Adolescent girls and young women: Policy-to-implementation gaps for addressing sexual and reproductive health needs in South Africa

Seventeen articles make up this special collection, covering a range of different, but cross-cutting themes. These highlight contemporary concerns in African research and scholarship about the factors configuring the sexual and reproductive health needs of adolescent girls and young women (AGYW). The articles interrogate contextual and cultural impediments, problematic representations, perceptions of vulnerabilities and rights, experiences of gender-based violence, coercive sex, unplanned motherhood—and agency, resistance and strategic interventions. While a diverse range of issues, theories, and methodologies are evident, all the articles reflect on how the circumstances of young women in Africa can be effectively improved to engender empowerment, good health, and personal and sexual autonomy.

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“As a Young Pregnant Girl… The Challenges You Face”: Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa

AIDS and Behavior ◽

10.1007/s10461-020-02974-3 ◽

2020 ◽

Author(s):

Zoe Duby ◽

Tracy McClinton Appollis ◽

Kim Jonas ◽

Kealeboga Maruping ◽

Janan Dietrich ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Reproductive Health ◽

Adolescent Girls ◽

Young Women ◽

Sexual And Reproductive Health

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The PrEPARE Pretoria Project: protocol for a cluster-randomized factorial-design trial to prevent HIV with PrEP among adolescent girls and young women in Tshwane, South Africa

BMC Public Health ◽

10.1186/s12889-020-09458-y ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Wendee M. Wechsberg ◽

Felicia A. Browne ◽

Jacqueline Ndirangu ◽

Courtney Peasant Bonner ◽

Alexandra M. Minnis ◽

...

Keyword(s):

South Africa ◽

Hiv Prevention ◽

Reproductive Health ◽

Adolescent Girls ◽

Young Women ◽

Sexual And Reproductive Health ◽

Hiv Prevention Intervention ◽

Stigma And Discrimination ◽

Catchment Areas

Abstract Background Despite increased prevention efforts, HIV remains the leading cause of death among adolescent girls and young women in South Africa. Although research indicates important determinants of HIV acquisition at the individual and interpersonal levels, structural-level stigma and discrimination continue to be critical barriers to reaching and retaining this key population for HIV prevention and sexual and reproductive health services. Innovative and multilevel interventions are needed that can address the intersectional structural and gender issues that young women face, including stigma, alcohol and drug use, gender-based violence, and other risk factors when seeking health services. Oral pre-exposure prophylaxis (PrEP) taken daily has been found to be an effective biomedical HIV prevention tool. Testing a comprehensive gender-focused biobehavioral HIV prevention intervention that is inclusive of social ecological determinants, such as stigma and discrimination reduction in clinics, is critical for reducing HIV among adolescent girls and young women. Methods This project involves both a Community Collaborative Board and a Youth Advisory Board in helping to adapt the Young Women’s Health CoOp intervention and the Health Policy Project (HPP) Stigma and Discrimination (S&D) reduction training curriculum to the setting and population. This study uses a two-by-two factorial design with stratified randomization of 12 clinics, each with distinct catchment areas. The Young Women’s Health CoOp addresses substance use, sexual risk, violence prevention and sexual negotiation, condom demonstration, and problem solving with the following additions: knowledge of PrEP, the importance of PrEP adherence, and sexual and reproductive health. Adolescent girls and young women will be assessed with behavioral and biological measures at baseline, 3-, 6- and 9-month follow-up. The S&D reduction training is provided for all staff in the clinics randomized to this condition. Clinic staff will be surveyed at baseline, 4- and 8-month follow-up. We will recruit 900 AGYW from communities in the 12 clinic catchment areas. Discussion The study findings, if efficacious across the outcomes, will be incorporated into the gender-focused HIV prevention intervention toolkit and disseminated to inform multilevel prevention approaches. Trial registration ClinicalTrials.gov. Identifier: NCT04048551 (Recruiting). Registered: August 7, 2019 (Retrospectively registered).

