Transactional Sex and HIV Incidence in a Cohort of Young Women in the Stepping Stones Trial

Abstract Background Combination interventions may be an effective way to prevent human immunodeficiency virus (HIV) in adolescent girls and young women. However, current studies are not designed to understand which specific interventions and combinations will be most effective. We estimate the possible impacts of interventions on a combination of factors associated with HIV. Methods We used the g-formula to model interventions on combinations of HIV risk factors to identify those that would prevent the most incident HIV infections, including low school attendance, intimate partner violence, depression, transactional sex, and age-disparate partnerships. We used data from the HIV Prevention Trials Network (HPTN) 068 study in rural South Africa from 2011 to 2017. We estimated HIV incidence under a potential intervention that reduced each risk factor and compared this to HIV incidence under the current distribution of these risk factors. Results Although many factors had strong associations with HIV, potential intervention estimates did not always suggest large reductions in HIV incidence because the prevalence of risk factors was low. When modeling combination effects, an intervention to increase schooling, decrease depression, and decease transactional sex showed the largest reduction in incident infection (risk difference, –1.4%; 95% confidence interval [CI], –2.7% to –.2%), but an intervention on only transactional sex and depression still reduced HIV incidence by –1.3% (95% CI, –2.6% to –.2%). Conclusions To achieve the largest reductions in HIV, both prevalence of the risk factor and strength of association with HIV must be considered. Additionally, intervening on more risk factors may not necessarily result in larger reductions in HIV incidence.

Download Full-text

Education and HIV incidence among young women in KwaZulu-Natal: An association but no evidence of a causal protective effect

PLoS ONE ◽

10.1371/journal.pone.0213056 ◽

2019 ◽

Vol 14 (3) ◽

pp. e0213056 ◽

Cited By ~ 1

Author(s):

Dick Durevall ◽

Annika Lindskog ◽

Gavin George

Keyword(s):

Protective Effect ◽

Young Women ◽

Hiv Incidence ◽

Kwazulu Natal

Download Full-text

Recently formed age-disparate partnerships are associated with elevated HIV-incidence among young women in South Africa

AIDS ◽

10.1097/qad.0000000000002362 ◽

2020 ◽

Vol 34 (1) ◽

pp. 149-154 ◽

Cited By ~ 1

Author(s):

Brendan Maughan-Brown ◽

Atheendar Venkataramani ◽

Ayesha B.M. Kharsany ◽

Sean Beckett ◽

Kaymarlin Govender ◽

...

Keyword(s):

South Africa ◽

Young Women ◽

Hiv Incidence

Download Full-text

High HIV Incidence and Prevalence Among Young Women in Rural South Africa: Developing a Cohort for Intervention Trials

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/00042560-200004150-00007 ◽

2000 ◽

Vol 23 (5) ◽

pp. 405-409 ◽

Cited By ~ 17

Author(s):

David Wilkinson ◽

S. S. Abdool Karim ◽

Brian Williams ◽

Eleanor Gouws

Keyword(s):

South Africa ◽

Young Women ◽

Hiv Incidence ◽

Rural South ◽

Intervention Trials ◽

Rural South Africa

Download Full-text

Transactional sex and incident HIV infection in a cohort of young women from rural South Africa

AIDS ◽

10.1097/qad.0000000000001866 ◽

2018 ◽

Vol 32 (12) ◽

pp. 1669-1677 ◽

Cited By ~ 25

Author(s):

Kelly Kilburn ◽

Meghna Ranganathan ◽

Marie C.D. Stoner ◽

James P. Hughes ◽

Catherine MacPhail ◽

...

Keyword(s):

South Africa ◽

Hiv Infection ◽

Young Women ◽

Transactional Sex ◽

Rural South ◽

Rural South Africa

Download Full-text

Transactional Sex among Young Women in Post-Earthquake Haiti: Prevalence and Vulnerability to HIV

Journal of Sociology and Social Work ◽

10.15640/jssw.v5n1a6 ◽

2017 ◽

Author(s):

Carol Ann Daniel ◽

Carmen Logie

Keyword(s):

Young Women ◽

Transactional Sex

Download Full-text

Characteristics of HIV seroconverters in the setting of universal test and treat: Results from the SEARCH trial in rural Uganda and Kenya

PLoS ONE ◽

10.1371/journal.pone.0243167 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0243167

Author(s):

Marilyn N. Nyabuti ◽

Maya L. Petersen ◽

Elizabeth A. Bukusi ◽

Moses R. Kamya ◽

Florence Mwangwa ◽

...

