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Current HIV/AIDS Reports

, Volume 12, Issue 2, pp 207–215 | Cite as

Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral, and Structural Factors and Emerging Intervention Approaches

  • Abigail HarrisonEmail author
  • Christopher J. Colvin
  • Caroline Kuo
  • Alison Swartz
  • Mark Lurie
The Global Epidemic (SH Vermund, Section Editor)
Part of the following topical collections:
  1. Topical Collection on The Global Epidemic

Abstract

Young women in southern Africa experience some of the highest incidence rates of HIV infection in the world. Across southern Africa, HIV prevalence among women increases rapidly between the teenage years and young adulthood. Adult HIV prevalence is 16.8 % in South Africa, 23 % in Botswana, 23 % in Lesotho, and 26.5 % in Swaziland. Existing research has illuminated some of the key social, behavioral, and structural factors associated with young women’s disproportionate HIV risk, including gendered social norms that advantage male power in sexual relationships and age disparities in relationships between younger women and older male partners. Important structural factors include the region’s history of labor migration and legacy of family disruption, and entrenched social and economic inequalities. New interventions are emerging to address these high levels of HIV risk in the key population of young women, including structural interventions, biomedical prevention such as PrEP, and combined HIV prevention approaches.

Keywords

Women HIV infection Southern Africa Structural factors Interventions 

Notes

Acknowledgments

We gratefully acknowledge support from the Eunice Kennedy Shriver National Institute for Child Health and Development (NICHD), via R24HD077976-01.

