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The majority of cognitive models used in HIV prevention identify risk perception as essential, and the first step towards safer sexual behaviors. Yet, previous studies have rarely examined risk perceptions as an outcome variable, and the few that have, limited their analysis to individual-level determinants. Conspicuously missing in the literature is how school/community level factors affect risk perceptions among school-going youth. Using data collected from primary school youth in Nyanza, Kenya and employing hierarchical linear modeling, this study examines how both individual and community level factors shape individuals' perceived risks of contracting HIV. Results indicate that measures captured at both individual and school/community levels were significantly associated with risk perception. At the individual level, and for boys, high risk perception was associated with higher knowledge about HIV, rejection of myths surrounding HIV transmission, higher condom use self-efficacy and having engaged in risky sexual behaviors. For girls, it was pressure from others to engage in sexual activity, having engaged in risky sexual behaviors and knowing someone infected with HIV that resulted in increased risk perceptions. Beyond individual level variables, some school/community level factors are significantly associated with risk perception. For instance, boys and girls in communities with higher estimates of AIDS deaths reported higher risk perceptions. Boys in communities where AIDS was acknowledged as the cause of death at funerals were less likely to report high risk perceptions. The findings suggest that interventions targeting HIV prevention among young people in Nyanza, Kenya could benefit immensely from an understanding of how schools and communities affect risk perceptions and behavioral change., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Context: Delaying sexual debut is an important HIV prevention strategy, yet few studies have examined associations between both community- and individual-level characteristics and sexual debut among youth in Sub-Saharan Africa., Methods: Cross-sectional survey data collected from 8,183 youth aged 11-17 in 160 schools in Nyanza, Kenya, were used to examine the relationships between individual and community measures and the timing of sexual debut. Multilevel discrete-time hazard models were used to identify bivariate and multivariate associations., Results: At the individual level, youth were more likely to have initiated sex (or had done so at an earlier age) if they had felt pressure to engage in sex from a greater number of sources (odds ratios, 1.3-1.8); perceived that they had a small or (among females) moderate chance, rather than no chance, of contracting HIV (1.2-1.3); or endorsed a greater number of HIV transmission myths (1.1 for both sexes). In addition, males with higher abstinence selfefficacy had a reduced risk of sexual debut (0.95). At the community level, males and females had a reduced risk of sexual debut if they lived in a community where AIDS deaths were publicly acknowledged (0.6-0.8) or the Primary School Action for Better Health program had been implemented (0.8-0.95); risk was also reduced among young men who lived in communities where HIV was discussed at a greater number of parent-teacher association meetings (0.9) or where abstinence was the primary AIDS prevention message conveyed to youth (0.9)., Conclusion: Community-level variables are frequently associated with sexual debut and should be included in future research.

The policy framework guiding Kenya's response to the AIDS epidemic identifies voluntary counseling and testing as crucial to risk reduction and HIV-preventive activities. Yet in Kenya, as in most sub-Saharan countries, voluntary testing rates are low, especially among young people. Using hierarchical linear models, we identify both individual- and teacher/school-level factors that affect voluntary HIV testing among secondary school students in Kenya. Results indicate that adolescents are more likely to test for HIV serostatus when they are knowledgeable about testing, have been involved in HIV/AIDS activities in primary school, have been provided with HIV information in secondary school, perceive themselves as at high risk of contracting HIV or know of someone infected with or who has died from HIV/AIDS, and have ever engaged in sexual intercourse. Barriers include fear of going to testing centers and being perceived as HIV-positive. Teacher/school-level characteristics are relevant for explaining rates of HIV testing, especially among girls. To encourage testing, policymakers should attend to teacher/school-level factors as well as individual characteristics of students., (© 2013 The Population Council, Inc.)

Context: Despite the relevance of the timing of first intercourse for the risk of HIV infection, few studies have examined postponement of first sex as a strategy to prevent infection., Methods: Survey data collected in October 2003 from 8,183 standard six and standard seven students aged 11-17 in 160 schools in Nyanza Province, Kenya, were used in logit and log-normal hazard models to understand the factors that influence the timing of first sexual intercourse., Results: Both males and females who rejected myths about HIV transmission, those who experienced less sexual pressure and those who did not know anyone who had died of AIDS, as well as males who had a stronger belief in their ability to abstain, were more likely to postpone sexual intercourse than were young people who lacked those characteristics. Although lower levels of perceived HIV risk were associated with early sexual initiation, adolescents who felt they were at no risk of HIV infection were most likely to postpone initiation. The pattern of associations across gender suggests that males are pressured into very early sexual activity to prove their maturity, although males who had confidence that they could abstain were more likely to do so. Females, however, were not able to translate belief in their ability to abstain into abstinence and were influenced to engage in intercourse by social and environmental pressures., Conclusions: To support delays in sexual initiation, HIV prevention programming and policy need to be focused on dispelling myths about HIV transmission and countering the gendered pressures that young people feel to initiate sexual activity during their early adolescence.