Keyword(s):

Risk Factors ◽

Hiv Infection ◽

Incidence Rates ◽

Transactional Sex ◽

Self Report ◽

Hiv Incidence ◽

High Uptake ◽

Universal Testing ◽

Hiv Test ◽

Universal Test And Treat

Background Additional progress towards HIV epidemic control requires understanding who remains at risk of HIV infection in the context of high uptake of universal testing and treatment (UTT). We sought to characterize seroconverters and risk factors in the SEARCH UTT trial (NCT01864603), which achieved high uptake of universal HIV testing and ART coverage in 32 communities of adults (≥15 years) in rural Uganda and Kenya. Methods In a pooled cohort of 117,114 individuals with baseline HIV negative test results, we described those who seroconverted within 3 years, calculated gender-specific HIV incidence rates, evaluated adjusted risk ratios (aRR) for seroconversion using multivariable targeted maximum likelihood estimation, and assessed potential infection sources based on self-report. Results Of 704 seroconverters, 63% were women. Young (15–24 years) men comprised a larger proportion of seroconverters in Western Uganda (18%) than Eastern Uganda (6%) or Kenya (10%). After adjustment for other risk factors, men who were mobile [≥1 month of prior year living outside community] (aRR:1.68; 95%CI:1.09,2.60) or who HIV tested at home vs. health fair (aRR:2.44; 95%CI:1.89,3.23) were more likely to seroconvert. Women who were aged ≤24 years (aRR:1.91; 95%CI:1.27,2.90), mobile (aRR:1.49; 95%CI:1.04,2.11), or reported a prior HIV test (aRR:1.34; 95%CI:1.06,1.70), or alcohol use (aRR:2.07; 95%CI:1.34,3.22) were more likely to seroconvert. Among survey responders (N = 607, 86%), suspected infection source was more likely for women than men to be ≥10 years older (28% versus 8%) or a spouse (51% vs. 31%) and less likely to be transactional sex (10% versus 16%). Conclusion In the context of universal testing and treatment, additional strategies tailored to regional variability are needed to address HIV infection risks of young women, alcohol users, mobile populations, and those engaged in transactional sex to further reduce HIV incidence rates.

Download Full-text

Emotional Violence is Associated with Increased HIV Risk Behavior Among South African Adolescent Girls and Young Women in the HPTN 068 Cohort

AIDS and Behavior ◽

10.1007/s10461-021-03535-y ◽

2021 ◽

Author(s):

Anna M. Leddy ◽

Amanda Selin ◽

Sheri A. Lippman ◽

Linda J. Kimaru ◽

Rhian Twine ◽

...

Keyword(s):

Alcohol Use ◽

Young Women ◽

Hiv Risk ◽

Partner Violence ◽

Transactional Sex ◽

Hiv Risk Behavior ◽

Future Research ◽

Cross Sectional ◽

Logistic Regression Models ◽

Condomless Sex

AbstractLimited research has explored how emotional intimate partner violence (IPV) shapes HIV risk behaviors. Using cross-sectional data from the HPTN 068 post-trial visit (N = 1942), we assessed the association between emotional IPV and its sub-domains (verbal abuse and threats) with condomless sex, transactional sex, and frequent alcohol use among young women in South Africa. In adjusted multivariable logistic regression models, any emotional IPV and verbal IPV were associated with increased odds of condomless sex (aOR: 1.47; 95% CI: 1.15, 1.87; and aOR: 1.48; 95% CI: 1.15, 1.89), transactional sex (aOR: 2.32; 95% CI: 1.74, 3.08; and aOR: 2.02; 95% CI: 1.51, 2.71) and alcohol use (aOR: 1.88; 95% CI: 1.39, 2.53; and aOR: 1.87; 95% CI: 1.37, 2.55). Threats were associated with transactional sex (aOR: 3.67; 95% CI: 2.62, 5.14). Future research should examine this relationship over-time and HIV prevention programs should consider and address emotional IPV.

Download Full-text

Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors

American Journal of Epidemiology ◽

10.1093/aje/kwz238 ◽

2019 ◽

Vol 189 (5) ◽

pp. 422-432 ◽

Cited By ~ 1

Author(s):

Dana E Goin ◽

Rebecca M Pearson ◽

Michelle G Craske ◽

Alan Stein ◽

Audrey Pettifor ◽

...

Keyword(s):

Depressive Symptoms ◽

Adolescent Girls ◽

Young Women ◽

Indirect Effect ◽

Parental Monitoring ◽

Public Health Problem ◽

Sub Saharan Africa ◽

Hiv Incidence ◽

Nonparametric Bootstrap ◽

Linear Probability

Abstract The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13–21 years) in rural Mpumalanga Province, South Africa, during 2011–2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and we assessed mediation using inverse odds ratio weighting. Inference was calculated using the nonparametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared with those without (risk difference = 3.5, 95% confidence interval (CI): 0.1, 7.0). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6, 95% CI: 0.0, 3.3) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5, 95% CI: –0.3, 3.3). All mediators jointly explained two-thirds (indirect effect = 2.4, 95% CI: 0.2, 4.5) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health might reduce risk of acquiring HIV among AGYW.

Download Full-text