Contextual drivers of HIV risk among young African women

Abstract

Introduction Significant progress has been made in the African HIV pandemic; however, the pace of incidence decline has slowed or stalled in many East and Southern African countries, especially among young women. This stall is worrying because many countries have burgeoning youth populations. There is an important window of opportunity to halt the epidemic as well as the potential for millions more infections if primary prevention efforts are not strengthened. Discussion Many hyper‐endemic settings have been exposed to numerous interventions; however, HIV incidence among young women has remained high. In this paper, we characterize the intervention context and examine how it can be strategically utilized to maximize HIV prevention interventions among young women. We begin by examining how contextual dynamics drive HIV risk. We illustrate how epidemiological contexts, gendered normative and economic contexts, and environmental contexts work synergistically to make young women especially vulnerable to HIV infection. We then examine how these contexts can undermine HIV prevention interventions. Finally, we discuss the importance of fully mapping out the intervention context to enhance the effectiveness of HIV prevention interventions. Conclusions Understanding an intervention context, and how its features work together to amplify young women's risk in hyper‐endemic settings can contribute to sustained momentum in reducing HIV incidence among young women and help to limit the reach of the HIV pandemic into new generations of Africans.

Maximizing the impact of HIV prevention technologies in sub‐Saharan Africa

“…In this supplement, we have brought together a number of articles that build on some of the discussions at that meeting, representing a variety of disciplinary perspectives. Mojola and Wamoyi start with a narrative and insightful review into the drivers of HIV risk among young African women , and use insights from their own and others’ research to show how epidemiological, gender‐normative and environmental contexts interact to drive hyperendemics of HIV, and how similar factors undermine preventive interventions. Their deep descriptions of how social drivers result in risky settings and behaviours are then used to suggest how that context can inform intervention planning.…”

Capitalising on aspirations of adolescent girls and young women to reduce their sexual health risks: Implications for HIV prevention

“…Aspirations which closely resemble an individual's living standards can disincentivise change, while aspirations too far removed from current living standards can disempower individuals to change (Appadurai, 2004;Ray, 2006). Adolescents' aspirations and hopes (realistic plans/expectations) evolve and increasingly shape their life choices (Appadurai, 2004;Davids et al, 2017) including those related to their sexual behaviours (Kagan et al, 2012), as they are exposed to various structural factors (Mojola & Wamoyi, 2019) and through social interactions with peers (Appadurai, 2004).…”

There are no equal opportunity infectors: Epidemiological modelers must rethink our approach to inequality in infection risk

“…Similarly, public health historian Samuel Kelton Roberts detailed how racial residential segregation drove TB infection and mortality among African-Americans in 20th century Baltimore via impacts on housing, workplace conditions, medical treatment, and public health policies [ 50 ]. These mechanisms have been repeatedly articulated in narrative histories, risk-factor analyses, and mixed-methods studies of many infections including cholera [ 51 ], HIV [ 52 , 53 ], and malaria [ 54 , 55 ]. Clouston and colleagues found that while high-income US counties were the first to see an introduction of SARS-CoV-2 infection, the pace of infection and mortality in these counties quickly slowed through NPIs (e.g., work from home, school closures).…”