Compliance with Ethics Guidelines

Conflict of Interest

Abigail Harrison, Christopher J. Colvin, Caroline Kuo, Alison Swartz, and Mark Lurie declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    UNAIDS. UNAIDS report on the global AIDS epidemic, 2012. Geneva: UNAIDS; 2013.Google Scholar
  2. 2.
    Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town: HSRC Press; 2014.Google Scholar
  3. 3.
    Idele P, Gillespie A, Porth T, et al. Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr. 2014;66 Suppl 2:S144–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Abdool Karim Q et al. HIV incidence in young girls in KwaZulu-Natal, South Africa—public health imperative for their inclusion in HIV biomedical intervention trials. AIDS Behav. 2012;16(7):1870–6.CrossRefPubMedGoogle Scholar
  5. 5.
  6. 6.
    Fauci, Anthony. Address to HIV research for prevention conference (R4P). Cape Town, South Africa: October 28, 2014.Google Scholar
  7. 7.
    Abdool Karim Q, Sibeko S, Baxter C. Preventing HIV infection in women: a global health imperative. Clin Infect Dis. 2010;50(S3):S122–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Laga M, Schwartlander B, Pisani E, et al. To stem HIV in Africa, prevent transmission to young women. AIDS. 2001;15(7):931–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Jones A, Cremin I, Abdullah F, et al. Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention. Lancet. 2014;384(9939):272–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Dellar RC, Dlamini S, Karim QA. Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc. 2015;18(2(Suppl 1)):19408. E-collection 2015.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Beyrer C, Baral SD, Weir B, et al. A call to action for concentrated HIV epidemics. Curr Opin HIV AIDS. 2014;9(2):95–100.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    UNAIDS. Report on the Global AIDS Epidemic, 2013. Geneva: UNAIDS; 2014.Google Scholar
  13. 13.
    Jewkes RK, Morrell R. Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc. 2010;13:6.PubMedCentralPubMedGoogle Scholar
  14. 14.
    Otwombe K, Dietrich J, Laher F, et al. Health-seeking behaviours by gender among adolescents in Soweto, South Africa. Glob Health Action. 2015;8:26080. Ecollection 2015.Google Scholar
  15. 15.
    Stirling M, Rees H, Kasedde S et al. Introduction: addressing the vulnerability of young women and girls to stop the HIV epidemic in southern Africa. AIDS. 2008;22 Suppl 4:S1–S3.Google Scholar
  16. 16.
    Dunkle KL, Jewkes RK, Brown HC, et al. Gender-based violence, relationship power, and risk of prevalent HIV infection among women attending antenatal clinics in Soweto, South Africa. Lancet. 2004;363:1415–21.CrossRefPubMedGoogle Scholar
  17. 17.
    Harrison A, Cleland J, Frohlich J. Young people’s sexual partnerships in KwaZulu/Natal, South Africa: patterns, contextual influences, and HIV risk. Stud Fam Plan. 2008;39(4):295–308.CrossRefGoogle Scholar
  18. 18.
    Harling G, Newell ML, Tanser F, et al. Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa. JAIDS. 2014;66(4):443–51.PubMedGoogle Scholar
  19. 19.
    Toska E, Cluver C, Boyes M, Panetlic M, Kuo C. From “sugar daddies” to “sugar babies”: exploring a pathway between age-disparate sexual relationships, condom use, and adolescent pregnancy in South Africa. Sex Health. 2015. doi: 10.1071/SH14089.PubMedGoogle Scholar
  20. 20.
    LeClerc-Madlala S. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. AIDS. 2008;22(S4):S17–26.CrossRefPubMedGoogle Scholar
  21. 21.
    Kacanek D, Bostrom A, Montgomery ET, et al. Intimate partner violence and condom and diaphragm non-adherence among women in an HIV prevention trial in southern Africa. J Acquir Immune Defic Syndr. 2013;64(4):400–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Luke N. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plan. 2003;34(2):67–86.CrossRefGoogle Scholar
  23. 23.
    Dunkle KL, Jewkes R, Nduna M, Jama N, Levin J, Sikweyiya Y, et al. Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence. Soc Sci Med. 2007;65(6):1235–48.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Andersson N, Cockcroft A, Shea B. Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa. AIDS. 2008;22 suppl 4:S73–86.CrossRefPubMedGoogle Scholar
