Being young and on the move in South Africa: how ‘waithood’ exacerbates HIV risks and disrupts the success of current HIV prevention interventions

Abstract

The period between childhood and adulthood has been characterised as a period of 'waithood' in which structural conditions may disable young people's access to basic resources to become independent adults. We consider the specific implications of this experience for newly migrant young people in KwaZulu-Natal, South Africa. We conducted repeat in-depth interviews and participatory workshops over a 12-month period with 38 young people on their experiences of migration, employment, sexual relationships and approaches taken to mitigate HIV-risk, in a high HIV-risk periurban setting. The lives of participants within the first year of arriving in a new place were characterised by fluidity and transience, underpinned by the inherent fragility of options and exacerbated by exploitative employers. Conditions of gendered employment opportunities shaped their capacity to source income, including through sexual relationships. Although risks were evident and ongoing, their significance were under-played with exposure conceived as unavoidable and temporary. HIV prevention services were consequently viewed as relevant to 'other' young people. Although navigating an 'adult' world, these 'not yet adults' are exposed to substantial risks. Services should be tailored to address specific and practical support needs of this transient population, alongside provision of harm-reduction and health support. ARTICLE HISTORY

‘This is what is going to help me’: Developing a co-designed and theoretically informed harm reduction intervention for mobile youth in South Africa and Uganda

“…Young migrants in Sub-Saharan Africa (SSA) are particularly vulnerable to HIV-acquisition (Camlin et al, 2010;Coffee et al, 2005;Jochelson & Leger, 1991;Schuyler et al, 2017), and thus constitute a population of unique public health significance (Bernays et al, 2020;Vearey, 2018) within the context of broader efforts to address the burden of adolescent HIV. In Eastern and Southern Africa, where the burden of global HIV is greatest (UNAIDS, 2020), 41% of new adult HIV-infections occurred amongst youth aged 15-24 years in 2018 (UNAIDS, 2020) (94,000 new youth infections in South Africa; and 19,000 in Uganda) (UNAIDS, 2020); with a disproportionate impact upon girls and young women (UNAIDS, 2020).…”

“…They experience a heightened risk of HIV acquisition (Camlin et al, 2010;Schuyler et al, 2017) and unintended pregnancy (Bernays et al, 2018). Patterns of early sexual debut, coercive and transactional sex, multiple sexual partners, and economic hardship exacerbate vulnerabilities, especially amongst adolescent girls (Bernays et al, 2020;Hardee et al, 2014).…”

“…Recent research indicates that young migrants are negotiating sexual behaviour decisions amidst exposure to broader sexual networks, loosened bonds with protective support networks, and often inequitable intergenerational and gender power relations (Jones, 2016). Consequently, with limited experience-based knowledge and skills, their increased mobility alongside limited caregiver surveillance and an increase in substance use (Bernays et al, 2020), results in greater potential involvement in exploitative relationships (including rape), and greater pressure to engage in sexual 'transactions' to ensure financial support (Erulkar et al, 2006;Operario et al, 2011).…”

The Drive to Take an HIV Test in Rural Uganda: A Risk to Prevention for Young People?

“…Young people's lives were characterised in many cases by exploitative employment situations, precarious living conditions and meagre incomes. Limited economic opportunities for these youth mean that transactional sex, where sex is used as a resource to be leveraged for material and social gain, has become increasingly normative (Bernays et al 2020). Such sexual relationships tend to be transient in character, often concurrent and desired not only for their personal and relational pleasure, but also for their economic value.…”

Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

“…Drivers of risk and barriers to effective uptake of multi-level HIV prevention for adolescents and young adults in rural KZN drawn from survey data (n = 4918) and studies conducted 2016-2018[1,6,8,37,40,[43][44][45][46][47][48][49][51][52][53][54][55][56] …”