INTIMATE PARTNER VIOLENCE AND INCIDENT HIV AMONG ADOLESCENT GIRLS AND YOUNG WOMEN IN AGINCOURT AREA, SOUTH AFRICA

Abstract

HIV continues to be an epidemic globally, with approximately 2.1 million incident cases reported in 2015. South Africa contributes a substantial number of these cases, with South African adolescent girls and young women (AGYW) contributing up to an estimated 100,000 a year. Given their high risk, more information is needed about potential risk factors for HIV such as intimate partner violence (IPV), based on mixed conclusions in the literature on the IPV - Incident HIV relationship and limited data related to AGYW, specifically. We leveraged longitudinal data from HPTN 068, a randomized controlled trial conducted in Mpumalanga Province, South Africa, to explore IPV and the IPV - HIV relationship among AGYW aged 13-20 years. In Aim 1, we used group-based trajectory modeling and identified two physical IPV (PIPV) trajectory groups among 8th and 9th grade adolescent girls. The higher risk group showed a predicted probability of PIPV in the last 12 months of 13.5% - 41.1% over four years, while the lower risk group had predicted past-year PIPV probabilities of 2.3% - 10.3%. Baseline correlates of higher risk group membership included older age (aOR per one-year increase: 1.39, 95% CI: 1.11, 1.73), borrowing money in the past 12 months (aOR: 1.95, 95% CI: 1.01, 3.79), and ever having had sex (aOR: 4.42, 95% CI: 1.56, 12.57). Having more equitable gender norms (aOR per one unit increase: 0.89, 95% CI: 0.81, 0.97) and being in the HPTN 068 intervention arm (aOR: 0.29, 95% CI: 0.17, 0.51) were inversely associated. In Aim 2, we explored the longitudinal relationship between IPV and incident HIV and found that any lifetime sexual IPV (aIRR: 1.87, 95% CI: 1.05, 3.33), any lifetime PIPV (aIRR: 1.32, 95% CI: 0.93, 1.87), and any lifetime (sexual or physical) IPV (aIRR: 1.41, 95% CI: 1.00, 1.99) were associated with HIV acquisition. Last 12 month IPV experiences were not strongly associated with incident HIV after controlling for confounders. PIPV risk differs among South African AGYW, and lifetime experience of IPV, as compared to recent IPV, was associated with acquiring HIV in South Africa. IPV-focused interventions are needed.