Table 1 Drivers of risk and barriers to effective uptake of multi-level HIV prevention for adolescents and young adults in rural KZN drawn from survey data (n = 4918) and studies conducted 2016–2018 [1, 6, 8, 37, 40, 43,44,45,46,47,48,49, 51,52,53,54,55,56]
Unmet need and challenges | Consequences of unmet need |
|---|---|
Social vulnerability of youth | • High unemployment (85% of school-leavers are unemployed) |
• Migration (30% moved location in past year) | |
• Transactional sex (13% in past year) | |
Sexual health needs | • 20% of women and 10% of men had a curable STI. |
• 75% of these reporting no symptoms, | |
• 40% of the women had bacterial vaginosis. | |
• Home-based self-sampling and treatment for STIs was acceptable and desirable to young people | |
• Teenage pregnancy levels are persistently high, with an annual incidence of teenage pregnancy of 6.4% (5.7–8.6) (unpublished data) | |
• The majority of young women 15–24 start contraception after their first pregnancy. | |
• Poor sexual health and knowledge despite the importance of fertility | |
Unmet mental health needs | • High levels of common mental disorders (CMD) which increase with age (rising to 32% of those aged 20–22). |
Challenges to uptake of HIV prevention interventions | • Multiple service providers |
• Increasing uptake of community-based interventions (social asset building; community mobilisation and parenting programmes) over the 2 year period | |
• Less success in reaching older adolescents, those out of school, and those who move | |
• Young boys felt excluded – apart from Voluntary Medical Male Circumcision. | |
• Limited uptake of regular HIV testing – despite over 94% knowing where to get ART and wide-spread availability of free point of care HIV testing, < 50% of 15–24-year olds tested for HIV within the previous 12 months, with pregnancy being the strongest predictor of HIV-testing in women. | |
• Poor uptake of HIV care: < 20% of men aged 15–30 who tested positive linked to care. | |
• Social costs (time and cost of travel, waiting times, stigma and attitude of health care providers to adolescent sexuality) of HIV testing and care outweighing any perceived benefits. | |
Sources of youth resilience | • Access to good sexual and reproductive health information |
• Supportive network of peers, schools, and family members | |
• Social cohesion that support hope, a sense of belonging and altruism | |
• Interventions that were consistent and re-enforced existing cultural and social norms |