. 2018 Oct;47(7):1969-1982.

doi: 10.1007/s10508-017-1056-8. Epub 2017 Nov 13.

HIV Prevention Among Young Women in South Africa: Understanding Multiple Layers of Risk

Christina Psaros^{1

2}, Cecilia Milford³, Jennifer A Smit^{3

4}, Letitia Greener³, Nzwakie Mosery³, Lynn T Matthews^{5

6}, Abigail Harrison⁷, Janna R Gordon⁸, Matthew Mimiaga^{9

10

11

12

13}, David R Bangsberg¹⁴, Steven A Safren¹⁵

Affiliations

¹ Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. cpsaros@mgh.harvard.edu.
² Department of Psychiatry, Harvard Medical School, Boston, MA, USA. cpsaros@mgh.harvard.edu.
³ MatCH Research Unit (Maternal, Adolescent, and Child Health Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
⁴ School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
⁵ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁶ Center for Global Health and Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.
⁷ Department of Behavioral and Social Sciences and International Health Institute, Brown University School of Public Health, Providence, RI, USA.
⁸ San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.
⁹ The Fenway Institute at Fenway Health, Boston, MA, USA.
¹⁰ Department of Behavioral and Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
¹¹ Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA.
¹² Institute for Community Health Promotion, Brown University, Providence, RI, USA.
¹³ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
¹⁴ School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA.
¹⁵ Department of Psychology, University of Miami, Miami, FL, USA.

PMID: 29134422
PMCID: PMC5966340
DOI: 10.1007/s10508-017-1056-8

HIV Prevention Among Young Women in South Africa: Understanding Multiple Layers of Risk

Christina Psaros et al. Arch Sex Behav. 2018 Oct.

. 2018 Oct;47(7):1969-1982.

doi: 10.1007/s10508-017-1056-8. Epub 2017 Nov 13.

Authors

Affiliations

¹ Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. cpsaros@mgh.harvard.edu.
² Department of Psychiatry, Harvard Medical School, Boston, MA, USA. cpsaros@mgh.harvard.edu.
³ MatCH Research Unit (Maternal, Adolescent, and Child Health Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
⁴ School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
⁵ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁶ Center for Global Health and Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.
⁷ Department of Behavioral and Social Sciences and International Health Institute, Brown University School of Public Health, Providence, RI, USA.
⁸ San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.
⁹ The Fenway Institute at Fenway Health, Boston, MA, USA.
¹⁰ Department of Behavioral and Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
¹¹ Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA.
¹² Institute for Community Health Promotion, Brown University, Providence, RI, USA.
¹³ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
¹⁴ School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA.
¹⁵ Department of Psychology, University of Miami, Miami, FL, USA.

PMID: 29134422
PMCID: PMC5966340
DOI: 10.1007/s10508-017-1056-8

Abstract

Despite concerted prevention efforts, young South African women remain at the epicenter of the HIV epidemic. Although these women have grown up in a community powerfully affected by HIV, systematic investigation into how this "second generation" of HIV-affected youth navigates HIV risk is lacking. This study qualitatively explored a complex interplay of factors influencing HIV risk among young pregnant women in KwaZulu-Natal, South Africa. We conducted in-depth interviews with 35 pregnant women (22 HIV-uninfected and 13 HIV-infected) aged 18-21, 18 healthcare providers, and focus groups with 19 community stakeholders. Among the young women, HIV knowledge was high, and many reported taking some action to prevent pregnancy or HIV; however, these efforts were not routinely implemented. Themes related to HIV acquisition risk from all participants were organized using a socioecological framework and revolved around individual and developmental experiences (personal experience with HIV, perceived invincibility), family barriers (lack of adult supervision, pressure to leave school), relational barriers (lack of disclosure and partner communication, "burn out" around attempts to discuss condom use with partners, overdependence on partners), community-level barriers (township environment, lack of structured activities), and social barriers (poverty, HIV-related stigma). Some novel concepts emerged from the data, including an understanding of how overdependence on the romantic relationship may develop. Current HIV prevention efforts, including traditional HIV counseling and testing, condom distribution, and biomedical agents for HIV prevention, are unlikely to be effective without a broader, ecological up-to-date understanding of the evolving, intertwined, and complex constellation of factors that drive HIV risk behavior in this high-risk population.

Keywords: HIV risk; Interventions; Pregnancy; South Africa; Young women.

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Conflict of interest statement

Conflict of interest Psaros, Milford, Smit, Greener, Mosery, Matthews, Harrison, Gordon, Mimiaga, Bangsberg declare that they have no conflict of interest. Dr. Safren has published books and materials about Cognitive Behavioral Therapy with Oxford University Press, Guilford Publications, and Springer.

Figures

**Fig. 1**
Proposed model of HIV risk behavior

See this image and copyright information in PMC

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HIV Prevention Among Young Women in South Africa: Understanding Multiple Layers of Risk

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HIV Prevention Among Young Women in South Africa: Understanding Multiple Layers of Risk

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