Contextual drivers of HIV risk among young African women.

Abstract

INTRODUCTION: Significant progress has been made in the African HIV pandemic; however, the pace of incidence decline has slowed or stalled in many East and Southern African countries, especially among young women. This stall is worrying because many countries have burgeoning youth populations. There is an important window of opportunity to halt the epidemic as well as the potential for millions more infections if primary prevention efforts are not strengthened. DISCUSSION: Many hyper-endemic settings have been exposed to numerous interventions; however, HIV incidence among young women has remained high. In this paper, we characterize the intervention context and examine how it can be strategically utilized to maximize HIV prevention interventions among young women. We begin by examining how contextual dynamics drive HIV risk. We illustrate how epidemiological contexts, gendered normative and economic contexts, and environmental contexts work synergistically to make young women especially vulnerable to HIV infection. We then examine how these contexts can undermine HIV prevention interventions. Finally, we discuss the importance of fully mapping out the intervention context to enhance the effectiveness of HIV prevention interventions. CONCLUSIONS: Understanding an intervention context, and how its features work together to amplify young women's risk in hyper-endemic settings can contribute to sustained momentum in reducing HIV incidence among young women and help to limit the reach of the HIV pandemic into new generations of Africans.