Abstract
BackgroundSouth Africa is making tremendous progress in the fight against HIV, however, adolescent girls and young women aged 15–24 years (AGYW) remain at higher risk of new HIV infections. This paper investigates socio-demographic and behavioural determinants of HIV infection among AGYW in South Africa.MethodsA secondary data analysis was undertaken based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Multivariate stepwise backward and forward regression modelling was used to determine factors independently associated with HIV prevalence.ResultsOut of 3092 interviewed and tested AGYW 11.4% were HIV positive. Overall HIV prevalence was significantly higher among young women (17.4%) compared to adolescent girls (5.6%). In the AGYW model increased risk of HIV infection was associated with being young women aged 20–24 years (OR = 2.30, p = 0.006), and condom use at last sex (OR = 1.91, p = 0.010), and decreased likelihood was associated with other race groups (OR = 0.06, p < 0.001), sexual partner within 5 years of age (OR = 0.53, p = 0.012), tertiary level education (OR = 0.11, p = 0.002), low risk alcohol use (OR = 0.19, p = 0.022) and having one sexual partner (OR = 0.43, p = 0.028). In the adolescent girls model decreased risk of HIV infection was associated with other race groups (OR = 0.01, p < 0.001), being married (OR = 0.07), p = 0.016], and living in less poor household (OR = 0.08, p = 0.002). In the young women’s models increased risk of HIV infection was associated with condom use at last sex (OR = 2.09, p = 0.013), and decreased likelihood was associated with other race groups (OR = 0.17, p < 0.001), one sexual partner (OR = 0.6, p = 0.014), low risk alcohol use (OR = 0.17, p < 0.001), having a sexual partner within 5 years of age (OR = 0.29, p = 0.022), and having tertiary education (OR = 0.29, p = 0.022).ConclusionThese findings support the need to design combination prevention interventions which simultaneously address socio-economic drivers of the HIV epidemic, promote education, equity and access to schooling, and target age-disparate partnerships, inconsistent condom use and risky alcohol consumption.
Highlights
South Africa is making tremendous progress in the fight against Human immunodeficiency virus (HIV), adolescent girls and young women aged 15–24 years (AGYW) remain at higher risk of new HIV infections
Apart from collecting behavioural survey data, dried blood spots (DBS) specimens were collected from participants who consented for HIV testing
The overall HIV prevalence in this sample of young women was 11.4% (n = 3092)
Summary
South Africa is making tremendous progress in the fight against HIV, adolescent girls and young women aged 15–24 years (AGYW) remain at higher risk of new HIV infections. Eastern and Southern Africa countries carry the heaviest burden with an estimated 236,000 annual number of new infections, and South Africa leading with about 102,000 new infections in the same year [1, 2] This is the case despite significant investment and gains made to reduce HIV risk over the past decades in the country [3]. Vulnerability of AGYW to HIV is affected by societal norms supportive of male superiority and sexual entitlement Evidence shows that this leads to gender inequality and unequal power dynamics causing females to be unable to negotiate safe sex leading them to engage in risky sexual behaviours [4, 5]. Socio-demographic factors such as age, marital status, level of education, employment, and place of residence have been associated with risk of HIV among young people [11, 12]
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