Abstract
In sub-Saharan Africa, adolescents and young adults aged 15–24 years constitute 36% of an estimated 1. 3 million new HIV infections. Complex biological, social, behavioral and structural factors, as well as cultural norms contribute to whether and how young people perceive, are aware of and experience diverse HIV interventions. This qualitative study explored experiences and perceptions of intervention types among adolescents and young adults, and how different interventions could hinder or facilitate HIV treatment and prevention for adolescents and young adults in rural KwaZulu-Natal, South Africa. Data were collected as part of a DREAMS impact evaluation at the Africa Health Research Institute, KwaZulu-Natal between May 2017–January 2018. We used a combination of rapid community mapping and participant observation in four communities, 58 individual interviews, and 10 group discussions with 61 participants, conducted with both adolescent girls and young women and adolescent boys and young men. Thematic analysis focused on the changing HIV prevention landscape as experienced by adolescents and young adults. Participants reported a mix of new and old biomedical, behavioral, traditional, and locally-developed HIV prevention approaches. The appeal of the newer approaches depended on the extent to which they resonated with existing traditional and longstanding HIV prevention methods and the extent to which they engaged with adolescents and young adults' sexual experiences and with the social and structural factors including gender-related issues. These data demonstrate that in this context, newer methods and approaches can and should synergise with existing methods and beliefs. The HIV prevention landscape is evolving rapidly. Good community links and engagement offer an alternative support structure that could embrace both locally-developed approaches and traditional practices This structure could potentially support feasibility and acceptability of new and old HIV prevention approaches, without creating an impression that new approaches always need to replace the old.
Highlights
Despite developments achieved with HIV treatment and prevention efforts, the number of people who acquire HIV each year remains unacceptably high [1], among young women and men [2, 3] who represent 27% of the world’s population
A review conducted by the World Health Organization (WHO), indicates that adolescents, including those infected by HIV, are sensitive to the stigma associated with HIV and appreciate health care services that offer privacy and confidentiality [16]
This study used a qualitative research design, combining rapid community mapping [24, 25], focus group discussions (FGDs) [26, 27], semi structured in-depth interviews (IDIs) with AGYW and ABYM [28] and participant observation, in order to understand complex social interactions and culturally informed norms which influence perceptions, experiences and how the changing HIV landscape is navigated by adolescents and young adults [29]
Summary
Despite developments achieved with HIV treatment and prevention efforts, the number of people who acquire HIV each year remains unacceptably high [1], among young women and men [2, 3] who represent 27% of the world’s population. In 2015, sub-Saharan Africa (SSA), had an estimated 1.3 million new infections among adults aged ≥15 years [4]. A review focusing on barriers to adolescent HIV care in sub-Saharan Africa identified fear of stigma, family reaction, fear of the impact of a positive HIV diagnosis, perceived risk with respect to sexual exposure and poor attitude toward younger clinic-attendees by healthcare providers as major barriers that continue to impact effective HIV treatment and prevention efforts among adolescents [9]. Other major facilitators identified in that review include support—from providers, caregivers, peers, and the community—and skills development to increase selfconfidence, self-efficacy, and empowerment [16]
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