Friendships Among Young South African Women, Sexual Behaviours and Connections to Sexual Partners (HPTN 068)


Friends could be influential on young women’s sexual health via influences on sexual behaviours and as connections to sexual partners, but are understudied in sub-Saharan Africa. We cross-sectionally surveyed 2326 13–20 year-old young women eligible for grades 8–11 in rural South Africa about their sexual behaviour and up to three sexual partners. Participants each described five specific but unidentified friends and the relationships between them in an ‘egocentric’ network analysis design. We used logistic regression to investigate associations between friendship characteristics and participants’ reports of ever having had sex (n = 2326) and recent condom use (n = 457). We used linear regression with random effects by participant to investigate friendship characteristics and age differences with sexual partners (n = 633 participants, 1051 partners). We found that it was common for friends to introduce young women to those who later became sexual partners, and having older friends was associated with having older sexual partners, (increase of 0.37 years per friend at least 1 year older, 95% CI 0.21–0.52, adjusted). Young women were more likely to report ever having had sex when more friends were perceived to be sexually active (adjusted OR 1.85, 95% CI 1.72–2.01 per friend) and when they discussed sex, condoms and HIV with friends. Perception of friends’ condom use was not associated with participants’ reported condom use. While this study is preliminary and unique in this population and further research should be conducted, social connections between friends and sexual partners and perceptions of friend sexual behaviours could be considered in the design of sexual health interventions for young women in South Africa.

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EF was funded with a Bloomsbury Colleges PhD studentship with fieldwork funding from the London International Development Centre. This work was supported by Award Numbers UM1 AI068619 (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center) from the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health and the National Institute on Drug Abuse of the National Institutes of Health. This work was also supported by NIMH R01 (R01MH087118) and the Carolina Population Center and its NIH Center Grant (P2C HD050924). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Elizabeth Fearon.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the London School of Hygiene and Tropical Medicine, with the original trial obtaining approval from Mpumalanga Province Health Research and Ethics Committee, the University of North Carolina Chapel Hill, the University of the Witwatersrand and the London School of Hygiene and Tropical Medicine.

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Informed consent was obtained from all individual participants included in the study aged 18 years or over at enrolment. Individuals aged under 18 years at the time of enrolment gave assent, with informed consent obtained from their parent or guardian.

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Fearon, E., Wiggins, R.D., Pettifor, A.E. et al. Friendships Among Young South African Women, Sexual Behaviours and Connections to Sexual Partners (HPTN 068). AIDS Behav 23, 1471–1483 (2019).

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  • Peer influence
  • Sexual behaviour
  • Sexual partners
  • Adolescents
  • South Africa