  25. 25.
    Hatcher AM, Woollett N, Pallitto CC, et al. Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother-to-child transmission. J Int AIDS Soc. 2014;17:19233.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Shannon K, Leiter K, Phaladze N, et al. Gender inequity norms are associated with increased male-perpetrated rape and sexual risks for HIV infection in Botswana and Swaziland. PLoS One. 2012;7(1):e28739.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Petersen I, Bhana A, McKay M. Sexual violence and youth in South Africa: the need for community-based prevention interventions. Child Abuse Negl. 2005;29(11):1233–48.CrossRefPubMedGoogle Scholar
  28. 28.
    Matzopoulos R, Bowman B, Mathews S, Myers J. Applying upstream interventions for interpersonal violence prevention: an uphill struggle in low- to middle-income contexts. Health Policy. 2010;97(1):62–70.CrossRefPubMedGoogle Scholar
  29. 29.••
    World Health Organization. Health for the world’s adolescents: a second chance in the second decade. Geneva: WHO, 2014. This seminal report lays the groundwork for the next generation of adolescent research and programs across health sectors, including HIV/AIDS. It offers an integrated online tool for researchers and practitioners, through a linked web-based interface connecting up-to-date global research, statistics and policy documents in one place. A CD-ROM version is available for use in less-resourced settings. Google Scholar
  30. 30.
    Doyle AM, Mavedzenge SN, Plummer ML, Ross DA. The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveys. Trop Med Int Health. 2012;17(7):796–807.CrossRefPubMedGoogle Scholar
  31. 31.
    Chersich MF, Rees H. Vulnerability of women in southern Africa to infection with HIV: biological determinants and priority health sector interventions. AIDS. 2008;22(S4):S27–40.CrossRefPubMedGoogle Scholar
  32. 32.
    Patel V, Flisher A, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369:1302–13.CrossRefPubMedGoogle Scholar
  33. 33.
    Myer L, Stein DJ, Grimsrud AT, Herman A, Seedat S, et al. DSM-IV- defined common mental disorders: association with HIV testing, HIV-related fears, perceived risk and preventive behaviours among South African adults. S Afr Med J. 2009;99:396–402.PubMedCentralPubMedGoogle Scholar
  34. 34.
    Eaton L, Flisher AJ, Aaro LE. Unsafe sexual behaviour in South African youth. Soc Sci Med. 2003;56(1):149–65.CrossRefPubMedGoogle Scholar
  35. 35.
    Harrison A, Newell ML, Imrie J, Hoddinott G. HIV prevention for South African youth: which interventions work? A systematic review of current evidence. BMC Public Health. 2010;10:102.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Dietrich J, Sikkema K, Otwombe K, et al. Multiple levels of influence in predicting sexual activity and condom use among adolescents in Soweto, Johannesburg, South Africa. J HIV/AIDS Soc Serv. 2013;12(3–4):404–23.CrossRefGoogle Scholar
  37. 37.
    Michielsen K, Chersich MF, Luchters S, DeKoker P, Van Rossem R, Temmerman M. Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials. AIDS. 2010;24:1193–202.CrossRefPubMedGoogle Scholar
  38. 38.
    Thurston IB, Dietrich J, Bogart LM, et al. Correlates of sexual risk among sexual minority and heterosexual South African youths. Am J Public Health. 2014;104(7):1265–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Smith J, Nyamukapa C, Gregson S. The distribution of sex acts and condom use within partnerships in a rural sub-Saharan African population. PLoS One. 2014;9(2):e88378.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Heeren GA, Jemmott III JB, Mandeya A, Tyler JC. Theory-based predictors of condom use among university students in the United States and South Africa. AIDS Educ Prev. 2007;19(1):1–12.CrossRefPubMedGoogle Scholar
  41. 41.
    Moyo W, Levandowski B, MacPhail C, et al. Consistent condom use in South African youth’s most recent sexual relationships. AIDS Behav. 2008;12(3):431–40.CrossRefPubMedGoogle Scholar
  42. 42.
    Chirinda W, Peltzer K. Correlates of inconsistent condom use among youth aged 18–24 years in South Africa. J Child Adolesc Mental Health. 2014;26(1):75–82.CrossRefGoogle Scholar
