Early Sexual Debut and the Effects on Well-Being among South African Adolescent Girls and Young Women Aged 15 to 24 Years

Abstract Background Evidence indicate that intimate partner violence (IPV) is disturbingly high among South African adolescent girls and young women (AGYW). Understanding prevalence and risk factors for IPV among these emerging adults is critical for developing appropriate interventions to prevent adverse health outcomes later in life. This study investigates the prevalence and factors associated with lifetime physical IPV experience among AGYW, aged 15–24 years, using the South African national HIV prevalence, incidence, behaviour and communication survey conducted in 2017. Methods The data used in this secondary analysis was obtained from a cross-sectional, population-based household survey data, conducted using a multi-stage stratified random cluster sampling approach. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with IPV. Results Of 716 AGYW that responded to the two commonly answered questions on IPV, 13.1% (95% CI: 9.6–17.6) indicated that they experienced IPV. The odds of reporting experiences of IPV were significantly lower among AGYW residing in high SES households [AOR = 0.09 (95% CI: 0.02–0.47), p = 0.004] than low SES households, and those residing in rural informal/tribal areas [AOR = 0.01 (95% CI: 0.00–0.22), p = 0.004] than urban areas. AGYW experiencing IPV had higher odds of reporting psychological distress compared to their counterparts [AOR = 4.37 (95% CI, 0.97–19.72), p = 0.054]. Conclusion The findings highlight the need for targeted structural and psychosocial interventions in low SES households and especially in urban areas.

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Defining characteristics of genital health in South African adolescent girls and young women at high risk for HIV infection

PLoS ONE ◽

10.1371/journal.pone.0213975 ◽

2019 ◽

Vol 14 (4) ◽

pp. e0213975 ◽

Cited By ~ 8

Author(s):

Smritee Dabee ◽

Shaun L. Barnabas ◽

Katie S. Lennard ◽

Shameem Z. Jaumdally ◽

Hoyam Gamieldien ◽

...

Keyword(s):

High Risk ◽

Hiv Infection ◽

South African ◽

Adolescent Girls ◽

Young Women

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Qualitative characterizations of relationships among South African adolescent girls and young women and male partners: implications for engagement across HIV self‐testing and pre‐exposure prophylaxis prevention cascades

Journal of the International AIDS Society ◽

10.1002/jia2.25521 ◽

2020 ◽

Vol 23 (S3) ◽

Cited By ~ 1

Author(s):

Leah E Holmes ◽

Michelle R Kaufman ◽

Albert Casella ◽

Mutsa Mudavanhu ◽

Lillian Mutunga ◽

...

Keyword(s):

South African ◽

Adolescent Girls ◽

Young Women ◽

Male Partners ◽

Self Testing ◽

Exposure Prophylaxis

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Sexual Relationship Types, Partner HIV Self-Testing, and Pre-Exposure Prophylaxis Among South African Adolescent Girls and Young Women

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000002569 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Kaitlyn Atkins ◽

Katherine Rucinski ◽

Mutsa Mudavanhu ◽

Leah Holmes ◽

Lillian Mutunga ◽

...

Keyword(s):

South African ◽

Adolescent Girls ◽

Young Women ◽

Sexual Relationship ◽

Relationship Types ◽

Self Testing ◽

Exposure Prophylaxis

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Mental health outcomes of a pilot 2-arm randomized controlled trial of a HIV-prevention program for South African adolescent girls and young women and their female caregivers

BMC Public Health ◽

10.1186/s12889-021-12010-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Geri Donenberg ◽

Katherine G. Merrill ◽

Millicent Atujuna ◽

Erin Emerson ◽

Bethany Bray ◽

...

