Hasina Subedar and colleagues describe the intersectoral collaboration enabling She Conquers, a three year national campaign rolled out across South Africa, to tackle the multiple drivers of the high rates of HIV infection among adolescent girls and young women

BackgroundIn South Africa, young women are at disproportionate risk of HIV infection with about 2363 new infections per week in 2015. Proper condom use is one of the most effective HIV/AIDS prevention strategies among sexually active persons. Understanding factors associated with male condom use in this key population group is important to curb the spread of HIV. This study determined practices and predictors of male condom use among sexually active young women in South Africa.MethodsThe 2012 National HIV Communication Survey measured the extent of exposure to communication activities for HIV prevention among men and women aged 16–55 years in South Africa. We performed a secondary data analysis on a subset of this survey, focussing on 1031 women aged 16–24 years who reported having had sex in the past 12 months. We determined predictors of male condom use using the unconditional multivariable logistic regression model.ResultsOf the 1031 young women, 595 (57.8%) reported using a male condom at last sex, 68.4% in women aged 16–19 years and 54.5% in women aged 20–24 years (p < 0.001). Delayed sexual debut [20 years or above] (Adjusted Odds Ratio [aOR] 2.1, 95% CI: 1.2 to 3.7, p = 0.006); being a student (aOR 1.6, 95% CI: 1.2 to 2.3, p = 0.005); and exposure to HIV communication programmes (aOR 3.1, 95% CI: 1.2 to 8.6, p = 0.025) were significantly associated with male condom use at last sex.ConclusionMale condom use was a common practice among young women and was associated with delayed sexual debut and exposure to HIV communication programmes. Behavioral interventions and HIV communication programmes should therefore encourage young women to delay initiation of sex and promote usage of male condoms.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6039-8) contains supplementary material, which is available to authorized users.

Background Human immunodeficiency virus (HIV) risky behaviours including multiple sexual partnership (MSP) and non-condom use (nCU) are known to be drivers of the spread of HIV; cognitive factors including perceived susceptibility of HIV, self-efficacy and attitudes play a significant role in influencing risky sexual behaviours. Objectives We sought to investigate personal beliefs, perceptions, thoughts and actions that are associated with MSP and nCU in South Africa. Methods We analysed nationally representative data from the 2012 National HIV Communication Survey (NCS) that included about 10 000 participants aged 16–55 years. Five constructs were created to measure psychosocial and cognitive determinants. Cronbach’s alpha coefficient for internal consistency reliability was calculated. Multivariable logistic regression was used to determine factors associated with MSP and nCU. Results Of the 6061 sexually active respondents, 13% (95% CI: 11.47–13.12) reported MSP and 52.7% ( n = 3158 of 6039) (95% CI: 51.0–53.55) nCU at last sex. Factors associated with MSP included perceived benefits, adjusted odds ratio (aOR) = 2.16 (95% CI: 1.80–2.58), perceived susceptibility to HIV, aOR = 2.22 (95% CI: 1.83–2.69) and engaging in intergenerational sex, aOR = 2.14 (95% CI: 1.78–2.56). Predictors of nCU were perceived benefits, aOR = 1.25 (95% CI: 1.09–1.43); perceived susceptibility to HIV, aOR = 1.6 (95% CI: 1.39–1.83); and personal beliefs, aOR = 1.35 (95% CI: 1.13–1.62). Conclusion Cognitive and behavioural factors were found to be predictors of risky sexual behaviours for HIV. This highlights the importance of considering personal perception and reasoning when attempting to understand and influence an individual’s sexual behaviour. This could be done through enhancing awareness of HIV risk in the general population and by influencing cognitive behaviour change through community mobilisation, advocacy and creating activities to improve self-esteem.

Background: The HIV Prevention Self-Assessment Tools (PSATs) were developed by the Global Prevention Coalition as an easy-to-use tool for country-led review of national HIV prevention response against a global standardised set of programmatic components. As part of the South to South Learning Network (SSLN), country-level data on HIV prevention programmes for sex workers were collected by 10 African countries, using the PSAT to self-assess their HIV prevention progress. Methods: Data were collected August 2020 to July 2021 from participating countries. In each country, a technical team of 8-10 members completed the tool with support from the SSLN. The PSAT collects data for three programme domains: management, implementation and outcomes and sustainability, each of which comprises essential programme functions and elements. Once all elements are scored, the tool automatically calculates the final scores for each domain, on a scale of 1-5. Also, 15 interviews were conducted with 15 country leaders to understand the ease and usefulness of the PSAT process. Results: The overall PSAT scores ranged between 4.1 (Kenya) to 2.3 in Zambia. Of the three domains, Programme Management achieved the highest scores, with four countries (Kenya, Ghana, Zimbabwe, and South Africa) scoring more than four. High scores were seen in the Programme Implementation domain as well; five countries (Zimbabwe, South Africa, Mozambique, Malawi and Uganda) scored between 3 to 4. For Programme Outcomes and Sustainability, other than Kenya, which did not score the outcomes, all countries scored poorly with scores ranging between 3.8 to 1.5. Comparing PSAT scores with UNAIDS suggested epidemic metrics have shown that countries with the highest PSAT scores also have high condom use rates and significant reductions in HIV incidence from 2010 to 2019. Conclusions: This exercise has helped country’s leadership to self-reflect on their HIV prevention programmes, increase ownership and identify areas that need strengthening.