  43. 43.
    Church K, Wringe A, Fakudze I, et al. Reliance on condoms for contraceptive protection among HIV care and treatment clients: a mixed methods study on contraceptive choice and motivation within a generalised epidemic. Sex Trans Inf. 2014;90(5):394–400.CrossRefGoogle Scholar
  44. 44.
    Marlow HM, Maman S, Groves AK, Moodley D. Fertility intent and contraceptive decision-making among HIV positive and negative antenatal clinic attendees in Durban, South Africa. Health Care Women Int. 2012;33(4):342–58.CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Pitpitan EV, Kalichman SC, Cain D. Condom negotiation, HIV testing, and HIV risks among women from alcohol serving venues in Cape Town, South Africa. PloS One. 2012;7(10):e45631.CrossRefPubMedCentralPubMedGoogle Scholar
  46. 46.
    Russell BS, Eaton LA, Petersen-Williams P. Intersecting epidemics among pregnant women: alcohol use, interpersonal violence, and HIV infection in South Africa. Curr HIV/AIDS Rep. 2013;10(1):103–10.CrossRefPubMedCentralPubMedGoogle Scholar
  47. 47.
    Abler L, Sikkema KJ, Watt MH, et al. traumatic stress and the mediating role of alcohol use on HIV-related sexual risk behavior: results from a longitudinal cohort of South African women who attend alcohol-serving venues. J Acquir Immune Defic Syndr. 2015;68(3):322–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Moreno R, Nababan HY, Ota E, et al. Structural and community-level interventions for increasing condom use to prevent the transmission of HIV and other sexually transmitted infections. Cochrane Database Syst Rev. 2014;7, CD003363.PubMedGoogle Scholar
  49. 49.
    South African National AIDS Commission (SANAC). Global AIDS response progress report. Pretoria: Republic of South Africa; 2012.Google Scholar
  50. 50.
    MacPhail CL, Pettifor A, Coates TJ, Rees H. “You must do the test to know your status”: attitudes to HIV voluntary counseling and testing for adolescents among South African youth and parents. Health Educ Behav. 2008;35(1):87–104.CrossRefPubMedGoogle Scholar
  51. 51.
    Denison J, McCauley AP, Dunnett-Dagg WA, et al. HIV testing among adolescents in Ndola, Zambia: how individual, relational and environmental factors relate to demand. AIDS Educ Prev. 2009;21(4):314–24.CrossRefPubMedGoogle Scholar
  52. 52.
    Ramirez-Avila L, Nixon K, Noubary F, et al. Routine HIV testing in adolescents and young adults presenting to an outpatient clinic in Durban, South Africa. PLoS One. 2012;7(9):e45507.CrossRefPubMedCentralPubMedGoogle Scholar
  53. 53.
    Christofides NJ, Jewkes RK, Dunkle KL, et al. Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women. Glob Health Action. 2014;7:23719. eCollection 2014.PubMedGoogle Scholar
  54. 54.
    Abdool Karim Q, Kharsany AB, Leask K, et al. Prevalence of HIV, HSV-2 and pregnancy among high school students in rural KwaZulu-Natal, South Africa: a bio-behavioural cross-sectional survey. Sex Trans Inf. 2014;90(8):620–6.CrossRefGoogle Scholar
  55. 55.
    Department of Health, Medical Research Council, ORC/Macro. South African demographic and health survey, 2003. Pretoria: Department of Health; 2007.Google Scholar
  56. 56.•
    Christofides NJ, Jewkes RK, Dunkle KL et al. Early adolescent pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: a longitudinal study. J Int AIDS Soc 2014; 17(1):18585. This is the first study to demonstrate causality between adolescent pregnancy and risk of HIV infection; in this longitudinal analysis, early pregnancy is associated with acquisition of HIV infection in the later teen years. Google Scholar
  57. 57.
    Department of Health, Republic of South Africa. National HIV sero-prevalence survey of women attending public antenatal clinics in South Africa, 2012. Summary Report. Pretoria: Department of Health; 2013.Google Scholar
  58. 58.
    Reid SE, Dai JY, Wang J, et al. Pregnancy, contraceptive use, and HIV acquisition in HPTN 039: relevance for HIV prevention trials among African women. J Acquir Immune Defic Syndr. 2010;53(5):606–13.PubMedCentralPubMedGoogle Scholar
  59. 59.
