Sexual partner type and risk of incident HIV infection among adolescent girls and young women in rural South Africa Public Deposited

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  • March 20, 2019
Creator
  • Nguyen, Nadia
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Adolescent girls and young women (AGYW) in South Africa face an unparalleled HIV burden and are a key population in need of intervention. Sexual partners play a critical role in HIV transmission by exposing young women to HIV and by encouraging risk behaviors that increase the risk of infection. However, sexual partners have not been well characterized, and approaches that use pre-specified labels to categorize partners into main versus casual types may not capture important differences between sexual partner types that increase AGYW’s risk of HIV infection. Thus, the overall goal of this dissertation was to develop a better understanding of the different types of sexual partners among AGYW in rural South Africa, identify which partner types pose the greatest risk for HIV infection among AGYW, and identify AGYW-level risk factors which predict partner selection. We followed 1034 AGYW enrolled in a randomized controlled trial in South Africa and used latent class analysis (LCA) to identify sexual partner types based on reported partner sociodemographic and behavioral risk factors from 2968 reported partners over three years of follow up. We identified six, distinct sexual partner types, which differed by age, school enrollment, concurrency, condom use, transactional sex, perceived HIV-status, and other risk factors. AGYW applied the label main partner/boyfriend broadly to describe a wide variety of partner types identified by LCA. Partner types identified by LCA strongly predicted incident HIV infection among AGYW, while partner types based on pre-specified labels were not significantly associated with HIV infection. AGYW who were not enrolled in school, reported high risk sexual behaviors (young age at first sex and multiple sexual partners in the past year), and reported substance use were more likely to select high risk sexual partners associated with increased risk of HIV infection compared to AGYW who did not report these behaviors. These results highlight the limitations of the main versus casual distinction as a proxy measure for other sociodemographic and behavioral differences between partners. Partner types based on explicit, reported partner characteristics offer an alternative model for measuring and targeting specific partner types for HIV research and intervention.
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  • In Copyright
Advisor
  • Green-Howard, Annie
  • Pettifor, Audrey
  • Miller, William
  • Powers, Kimberly
  • Halpern, Carolyn
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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