Abstract
BackgroundAdolescent girls and young women (AGYW) bear the brunt of the HIV epidemic in South Africa. ‘DREAMS’ aims to reduce HIV incidence through multi-level combination prevention. We describe HIV incidence and uptake of HIV and sexual reproductive health (SRH) by AGYW in KwaZulu-Natal (KZN), prior to DREAMS.MethodsLongitudinal and cross-sectional analysis of women (15–24 year old) in a population-based HIV incidence cohort within a demographic surveillance site in KZN. Observation time for HIV incidence was person-years at risk while resident. “Current use of contraceptives” and “having an HIV test in the past 12 months” was compared between 2011 and 2015.ResultsIn 2015, HIV prevalence was 11.0% and 34.1% and HIV incidence (2011–2015) was 4.54% (95%CI:3.89–5.30) and 7.45% (95%CI:6.51–8.51) per year in 15–19 and 20–24 year olds respectively, with no significant decline compared to 2006–2010. In 2015, 90.7% of 20-24-year-olds were unemployed, 36.4% and 51.7% of 15–19 and 20–24 year olds reported recent migration; 20.9% and 72.6% of 15–19 and 20–24 year olds had ever been pregnant. In 2015, less than 50% reported condom-use at last sex, 15.0% of 15–19 year olds and 48.9% of 20–24 year olds were currently using contraception and 32.0% and 66.7% of 15–19 and 20–24 year olds had tested for HIV in the past 12 months. There had been no improvement compared to 2011. Factors associated with AGYW testing for HIV in the past 12 months were, survey year—2011 more likely than 2015 (aOR = 0.50), number of partners (aOR = 3.25), ever been pregnant (aOR = 2.47) and knowing where to find ART (aOR = 1.54). Factors associated with contraception use were being older (aOR = 4.83); ever been pregnant (aOR = 12.62); knowing where to get ART (aOR = 1.79) and having had an HIV test in past 12 months (aOR = 1.74).ConclusionPrior to DREAMS, HIV incidence in AGYW was high. HIV and SRH service uptake did not improve and was suboptimal. Findings highlight the need for combination HIV prevention programmes for AGYW in this economically vulnerable area.
Highlights
In South Africa six million people are living with HIV, with nearly 400,000 new HIV infections per year
We describe HIV incidence and uptake of HIV and sexual reproductive health (SRH) by AGYW in KwaZulu-Natal (KZN), prior to Determined Resilient Empowered AIDS-free Mentored Safe (DREAMS)
Our aim in this paper is to describe the trends in HIV incidence and uptake of HIV testing and SRH services in a population-based sample of AGYW prior to DREAMS roll out in 2015
Summary
In South Africa six million people are living with HIV, with nearly 400,000 new HIV infections per year. Young women bear a disproportionate burden of infection because of multiple factors including biology, sexual behaviour, socially constructed gender differences between men and women, as well as differential access to resources and decision-making power [3; 4; 5] This has led to a growing body of evidence showing the effectiveness of HIV prevention interventions that tackle either biological susceptibility or behavioural risk at an individual level as well as those that tackle structural factors that increase vulnerability to HIV such as education, economic disadvantage, and gender based violence [6; 7; 8]. We describe HIV incidence and uptake of HIV and sexual reproductive health (SRH) by AGYW in KwaZulu-Natal (KZN), prior to DREAMS
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