    Wilcher R, Petruney T, Reynolds HW, Cates W. From effectiveness to impact: contraception as an HIV prevention intervention. Sex Transm Infect. 2008;84 Suppl 2:ii54–60.CrossRefPubMedGoogle Scholar
  60. 60.•
    Raifman J, Chetty T, Tanser F, et al. Preventing unintended pregnancy and HIV transmission: effects of the HIV treatment cascade on contraceptive use and choice in rural KwaZulu-Natal. J Acquir Immune Defic Syndr. 2014;67 Suppl 4:S218–27. This paper demonstrates the positive effects of women’s participation in HIV treatment on contraceptive use and dual protection, suggesting overall benefit to women’s health – and reproductive health particularly – from awareness of HIV status and continuation of HIV treatment over time.CrossRefPubMedCentralPubMedGoogle Scholar
  61. 61.
    MacPhail C et al. Contraception use and pregnancy among 15–24 year old South African women: a nationally representative cross-sectional survey. BMC Med. 2007;5:31.CrossRefPubMedCentralPubMedGoogle Scholar
  62. 62.
    Mack N, Evens EM, Tolley EE, et al. The importance of choice in the rollout of ARV-based prevention to user groups in Kenya andSouth Africa: a qualitative study. J Int AIDS Soc. 2014;17(3 Suppl 2):19157.PubMedCentralPubMedGoogle Scholar
  63. 63.
    Baeten JM, Benki S, Chohan V, et al. Hormonal contraceptive use, herpes simplex virus infection, and risk of HIV-1 acquisition among Kenyan women. AIDS. 2007;21(13):1771–7.CrossRefPubMedGoogle Scholar
  64. 64.
    Morrison CS, Richardson BA, Mmiro F, et al. Hormonal contraception and the risk of HIV acquisition. AIDS. 2007;21(1):85–95.CrossRefPubMedGoogle Scholar
  65. 65.
    Kleinschmidt I, Rees H, Delany S, et al. Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort. Contraception. 2007;75(6):461–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Polis CB, Phillips SJ, Curtis KM, et al. Hormonal contraceptive methods and risk of HIV acquisition in women: a systematic review of epidemiological evidence. Contraception. 2014;90(4):360–90.CrossRefPubMedGoogle Scholar
  67. 67.•
    Ralph LJ, McCoy SI, Shiu K, Padian NS. Does hormonal contraceptive use increase women's risk of HIV acquisition? A meta-analysis of observational studies. Lancet Infect Dis. 2014;15(2):181–9. This paper extends the current scientific debate regarding linkages between hormonal contraceptive use and HIV acquisition risk, through a meta-analysis of available data.CrossRefGoogle Scholar
  68. 68.
    Stringer EM, Kaseba C, Levy J, Sinkala M, Goldenberg RL, Chi BH, et al. A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol. 2007;19(2):144.e1–8.Google Scholar
  69. 69.
    Hofmeyr GJ, Singata M, Sneden J. Hormonal contraception for women exposed to HIV infection. Cochrane Database Syst Rev. 2014;5, CD009741. doi: 10.1002/14651858.CD009741.pub2.PubMedGoogle Scholar
  70. 70.
    Sarnquist CC, Rahangdale L, Maldonado Y. Reproductive health and family planning needs among HIV-infected women in Sub-Saharan Africa. Curr HIV Res. 2013;11(2):160–8. Review. PubMed.CrossRefPubMedGoogle Scholar
  71. 71.
    Delvaux T, Buvé A. Hormonal contraception and HIV acquisition—what is the evidence? What are the policy and operational implications? Eur J Contracept Reprod Health Care. 2013;18(1):15–26. doi: 10.3109/13625187.2012.744819. Review. PubMed.CrossRefPubMedGoogle Scholar
  72. 72.
    Marks S. An epidemic waiting to happen? The spread of HIV/AIDS in South Africa in social and historical perspective. Afr Stud. 2002;61(1):13–26.CrossRefGoogle Scholar
  73. 73.
    Budlender D, Lund F. South Africa: a legacy of family disruption. Dev Chang. 2011;42(4):925–46.CrossRefGoogle Scholar
  74. 74.
    Naidoo K, Matsie R, Ochse A. ‘Resting’, AIDS-affliction and marital constraints: engendered livelihood issues in the aftermath of Lesotho mineworker retrenchments. Dev South Afr. 2011; 28(5):681–689.Google Scholar
  75. 75.
    Murray C. Families divided: the impact of labour in Lesotho, ed. In: Dunn J, Lonsdale JM, Newberry DMG, Robertson AF, editors. Cambridge: Cambridge University Press, 1981.Google Scholar
  76. 76.
    Lurie MN, Williams BG, Zuma K, et al. The impact of migration on HIV-1 transmission in South Africa: a study of migrant and non-migrant men and their partners. Sex Transm Dis. 2003;30(2):149–56.CrossRefPubMedGoogle Scholar