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Hiv Prevention ◽

Reproductive Health ◽

Health Outcomes ◽

South African ◽

Adolescent Girls ◽

Young Women ◽

Sexual And Reproductive Health

Abstract Background South African adolescent girls and young women (AGYW) report significant mental distress and sexual and reproductive health concerns. Mental health problems and trauma symptoms are consistently associated with sexual and reproductive health behavior. Despite their intersection, few interventions address them simultaneously or engage female caregivers (FC) as collaborators. This study presents findings from a pilot test of an empirically supported culturally adapted family-based HIV-prevention program, Informed Motivated Aware and Responsible Adolescents and Adults- South Africa (IMARA-SA), on AGYW anxiety, depression, and trauma. Methods Sixty 15–19-year-old AGYW (mean age = 17.1 years) and their FC from outside Cape Town were randomized to IMARA-SA or a health promotion control program. AGYW reported their anxiety using the GAD-7, depression using the PHQ-9, and trauma using the PC-PTSD-5 at baseline and follow-up (6–10 months post). Both interventions were delivered by Xhosa-speaking Black South African women in groups over 2 days for approximately 10 h. We examined intervention effects using zero-inflated negative binomial regression for anxiety, multinomial logistic regression for depression, and logistic regression for trauma. Results At baseline, groups did not differ in demographic characteristics but AGYW randomized to IMARA-SA had higher depression scores than controls (p = 0.04) and a greater proportion screened positive for PTSD (p = .07). Controlling for baseline mental health scores, AGYW who received IMARA-SA compared to controls had significantly fewer anxiety symptoms at follow-up (adjusted incidence rate ratio for count model = 0.54, 95% CI = 0.29–0.99, p = 0.05), were less likely to report at least one depressive symptom relative to no symptoms (relative risk ratio = 0.22, 95% CI = 0.05, 0.95, p = 0.04), and were less likely to report symptoms of PTSD relative to no symptoms, but this difference was not statistically significant. Conclusions Mental health is implicated in risky sexual behavior, and reducing emotional distress can mitigate exposure to poor sexual and reproductive health outcomes. This pilot study yielded promising findings for the mental health impact of IMARA-SA, justifying replication in a larger randomized trial. Trial registration ClinicalTrials.gov Number NCT04758390, accepted 17/02/2021.

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Experiences of oral pre-exposure prophylaxis (PrEP) use disclosure among South African adolescent girls and young women and its perceived impact on adherence

PLoS ONE ◽

10.1371/journal.pone.0248307 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248307

Author(s):

Danielle Giovenco ◽

Katherine Gill ◽

Lauren Fynn ◽

Menna Duyver ◽

Shannon O’Rourke ◽

...

Keyword(s):

South African ◽

Adolescent Girls ◽

Young Women ◽

Community Education ◽

Social Groups ◽

Hiv Treatment ◽

Supportive Relationships ◽

Perceived Impact ◽

Exposure Prophylaxis ◽

Oral Prep

Introduction There is limited understanding of how social dynamics impact pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW) in generalized HIV-epidemic settings. We examined experiences of oral PrEP use disclosure to various social groups with the goal of identifying supportive relationships that can be leveraged to promote adherence. Methods We used qualitative methods to explore experiences disclosing PrEP use and the perceived impact of disclosure on adherence among 22 South African AGYW (16–25 years) taking daily oral PrEP. Serial in-depth-interviews (IDIs) were conducted 1-, 3-, and 12-months post-PrEP initiation. Respondents also self-reported their disclosures separately for various social groups and adherence was assessed using intracellular tenofovir-diphosphate levels. Results Qualitative respondents had a median age of 20.5 years and reported disclosing their PrEP use to friends (n = 36 total disclosures), partners, siblings, other family members (n = 24 disclosures each), and parents (n = 19 disclosures). IDI data revealed that parents and partners provided the most support to respondents and a lack of support from these groups was most often perceived as negatively affecting PrEP use. AGYW described difficulties explaining PrEP to their mothers, who believed PrEP was HIV treatment or would lead to HIV infection. Disclosure to household members was notably meaningful for AGYW (both positively and negatively). Respondents reported leveraging supportive relationships for pill reminders. For respondents who perceived a household member would be unsupportive, however, non-disclosure was less feasible and PrEP use was often stigmatized. To avoid stigma, several respondents hid or discontinued PrEP. Conclusions While supportive relationships may facilitate PrEP use, disclosure can also lead to stigma. Counselors should support AGYW in disclosing to key people in their social networks and provide AGYW with materials that lend credibility to explanations of PrEP. Community education is necessary to alleviate PrEP-related stigma and facilitate disclosure.

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