Tackling the Triple Threat in Kenya: Factors Associated with Protection against HIV Risk, Gender-Based Violence, and Pregnancy among Adolescent Girls and Young Women.

The government of Kenya's Triple Threat strategy recognises the need for urgent intervention to address the high incidence of HIV, gender-based violence (GBV) and pregnancy among adolescent girls and young women (AGYW). We used nationally representative data among AGYW aged 13-24 (n = 1344) from the 2018-19 Kenya Violence Against Children & Youth Survey (VACS) in multivariable logistic regression analyses to examine associations between three potential protective factors - gender-equitable attitudes, food security and parental monitoring - and outcomes related to the triple threat: Intimate partner violence (IPV); sexual violence; high HIV exposure risk; adolescent pregnancy; child marriage; and not being in school or paid work. Results showed that AGYW with gender-equitable attitudes were less likely to report IPV (adjusted odds-ratio (aOR):0.47, p < 0.01) and adolescent pregnancy (aOR:0.58, p < 0.05). AGYW who were food secure were less likely to report adolescent pregnancy (aOR:0.57, p < 0.05) and child marriage (aOR:0.51, p < 0.05). Those with high parental monitoring were less likely to report IPV (aOR:0.44, p < 0.01), sexual violence (aOR:0.49, p < 0.05), adolescent pregnancy (aOR:0.61, p < 0.05), and child marriage (aOR:0.41, p < 0.01). AGYW who had gender-equitable attitudes, food security and high parental monitoring (i.e., all three factors compared to none) had lower predicted probabilities of reporting IPV (22.3% vs. 5.0%), sexual violence (20.4% vs. 6.0%), adolescent pregnancy (23.7% vs. 7.7%), and child marriage (10.0% vs. 1.6%). The findings indicate that improving gender-equitable attitudes, food security and parental monitoring may positively impact multiple outcomes related to the triple threat; and that addressing all three may have the greatest impact.