Understanding and responding to HIV risk in young South African women: Clinical perspectives

Abstract

Young women (15 -24 years) contribute a disproportionate 24% to all new HIV infections in South Africa -more than four times that of their male peers. HIV risk in young women is driven by amplifying cycles of social, behavioural and biological vulnerability. Those most likely to acquire infection are typically from socioeconomically deprived households in high HIV-prevalence communities, have limited or no schooling, engage in transactional sex or other high-risk coping behaviours, and have a history of sexually transmitted infections (STIs) and/or pregnancy. Despite the imperative to prevent HIV acquisition in young women, there is a dearth of evidence-based interventions to do so. However, there are several steps that healthcare workers can take to improve outcomes for this key population at the individual level. These include being able to identify high HIV-risk young women, ensuring that they receive the maximum social support they are eligible for, providing reliable and non-judgemental counselling on sexual and reproductive health and relationships, delivering contraceptives and screening and treating STIs in the context of accessible, youth-friendly services.

An Evaluation of Selected Populations for HIV-1 Vaccine Cohort Development in Nigeria

“…Our findings of disproportionate numbers of HIV infections among young women in Nigeria is consistent with previous reports from sub-Saharan Africa where young women are three to four times more likely to be HIV-infected than their male peers [2, 31–34]. Factors contributing to the higher HIV burden in females may include the two to three fold increased likelihood of heterosexual transmission of HIV from a man to a woman, and even higher transmission risk during forced or coerced sex, which is common but rarely reported by women [35, 36].…”

Collaborative care for the detection and management of depression among adults receiving antiretroviral therapy in South Africa: study protocol for the CobALT randomised controlled trial

“…Current debate regarding the targets has concerned the funding required and the shape of the interventions needed to be scaled in order to meet them [ 2 ]. These include focusing on key populations such as young women [ 3 , 4 ], the introduction of universal test and treat programmes [ 5 ], and integration with related programmes including those for tuberculosis, maternal and child health, and sexually transmitted infections [ 6 ]. The intersection between HIV, non-communicable diseases (NCDs) and mental health is notably absent from this discourse, despite recent evidence demonstrating the scale and consequences of the collision of these respective epidemics.…”

Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

“…Young women (aged 15-24 years) bear a disproportionate burden of HIV infection, have an infection rate up to eight times higher than their male peers (Dellar, Dlamini, and Abdool Karim 2015), and acquire HIV infection at least five to seven years earlier than men (UNAIDS 2015). Several studies emphasise the biological (Dellar, Waxman, and Abdool Karim 2015;McKinnon and Abdool Karim 2016) and sociocultural complexities (Ackermann and Klerk 2002;Ogunlela 2014;Prince et al 2005;Weeks et al 2004) through which women negotiate safe-sex practices or condom use with their male partners. However, most available safer sex options require male co-operation.…”