Abstract
BackgroundEvidence suggests that multiple concurrent sexual partnering may be a key driver of the high HIV prevalence among young women in South Africa. However, little is known about whether and to what extent women who have multiple sexual partners also engage in other high risk sexual behaviors such as inconsistent condom use. And yet, multiple concurrent sexual partnering is of little epidemiological relevance if all partners in these sexual networks use condoms consistently. This study assesses the prevalence of sexual risk behaviors and HIV, and predictors of inconsistent condom use among women aged 16–24 with multiple sexual partners in a peri-urban setting in South Africa.MethodsWe used Respondent Driven Sampling, a sampling strategy for hard-to-reach populations to recruit 259 women aged 16–24 in a bio-behavioral cross-sectional survey in the Western Cape province. Estimates of population proportions and 95% confidence intervals (CIs) were calculated using the Respondent-Driven Sampling Analysis Tool 5.6 (RDSAT). The primary outcome was inconsistent condom use in the past three months.ResultsYoung women reported an average of 7 partners in the past 3 months and a high prevalence of sexual risk behaviors: concurrency (87%), transactional sex (91%) and age mixing (59%). Having >5 sexual partners in the last 3 months doubled the risk of unprotected sex (OR 2.43, CI 1.39–4.25). HIV prevalence was 4% among 16–19 year olds, increasing threefold (12%) at age 20–24.DiscussionMultiple sexual partnering, where a high number of partners are acquired in a short space of time, is a fertile context for unprotected and risky sexual behavior. The young women featured in this survey present with a constellation of high-risk sexual behaviors that cluster to form a risk syndrome. Carefully tailored repeat bio-behavioral surveillance surveys are recommended for this sub-population.
Highlights
The HIV epidemic has stabilized in South Africa, but at an unacceptably high national prevalence rate of 11% [1] with some sub-populations continuing to be more at risk of contracting HIV than others
HIV prevalence among young women increases dramatically with age: 7% among 15–19 year olds compared to 21% among 20–24 year olds and 33% among 25–29 year-olds [1]
Formative research revealed a number of risk factors for HIV in this community; the normative practice of concurrent sexual partnering among young women, very few recreational facilities, and a large number of alcohol serving venues (n = 16) known as shebeens, that are popular among young people, and men and women who want to meet new sexual partners
Summary
The HIV epidemic has stabilized in South Africa, but at an unacceptably high national prevalence rate of 11% [1] with some sub-populations continuing to be more at risk of contracting HIV than others. HIV prevalence among young women increases dramatically with age: 7% among 15–19 year olds compared to 21% among 20–24 year olds and 33% among 25–29 year-olds [1] This three- to four-fold increase in HIV prevalence among young women as they grow older demonstrates their escalating vulnerability to HIV. Owing to these HIV transmission dynamics among women aged 20–29, they have been classified as a most at risk population (MARP) [1]. This study assesses the prevalence of sexual risk behaviors and HIV, and predictors of inconsistent condom use among women aged 16–24 with multiple sexual partners in a peri-urban setting in South Africa
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