Abstract
Adolescent girls and young women (AGYW) ages 15-24 years are disproportionately affected by HIV/AIDS, particularly in East and Southern Africa. One strategy to reduce HIV among AGYW, proposed through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Initiative, is to prevent and manage HIV among their male sexual partners. To implement this strategy and reach men, programs need information about AGYW's potential sexual partners at the local level. To support DREAMS programming in Mozambique, we undertook a study to characterize this population of men in 3 districts with ongoing DREAMS programming. In mid-2017 we conducted 15 focus group discussions with AGYW (N=102) and a venue-based intercept survey of men (N=1,140). Male sexual partners of AGYW who took the survey were diverse in age, education level, and socioeconomic status. Older AGYW focus group participants sought partners who could provide for them financially. Multiple sexual partnerships and inconsistent condom use were widely reported, with AGYW emphasizing that gender norms disempowered them from negotiating condom use. Reported condom use varied by AGYW and male-partner demographic characteristics, as well as by their relationship type. Condom use rates were much higher than national and regional estimates. AGYW who were less educated/not-in-school, were pregnant, or single mothers were particularly disempowered in sexual relationships. Less educated men were less likely to use condoms than educated men, and condom use was least likely in marriage. Study findings underscore the importance of reaching the diversity of male sexual partners of AGYW with HIV services as part of a strategy to reduce HIV risk among AGYW. They also support an enhanced focus on female-controlled HIV prevention methods that do not require negotiation with a male partner and special efforts to reach out-of-school/less educated AGYW, as well as pregnant AGYW and single mothers.
Highlights
Adolescent girls and young women (AGYW) ages 15–24 years are disproportionately affected by HIV/AIDS.[1,2] In sub-Saharan African countries with generalized HIV epidemics, adolescence marks an increase in HIV prevalence and the emergence of gender disparities in HIV.[3]
A total of 102 AGYW participated in 15 focus group discussions (FGDs) across 3 study locations
This study did not assess HIV prevalence, sexual partnerships may be characterized as high-risk—condom use was infrequently reported and inconsistent, and many men described concurrent sexual partnerships
Summary
Adolescent girls and young women (AGYW) ages 15–24 years are disproportionately affected by HIV/AIDS.[1,2] In sub-Saharan African countries with generalized HIV epidemics, adolescence marks an increase in HIV prevalence and the emergence of gender disparities in HIV.[3] Recent estimates from 7 African countries found that the prevalence of HIV among girls and women ages 15–25 is more than twice that of their male counterparts.[4]. Despite the epidemiological and human rights imperative to help AGYW remain AIDS-free, programming in this area has resulted in uneven and slow progress in reducing HIV infection rates. Global Health: Science and Practice 2019 | Volume 7 | Number 3 living with HIV know their status,[4] and treatment uptake and global viral suppression rates among adolescents and young people, especially among females, are extremely low.[4,5,6,7] other age groups have experienced declines in AIDS-related deaths, adolescent AIDS-related deaths increased by about 50% globally between 2005–2012.3
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