Young women, their male partners and HIV – how relationships vary across settings
New research comparing partners of adolescent girls and young women in Kenya and South Africa reveals important differences between settings – giving further evidence for the need to contextualise HIV responses.
It’s common for adolescent girls and young women across sub-Saharan Africa to have relationship with men who are older than them, a practice which is a known driver of HIV in this group.
For this reason, it’s really important to know who these men are and their sexual behaviours.
In a study published in PLOS ONE, researchers compared population data from a site in South Africa and three sites in Kenya, in an attempt to understand the differences in the profiles of the sexual partners of adolescent girls and young women aged 15 to 24 in these areas.
What they found was that the characteristics of the male partners of these young women are not all the same, and therefore, interventions to prevent HIV in young women need to be tailored to specific settings.
Although older male partners were common across all settings, specific age differences varied, as well as the percentage of women and girls who reported casual relationships, as opposed to spousal or regular partners.
The data in Kenya came from Korogocho and Viwandani, two settlements in the capital Nairobi, and from Gem, a rural area in the south west of the country. In South Africa, data came from uMkhanyakude in KwaZulu-Natal province, an area where around two-thirds of the population are rural.
All three areas have a high HIV prevalence, with adolescent girls and young women disproportionately affected. For example, in uMkhanyakude, 11% of adolescent girls aged 15 to 19 were living with HIV, compared to 7% of males of the same age.
The large majority of adolescent girls and young women across all sites reported having older male partners – in excess of 67%. However, age disparity varied between the areas. For example, 91% of 15 to 19 year old females in uMkhanyakude reported having a male partner under the age of 25, compared to 86% in Nairobi and 74.6% in Gem.
The difference between areas was more pronounced when it came to the age of the male partner in young women aged 20 to 24. In Gem, 23% of male partners were under 25 years, compared to 45% in uMkhanyakude and 69% in Nairobi.
Male partners in Gem were more likely to be described as ‘spousal’ or ‘regular’, whereas in uMkhanyakude, both adolescent girls and young women and their male partners were more likely to report non-spousal and casual partners. These reporting patterns are likely to reflect the social context; marriage is much rarer in uMkhanyakude compared to Gem.
In the Kenyan settings, between 25% and 29% of men reported having two or more sexual partnerships with adolescent girls and young women in the past 12 months, much higher levels than in uMkhanyakude. Concurrent partnerships were also higher in Kenya, reported by 16% of male partners in Gem, compared to 3 to 4% in uMkhanyakude.
Few women in Gem and uMkhanyakude reported having multiple, non-overlapping partners (at 0.7% and 0.1%, respectively), whereas this proportion was significantly higher in Nairobi at 16%.
Two-thirds of male partners in Gem reported testing for HIV in the past six months and under half in uMkhanyakude reported testing for HIV in the past year, well short of national targets. Almost all male partners in Nairobi (96%) were circumcised, compared to 44.9% in Gem and 43.3% in uMkhanyakude.
The research was conducted to establish a baseline for the DREAMS (Determined Resilient Empowered AIDS-free, Mentored and Safe) Programme, which aims to reduce HIV among adolescent girls and young women and is now being rolled out in each area.
It provides yet more evidence of the need for HIV prevention programmes that are designed to address the specific context in which they operate.
It also confirms that encouraging men aged 15 to 34 – and particularly those aged 20 to 29, to reduce their multiple and concurrent partners, get tested and circumcised – will likely reduce the risk of HIV infection among both adolescent and young women and adult men.
However, as the study found many men left the area in which they live in order to work, this important mobile population must be targeted in order for efforts to break the cycle of HIV transmission to have their greatest impact.