Continuing Medical Education

Abstract

November 2015, Vol. 105, No. 11 Despite huge improvements in access to antiretroviral therapy (ART) and an overall decline in HIV incidence in South Africa (SA), young women (15 24 years) remain uniquely vulnerable to infection. They contribute about a quarter of all new HIV infections occurring in SA and are thus key to epidemic control. Understanding and responding to the risk they face is a public health imperative. Many studies have sought to characterise factors associated with higher vulnerability to HIV in young women. Together, these studies paint a picture of an amplifying cycle of risk for many young South Africans. Typically, this cycle is founded in poor socioeconomic backgrounds that drive engagement in high-risk sexual behaviours and expose young women to risks of sexual abuse, sexually transmitted infections (STIs) and pregnancy. Directly and indirectly, all these experiences have substantial implications for the odds of young women acquiring HIV. Those at greatest risk can be identified and prioritised by healthcare workers as being from unstable or child-headed households, not being in school, engaging in transactional sex, being victims of gender-based violence and/or having a history of pregnancy or STIs. Despite the current lack of biological technologies available to reduce HIV acquisition risk in young women, healthcare workers may have a substantive impact on young women’s lives at the individual level by helping them to break out of the cycles of vulnerability they face. Ensuring that young people receive the full available social and financial support they are eligible for via governmental and non-governmental organisations is an important first step, especially considering the many structural factors that drive high-risk behaviours in this key population. Healthcare workers can also provide reliable information on sexual and reproductive health. Importantly, such counselling should be tailored to the individual recipient and aim to include discussions about healthy relationships and female genital cleaning practices in addition to the more standard risk-reduction curriculum. Providing access to STI screening, STI treatment, and family planning services is key. Critical to all these healthcare worker-initiated strategies is an environment in which young people feel comfortable: a nonjudgemental, non-stigmatising, confidential service. Clinics in high HIV-prevalence areas might consider developing specially trained youth-friendly teams that serve clinics at specific hours suited to young people. Furthermore, in rural communities, mobile treatment and education services could reach more isolated young women. Healthcare worker cognizance of the real-life context of the lives of young women is vital to assisting them in reducing their HIV risk and supporting the public health goals of epidemic control.