Examining Mediators of the Relationship Between Community Mobilization and HIV Incidence Among Young South African Women Participating in the HPTN 068 Study Cohort

Anna M Leddy,Kathleen Kahn,Audrey Pettifor,Jennifer Ahern,Rhian Twine,Sheri A Lippman,Torsten B Neilands

doi:10.1007/s10461-021-03491-7

Abstract

We previously demonstrated that village community mobilization (CM) was associated with reduced HIV incidence among adolescent girls and young women (AGYW) in South Africa. Little remains known about the mechanisms linking CM to HIV incidence. Using longitudinal data from 2292 AGYW in the HPTN 068 cohort (2011–2017), we examined whether school attendance, pro-social engagement, and hope for the future mediated the relationship between CM and HIV incidence. CM was measured at the village-level via two population-based surveys (2012 and 2014). Mediators and incident HIV infection were measured through HPTN 068 surveys and HIV testing. Mediation analyses were conducted using Mplus 8.5, adjusting for village-level clustering and covariates. Hope for the future mediated the relationship between CM and HIV incidence (indirect effect-RR 0.98, bias-corrected 95% CI 0.96, 0.99). Pro-social engagement and school attendance did not demonstrate indirect effects. CM reduces AGYW’s HIV acquisition risk, in part, by engendering hope.

Highlights

Adolescent girls and young women (AGYW) ages 15 to 24 years in sub-Saharan Africa account for 25% of all new HIV infections globally [1]
While our findings suggest that community mobilization (CM) leads to reduced AGYW HIV incidence, at least in part, through a path of hope, CM may work through multiple additional paths that we are not measuring
Our findings suggest that hope for the future is an important mediator of the impact of CM on AGYW HIV incidence

Summary

Introduction

Adolescent girls and young women (AGYW) ages 15 to 24 years in sub-Saharan Africa account for 25% of all new HIV infections globally [1]. The highest HIV incidence rates among AGYW occur in South Africa [2], indicating the urgent need to prevent new infections among this population. Central to HIV prevention efforts must be an emphasis on addressing the social environment (i.e. the socio-cultural context in which people interact), which plays a critical role in shaping HIV risk behaviors [3]. The transition from adolescence to adulthood has been identified as a period of time when the social environment may play a prominent role in determining HIV risk compared to other stages of life [10,11,12]. During adolescence, increasing social connection to the community and engagement in prosocial activities, such as school and sports groups, have

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Conclusion