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HIV RISK FACTORS AND RISK PERCEPTION AMONG ADOLESCENT GIRLS AND YOUNG WOMEN IN MALAWI
Joan T. Price1, Nora E. Rosenberg1, Bertha Maseko2, Savvy Brar2, Twambilile Phanga2, Audrey Pettifor1, Linda-Gail Bekker3
1Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA,2Univ of North Carolina Proj–Malawi, Lilongwe, Malawi,3Univ of Cape Town, Cape Town, South Africa
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.