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Addressing the sexual and reproductive health needs of adolescents in South Africa: a human rights analysis of the GOLD peer education programme

Health Equity, Social Justice and Human Rights ◽

10.4324/9780203119242-15 ◽

2012 ◽

pp. 127-134

Keyword(s):

South Africa ◽

Human Rights ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Peer Education ◽

Education Programme ◽

Health Needs

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Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: a girl-centered agenda

Reproductive Health ◽

10.1186/s12978-019-0710-0 ◽

2019 ◽

Vol 16 (S1) ◽

Cited By ~ 4

Author(s):

Uchechi Roxo ◽

M. Linda Mobula ◽

Damilola Walker ◽

Allison Ficht ◽

Sarah Yeiser

Keyword(s):

Reproductive Health ◽

Adolescent Girls ◽

Young Women ◽

Sexual And Reproductive Health ◽

Hiv Treatment ◽

Care Services

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The case for integrated human papillomavirus vaccine and HIV prevention with broader sexual and reproductive health and rights services for adolescent girls and young women

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/trx032 ◽

2017 ◽

Vol 111 (4) ◽

pp. 141-143 ◽

Cited By ~ 1

Author(s):

Manjulaa Narasimhan ◽

Heather Pedersen ◽

Gina Ogilvie ◽

Sten H. Vermund

Keyword(s):

Human Papillomavirus ◽

Hiv Prevention ◽

Reproductive Health ◽

Adolescent Girls ◽

Young Women ◽

Sexual And Reproductive Health ◽

Human Papillomavirus Vaccine ◽

Papillomavirus Vaccine

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Uptake of Contraception Among Adolescent Girls and Young Women PrEP Clients: Leveraging the Opportunity to Strengthen HIV and Sexual and Reproductive Health Integration

Frontiers in Reproductive Health ◽

10.3389/frph.2021.684114 ◽

2021 ◽

Vol 3 ◽

Author(s):

Melanie Pleaner ◽

Zukiswa Fipaza ◽

Khuthala Mabetha ◽

Letitia Greener ◽

Sydney Ncube ◽

...

Keyword(s):

Reproductive Health ◽

Adolescent Girls ◽

Young Women ◽

Sexual And Reproductive Health ◽

Monitoring Data ◽

Consistent Condom ◽

Healthcare Facilities ◽

Routine Monitoring ◽

New Guidelines ◽

Exposure Prophylaxis

The introduction of oral pre-exposure prophylaxis (PrEP) for HIV prevention was a major breakthrough in South Africa (SA). While the initial introduction focused on issues such as the development and implementation of new guidelines, supply, and the development of demand creation strategies, the need to integrate PrEP services with sexual and reproductive health (SRH) services has gained traction both globally and locally. Project PrEP was implemented in eight healthcare facilities and four mobile clinics in three provinces in SA. Using monitoring data from across the four project clusters, and 4,949 clients, over a 21-month period, we conducted an analysis of baseline routine monitoring data to examine contraceptive uptake in adolescent girls and young women (AGYW) initiating PrEP at project sites. Two-thirds of women (62.3%, n = 3,083) reported the current use of contraception at baseline, with the most commonly used methods being hormonal injectables (61.9%, n = 1,829) and male condoms (19.4%, n = 575). A third (32.3%, n = 603) of the non-contraceptive users accepted a method at PrEP initiation. From a total of 1,007 (32.7%) current contraceptive users at baseline, 865 (85.9%) chose the same or a different method at this visit. The method uptake at PrEP initiation increased the overall contraceptive prevalence by 12.2 to 74.5%. Data indicated that over a third (38.8%, n = 725) who were not using a method at baseline described themselves as consistent condom users. Although a major focus of the project was on PrEP service provision, all women were counseled and offered contraceptive services. The acceptance of a method by a third of non-users was promising; however, more understanding of those who did not take up a method is required. The need to leverage opportunities for the promotion of the integration of HIV and family planning at all levels of PrEP provision was highlighted.

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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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