seeing someone attacked or killed are all key acts of violence against children and young people.6Brennan RT Molnar BE Earls F Refining the measurement of exposure to violence (ETV) in urban youth.J Community Psychol. 2007; 35: 603-618Crossref Scopus (49) Google Scholar To not include these forms of violence is problematic. Second, although the authors themselves acknowledge the need to cautiously celebrate their findings given, among other things, critical differences and declines in response rates between the surveys, additional reasons for caution exist. The study findings carry a substantial social desirability bias that is inherent in most research on intrusive and sensitive topics. To avoid being judged or perceived as violated, backward, or bigoted, many respondents in violence and gender norms research over-report positive attitudes and experiences and under-report negative ones.7Blair G Coppock A Moor M When to worry about sensitivity bias: a social reference theory and evidence from 30 years of list experiments.Am Polit Sci Rev. 2020; 114: 1297-1315Crossref Scopus (61) Google Scholar Annor and colleagues do not delve into the considerable implications of this dynamic in their study. Survey methodologies that reduce social desirability bias will substantially improve the reliability of future similar studies. Third, in Kenya, as in many other contexts, violence and HIV risks are disproportionately higher in young people from certain disadvantaged groups, such as poorer households, homeless young people and street children, children with disabilities, LGBT+ young people, young people who maintain independent residence, young sex workers slum children, out-of-school young people, and those who inject drugs.8Edwards KM Changilwa P Waterman E et al.A promising approach to preventing gender-based violence and HIV among slum-dwelling youth in Nairobi, Kenya.Violence Against Women. 2021; 12 (10778012211014562)Google Scholar, 9Embleton L Wachira J Kamanda A et al.“Once you join the streets you will have to do it”: sexual practices of street children and youth in Uasin Gishu County, Kenya.Reprod Health. 2015; 12: 106Crossref PubMed Scopus (23) Google Scholar These groups also generally exhibit slower rates of decline in exposure to health risks. Household surveys such as those used by Annor and colleagues often exclude these most at-risk children. Unless couched in robustly inclusive—but well disaggregated—data, summative findings from traditional household surveys could mask worsening outcomes or much less impressive results among crucial subpopulations of children and young people. Understanding whether and how vulnerabilities have shifted over time for the most at-risk young people should lie at the heart of any meaningful measurements of progress in violence and HIV reduction among children and young people. Finally, describing progress in health indicators is no longer enough. Demand for robust explanations of the drivers of improvements in health outcomes is at an all-time high. More than ever, donors, policy makers, programme implementers, and other development actors are eager for evidence on what works. During the period covered by the study, Kenya implemented several violence against children and young people and HIV prevention and response programmes. However, shrinking donor support for public health interventions in Kenya means that the country must identify, prioritise, and focus efforts on interventions that deliver the greatest effects. The lack of surefooted explanations for the reported declines and improvements in this study impedes the scaling up of promising interventions or their replication in other settings. This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on November 30, 2021 This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on November 30, 2021 We declare no competing interests. Changes in prevalence of violence and risk factors for violence and HIV among children and young people in Kenya: a comparison of the 2010 and 2019 Kenya Violence Against Children and Youth SurveysKenya observed significant declines in the prevalence of lifetime violence and some risk factors for violence and HIV, and improvements in some service seeking indicators between 2010 and 2019. Continued prioritisation of preventing and responding to violence in Kenya could contribute to further reductions in violence and its negative outcomes. Other countries in the region that have made substantial investments and implemented similar violence prevention programmes could use repeat VACS data to monitor violence and related outcomes over time. Full-Text PDF Open AccessCorrection to Lancet Glob Health 2021; published online Nov 22. https://doi.org/10.1016/S2214-109X(21)00487-3Izugbara CO, Obiyan MO. Measuring progress in reducing violence and HIV risk among children and young people. Lancet Glob Health 2021; published online Nov 22. https://doi.org/10.1016/S2214-109X(21)00487-3—In this Comment, the second sentence of the fourth paragraph should have read “Among female participants, the prevalence of lifetime violence reduced from 2010 to 2019, from 36·2% to 25·2% for any sexual violence, 74·9% to 45·9% for any physical violence, and 28·4% to 16·8% for any emotional violence.” This correction has been made as of Nov 30, 2021. Full-Text PDF Open Access