Journal Article

Persistently high incidence of HIV and poor service uptake in adolescent girls and young women in rural KwaZulu-Natal, South Africa prior to DREAMS

Chimbindi, Natsayi, Shahmanesh, Maryam, Floyd, Sian, Seeley, Janet, Mutevedzi, Tinofa, Fenty, Justin, Zuma, Thembelihle, Pillay, Deenan, Gareta, Dickman, Baisley, Kathy, Birdthistle, Isolde, Dreyer, Jaco, Herbst, Kobus, McGrath, Nuala, Smit, Theresa, Mthiyane, Nondumiso

2018

Overview

Adolescent girls and young women (AGYW) bear the brunt of the HIV epidemic in South Africa. 'DREAMS' aims to reduce HIV incidence through multi-level combination prevention. We describe HIV incidence and uptake of HIV and sexual reproductive health (SRH) by AGYW in KwaZulu-Natal (KZN), prior to DREAMS. Longitudinal and cross-sectional analysis of women (15-24 year old) in a population-based HIV incidence cohort within a demographic surveillance site in KZN. Observation time for HIV incidence was person-years at risk while resident. \"Current use of contraceptives\" and \"having an HIV test in the past 12 months\" was compared between 2011 and 2015. In 2015, HIV prevalence was 11.0% and 34.1% and HIV incidence (2011-2015) was 4.54% (95%CI:3.89-5.30) and 7.45% (95%CI:6.51-8.51) per year in 15-19 and 20-24 year olds respectively, with no significant decline compared to 2006-2010. In 2015, 90.7% of 20-24-year-olds were unemployed, 36.4% and 51.7% of 15-19 and 20-24 year olds reported recent migration; 20.9% and 72.6% of 15-19 and 20-24 year olds had ever been pregnant. In 2015, less than 50% reported condom-use at last sex, 15.0% of 15-19 year olds and 48.9% of 20-24 year olds were currently using contraception and 32.0% and 66.7% of 15-19 and 20-24 year olds had tested for HIV in the past 12 months. There had been no improvement compared to 2011. Factors associated with AGYW testing for HIV in the past 12 months were, survey year-2011 more likely than 2015 (aOR = 0.50), number of partners (aOR = 3.25), ever been pregnant (aOR = 2.47) and knowing where to find ART (aOR = 1.54). Factors associated with contraception use were being older (aOR = 4.83); ever been pregnant (aOR = 12.62); knowing where to get ART (aOR = 1.79) and having had an HIV test in past 12 months (aOR = 1.74). Prior to DREAMS, HIV incidence in AGYW was high. HIV and SRH service uptake did not improve and was suboptimal. Findings highlight the need for combination HIV prevention programmes for AGYW in this economically vulnerable area.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adolescent / Adolescents / Adult / AIDS / Antiretroviral agents / Antiretroviral therapy / Biology and Life Sciences / Contraception / Contraceptives / Demographics / Disease prevention / Dosage and administration / Drug therapy / Epidemics / Female / Gender differences / Girls / Health aspects / Health care / Health risks / Health services / HIV / HIV - pathogenicity / HIV infections / HIV Infections - drug therapy / HIV Infections - epidemiology / HIV Infections - pathology / HIV Infections - virology / HIV tests / Households / Human immunodeficiency virus / Humans / Hygiene / Incidence / Information systems / Male / Medical research / Medical tests / Medicine / Medicine and Health Sciences / Migration / Patient satisfaction / People and Places / Planning / Population / Pregnancy / Prevention / Reproductive health / Risk Factors / Rural areas / Rural Population / Sexual Behavior / Sexual health / Sexual Partners / Sexually transmitted diseases / Social aspects / South Africa - epidemiology / STD / Teenage girls / Teenagers / Wellness programs / Womens health / Young Adult / Young adults