Abstract
BackgroundWith an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa are at high HIV risk. This paper assesses young adults’ (18–24 years) knowledge, attitudes and practices regarding HIV prevention in Nkangala and OR Tambo districts.MethodsA cross-sectional household survey was conducted in two districts in 2017/8. Participants completed computer-assisted self-interviews on HIV knowledge, attitudes, behaviour practices, use of social media and condom use at last sex (proxy for high-risk sex). HIV knowledge was assessed using the South African-adapted UNAIDS scale. Descriptive analyses were conducted and logistic regression models were built to assess factors associated with being knowledgeable of HIV and condom use at last sex.ResultsOne thousand nine hundred fifty-five participants were interviewed (90% response rate). Less than half (44.7%) had correct knowledge of HIV prevention and 73% used a condom at last sex. Social media use predicted high HIV knowledge as higher odds were observed among participants using the print media (aOR1.87; 1.34–2.60), WhatsApp (aOR1.55; 1.26–1.90), radio/television (aOR2.75; 1.15–6.55) although social networking sites’ use protected against knowledge acquisition (aOR0.53; 0.34–0.82). Females (aOR0.75; 0.58–0.97) and participants reporting sexual risk were less likely to have HIV knowledge as negative associations were found for having multiple sexual partners in the last 3 months (aOR0.63;0.48–0.82) and ever having sex (aOR0.37;0.23–0.61). Participants who abused drugs (aOR1.40; 1.05–1.88) and had attitudes accepting people living with HIV (aOR2.05; 1.14–3.69) had higher odds of having HIV knowledge. Females (aOR0.70; 0.54–0.91), students (aOR0.52; 0.40–0.66) and participants who abused drugs (aOR0.58; 0.43–0.77) were less likely to report condom use at last sex.ConclusionsThere is a correlation between media use and HIV knowledge, non-condom use and HIV knowledge, and high-risk sexual behaviours and less HIV knowledge. An aggressive community media campaign utilising locally available, preferred and accessible media platforms among young adults is required for behaviour change.
Highlights
With an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa are at high HIV risk
Despite young women having the highest incidence, it is the young men who do not test for HIV which contributes to challenges to reaching the first 90 (HIV testing) of the UNAIDS’ 90–90-90 goals for South Africa
We found low HIV prevention knowledge levels which were much lower among women, coupled by inadequate but relatively high levels of condom use at last sex
Summary
With an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa are at high HIV risk. Young women (aged between 15 and 24 years) have the highest HIV incidence of any age or sex cohort, at 2.01% in 2015 and 1.51% in 2016 compared to their male counterparts with 0.49% in 2016 [1, 3, 4]. Young women in their early 20s have a fourfold burden compared to their male peers, with approximately 2000 new HIV infections occurring every week [5]. It is important to develop interventions that target communities with young adults to increase HIV prevention, testing and treatment
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