The high HIV incidence among adolescent girls and young women in sub-Saharan Africa has been associated with a range of individual, social, and structural risk factors. Perceived risk of HIV is a key element in the uptake of prevention programming; an understanding of the association between HIV risk factors and perceived risk in a vulnerable group can inform intervention planning and targeting.
Adolescent girls and young women 15-24 years old were recruited from four government-run health clinics in Lilongwe, Malawi to participate in a study evaluating four models of HIV service delivery. They completed a baseline survey assessing risk factors, and if HIV-uninfected or HIV-unknown, their risk perception. Risk perception was elicited by assessing lifetime chances of acquiring HIV with three possible responses: ‘no chance’, ‘small chance’, or ‘high chance’. This variable was then dichotomized for analysis into ‘any chance’ or ‘no chance’. We analyzed associations between risk perception and five HIV risk factors: inconsistent or no condom use, more than one lifetime sexual partner, >5 year age difference with a current partner, transactional sex, and forced sex with a current partner.
In a cohort of 1000 adolescent girls and young women, 967 reported being HIV-negative or of unknown status at baseline and were included in this analysis. The median age of respondents was 19 (IQR 17–21). 69% used condoms inconsistently or not at all; 54% had >1 lifetime sexual partner; 15% had a partner >5 years older; 21% reported current transactional sex; and 46% reported forced sex from a current partner. 41% reported no perceived lifetime risk of HIV. Inconsistent condom use (OR 1.86, 95% CI 1.40–2.47), >1 lifetime partner (OR 1.65, 95% CI 1.26–2.15), transactional sex (OR 1.50, 95% CI 1.07–2.11), and forced sex (OR 1.71, 95% CI 1.30–2.25) were associated with any perceived lifetime risk of HIV. Despite association between risk factors and risk perception, 35% of those with one or more risk factor perceived no lifetime risk of acquiring HIV.
Adolescent girls and young women in this cohort have a high prevalence of HIV risk factors. However, many participants with these risk factors perceive no risk of HIV acquisition. As a critical gap in the HIV prevention cascade, accurate risk perception is needed to tailor effective and sustained combination prevention strategies for this vulnerable population.