  77. 77.
    Weine SM, Kashuba AB. Labor migration and HIV risk: a systematic review of the literature. AIDS Behav. 2012;16(6):1605–21.CrossRefPubMedCentralPubMedGoogle Scholar
  78. 78.
    Camlin CS, Hosegood V, Newell ML, et al. Gender, migration and HIV in rural KwaZulu-Natal, South Africa. PLoS One. 2010;5(7):e11539.CrossRefPubMedCentralPubMedGoogle Scholar
  79. 79.
    Mayosi BM, Lawn JE, van Niekerk A, et al. Health in South Africa: changes and challenges since 2009. Lancet. 2012;380(9858):2029–43.CrossRefPubMedGoogle Scholar
  80. 80.
    Hunter M. The changing political economy of sex in South Africa: the significance of unemployment and inequalities to the scale of the AIDS pandemic. Soc Sci Med. 2007;64(3):689–700.CrossRefPubMedGoogle Scholar
  81. 81.
    Bongaarts J. Late marriage and the HIV epidemic in sub-Saharan Africa. Popul Stud. 2007;61(1):73–83.CrossRefGoogle Scholar
  82. 82.
    Hosegood V, McGrath N, Moultrie TA. Dispensing with marriage: Marital and partnership trends in rural KwaZulu-Natal, South Africa 2000–2006. Demogr Res. 2009;20(13):279–312.CrossRefPubMedCentralPubMedGoogle Scholar
  83. 83.
    Harrison A, O’Sullivan LF. In the Absence of marriage: long-term concurrent partnerships, pregnancy and HIV Risk dynamics among young adult South Africans. AIDS Behav. 2010;14(5):991–1000.CrossRefPubMedGoogle Scholar
  84. 84.
    Harrison A, Short S, Tuoane M. Re-focusing the gender lens: caregiving women, family roles and HIV/AIDS vulnerability in Lesotho. AIDS Behav. 2014;18(3):595–604.CrossRefPubMedCentralPubMedGoogle Scholar
  85. 85.
    Hosegood V, Preston-Whyte E, Busza J, Moitse S, Timaeus IM. Revealing the full extent of households’ experiences of HIV and AIDS in rural South Africa. Soc Sci Med. 2007;65(6):1249–59.CrossRefPubMedCentralPubMedGoogle Scholar
  86. 86.
    Sherr L, Cluver LD, Betancourt TS, et al. Evidence of impact: health, psychological and social effects of adult HIV on children. AIDS 2014;28 Suppl 3: S251-9.Google Scholar
  87. 87.
    Cluver L, Boyes M, Orkin M, et al. Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: a propensity-score-matched case–control study. Lancet Glob Health. 2013;1(6):e362–70.CrossRefPubMedGoogle Scholar
  88. 88.
    Young L, Ansell N. Fluid households, complex families: the impacts of children’s migration as a response to HIV/AIDS in Southern Africa. Prof Geogr. 2003;55(4):464–76.CrossRefGoogle Scholar
  89. 89.
    Cluver L, Orkin M, Boyes M, et al. Transactional sex amongst AIDS-Orphaned and AIDS-affected adolescents predicted by abuse and extreme poverty. J Acquir Immune Defic Syndr. 2011;58(3):336–43.CrossRefPubMedGoogle Scholar
  90. 90.
    Kim JC, Watts C. Gaining a foothold: tackling poverty, gender inequality, and HIV in Africa. Br Med J. 2005;331:769–72.CrossRefGoogle Scholar
  91. 91.
    Rao Gupta G, Parkhurst JO, Ogden JA, et al. Structural approaches to HIV prevention. Lancet. 2008;372:764–5.CrossRefGoogle Scholar
  92. 92.••
    Strathdee SJ, Wechsberg WM, Kerrigan DL, Patterson TL. HIV prevention among women in low- and middle-income countries: intervening upon contexts of heightened HIV risk. Annu Rev Public Health. 2013;34:301–16. This review paper outlines the need for interventions targeting the most vulnerable women, and the importance of contextual interventions in combination with proven individual level approaches such as condom promotion and STI treatment.CrossRefPubMedGoogle Scholar
  93. 93.
    Gibbs A, Willan S, Misselhorn A, Mangoma A. Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people. J Int AIDS Soc. 2012;15(3 Suppl 1):17362.PubMedCentralGoogle Scholar
  94. 94.
    Jewkes R, Wood K, Duvvury N. ‘I woke up after I joined Stepping Stones’: meanings of an HIV behavioural intervention in rural South African young people’s lives. Health Educ Res. 2010;25(6):1074–84.CrossRefPubMedCentralPubMedGoogle Scholar
  95. 95.
    Ross DA, Changalucha J, Obasi AIN, et al. Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial. AIDS. 2007;21:1943–55.CrossRefPubMedGoogle Scholar
  96. 96.
    Cowan FM, Pascoe SJ, Langhaug LF, et al. The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth. AIDS. 2010;24(16):2541–52.CrossRefPubMedCentralPubMedGoogle Scholar
