Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral, and Structural Factors and Emerging Intervention Approaches

Abstract

Young women in southern Africa experience some of the highest incidence rates of HIV infection in the world. Across southern Africa, HIV prevalence among women increases rapidly between the teenage years and young adulthood. Adult HIV prevalence is 16.8 percent in South Africa, 23 percent in Botswana, 23 percent in Lesotho and 26.5 percent in Swaziland. Existing research has illuminated some of the key social, behavioral and structural factors associated with young women's disproportionate HIV risk, including gendered social norms that advantage male power in sexual relationships, and age disparities in relationships between younger women and older male partners. Important structural factors include the region's history of labor migration and legacy of family disruption, and entrenched social and economic inequalities. New interventions are emerging to address these high levels of HIV risk in the key population of young women, including structural interventions, biomedical prevention such as PrEP, and combined HIV prevention approaches.

Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

“…28 Programmes are increasingly aiming to address the needs of adolescent girls in recognition of their vulnerability to HIV. 29 We expect that extending our analysis to allow for their prioritisation as a third key population would further increase the benefits of a focused approach to combination prevention. In the absence of additional data, we have assumed that cost and effect size are scale-invariant, and populations are all equally accessible.…”

Seeking wider access to HIV testing for adolescents in sub-Saharan Africa

“…However, beyond 14 y, female adolescents have much higher HIV incidence and prevalence as compared to males (7,8,(59)(60)(61) ( Table 1). Pregnant adolescent females (46,47), adolescents with early sexual debut, married, or partnered but living separately, engaging in transactional sex, especially in rural areas (62,63), having multiple or older sexual partners (59,60,64), and those experiencing high mobility and labor migration (65,66), have also been identified to be at increased risk of HIV infection and unfavorable outcomes. Lastly, the significant proportions of perinatally-infected individuals surviving into young adolescence and young adulthood should not be overlooked (51,61,67).…”

Chronicity, crisis, and the ‘end of AIDS’

“…Twenty-two million people living with HIV are not accessing ART and later diagnosis remains a significant barrier to HIV treatment scale up (UNAIDS, 2016). Many individuals, particularly women, sex workers, men who have sex with men (MSM), transgender persons, those who engage in injection and non-injection drug use, migrants, and refugees continue to face discrimination, stigma, and lack of access to HIV information, testing, and treatment due to various policies and practices that uphold structural and social barriers (Arreola et al, 2015; Baral, Sifakis, Cleghorn, & Beyrer, 2007; Baral et al, 2012; Baral et al, 2013; Beyrer & Karim, 2013; Beyrer et al, 2014; Dellar, Dlamini, & Karim, 2015; El-Bassel, Shaw, Dasgupta, & Strathdee, 2014; Galeucia & Hirsch, 2016; Harrison, Colvin, Kuo, Swartz, & Lurie, 2015; Karim et al, 2010; Mayer, Grinsztejn, & El-Sadr, 2016; Tanser, Bärnighausen, Vandormael, & Dobra, 2015; Weine & Kashuba, 2012). …”