  97. 97.
    Mathews C, Aarø LE, Grimsrud A, et al. Effects of the SATZ teacher-led school HIV prevention programmes on adolescent sexual behaviour: cluster randomised controlled trials in three sub-Saharan African sites. Int Health (RSTMH). 2012;4(2):111–22.CrossRefGoogle Scholar
  98. 98.
    Ehrhardt AA, Sawires S, McGovern T, et al. Gender, empowerment, and health: what is it? How does it work? J Acquir Immune Defic Syndr. 2009;51 Suppl 3:S96–S105.CrossRefPubMedCentralPubMedGoogle Scholar
  99. 99.
    Dworkin SL, Hatcher AM, Colvin C, Peacock D. Impact of a gender-transformative HIV and antiviolence program on gender ideologies and masculinities in two rural, South African communities. Men Masc 2013;16(2):181–202.Google Scholar
  100. 100.
    Wingood GM, Reddy P, Lang DL, et al. Efficacy of SISTA South Africa on sexual behavior and relationship control among isiXhosa women in South Africa: results of a randomized controlled trial. J Acquir Immune Defic Syndr. 2013;63 Suppl 1:S59–65.CrossRefPubMedCentralPubMedGoogle Scholar
  101. 101.
    Obiero J, Mwethera PG, Hussey GD, Wiysonge CS. Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis. BMC Infect Dis. 2012;12:289.CrossRefPubMedCentralPubMedGoogle Scholar
  102. 102.
    Abdool Karim Q, Abdool Karim SS, Frohlich J, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329:1168–74.CrossRefPubMedCentralPubMedGoogle Scholar
  103. 103.
    Amico KR, Mansoor LE, Corneli A, et al. Adherence support approaches in biomedical HIV prevention trials: experiences, insights and future directions from four multisite prevention trials. AIDS Behav. 2013;17(6):2143–55.CrossRefPubMedCentralPubMedGoogle Scholar
  104. 104.
    van der Straten A, Stadler J, Montgomery E, et al. Women's experiences with oral and vaginal pre-exposure prophylaxis: the VOICE-C qualitative study in Johannesburg, South Africa. PLoS One. 2014;9(2):e89118.CrossRefPubMedCentralPubMedGoogle Scholar
  105. 105.
    CONRAD. FACTS 001 Results: HIV prevention study does not confirm pericoital tenofovir gel effectiveness: protection observed in small group of women who used the product consistently. Seattle WA: Presentation at CROI, February 24, 2015. www.conrad.org.
  106. 106.••
    Coates TJ. An expanded behavioral paradigm for prevention and treatment of HIV-1 infection. J Acquir Immune Defic Syndr. 2013;63:SI79–182. An important paper outlining a new approach to HIV prevention and treatment, based on integrated use of biomedical and behavioral interventions; argues for a new biobehavioral paradigm for HIV prevention and treatment.CrossRefGoogle Scholar
  107. 107.••
    Baird SJ, Garfein RS, McIntosh CT, Ozler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012;379(9823):1320–9. This influential paper offers the first RCT evidence for impact of a cash transfer intervention targeting girls’ schooling on biological outcomes related to HIV prevention.CrossRefPubMedGoogle Scholar
  108. 108.
    MacPhail C, Adato M, Kahn K, et al. Acceptability and feasibility of cash transfers for HIV prevention among adolescent South African women. AIDS Behav. 2013;17(7):2301–12.CrossRefPubMedCentralPubMedGoogle Scholar
  109. 109.
    de Walque D, Dow WH, Nathan R, et al. Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania. BMJ Open. 2012;2:e000747.CrossRefPubMedCentralPubMedGoogle Scholar
  110. 110.
    Pronyk PM, Kim JC, Abramsky T, et al. Combined microfinance and training intervention can reduce HIV risk behaviour in young female participants. AIDS. 2008;22:1659–66.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Abigail Harrison
    • 1
    Email author
  • Christopher J. Colvin
    • 2
  • Caroline Kuo
    • 1
    • 3
  • Alison Swartz
    • 2
  • Mark Lurie
    • 4
  1. 1.Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceUSA
  2. 2.Division of Social and Behavioral SciencesUniversity of Cape Town School of Public Health and Family MedicineCape TownSouth Africa
  3. 3.Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
  4. 4.Department of EpidemiologyBrown University School of Public HealthProvidenceUSA

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