South African girls from the Star for Life programme, a non-profit organisation with the mission to inspire young people to believe in their dreams for the future and live in an AIDS-free generation. (Photo/ Wikimedia Commons)

Young Women Most At-Risk For HIV Are Not Taking Their Prevention Drugs. Why?

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IN sub-Saharan Africa, adolescent girls and young women account for 25% of all new HIV infections among adults, despite making up 17% of the general population. Women in general make up more than half (56%) of new HIV infections among adults, and seven in ten of all new adolescent infections are in girls.

Data from UNAIDS shows that in eastern and southern Africa, for example, adolescent girls in Mozambique had an HIV prevalence of 7%, which doubled to 15% by the time they were 25 years old.

In Lesotho, an HIV prevalence of 4% was recorded among adolescent girls, which increased to 24% among young women aged 20–24 years.

On average, young women acquired HIV 7-8 years earlier than their male counterparts. This pattern is repeated in almost every country in eastern and southern Africa – Kenya included, according to the organisation.

There are social forces that make women (young ones, especially), vulnerable to HIV infection.

Foremost of which are patriarchal gender norms that see a woman’s sexuality as something to be traded in return for resources – whether literally for cash and material support, or implicitly for social status and respectability in marriage.

The unequal power dynamic makes women unable to negotiate for safe sex, and restricts access to sexual and reproductive health services.


But there is some hope. Because young women represent a high percentage of those infected, organisations such as the Global Fund, the US AIDS agency, PEPFAR, and the National Institutes of Health have supported dozens of initiatives to protect them and break the cycle.

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Most of the focus has been on Pre-Exposure Prophylactic drugs, or PrEP, which is when non-infected people take HIV medicines daily to lower their chances of getting infected.

Last year, the WHO recommended a combination of two HIV medicines (tenofovir and emtricitabine), sold under the name Truvada, for daily use as PrEP to high-risk populations, such as gay men, sex workers, and young women, to prevent their chances of getting infected.

Clinical trials found Truvada was 92% effective when people took them as directed, but it is much less effective when not taken consistently.

In trials in South Africa targeting young women, the adherence rate was disappointingly low: young women skipped doses, complaining of mild, temporary side effects like nausea, and a fear of having their parents or partners find out about the treatments.


The truth goes deeper – the focus on pharmaceuticals overshadows the social injustices that women face. PrEP’s treatment regime is rigorous, and “when women are overwhelmed with worries about rape, exploitation, or where their next meal comes from, they are unlikely to add the additional burden of treating a disease they don’t have,” writes Amy Maxmen in this report for Vice.

It is an added responsibility that leaves the structural issues that make young women vulnerable to HIV in the first place untouched. And to take PrEP would mean admitting they have sex in a society that values virginity before marriage.

It just goes to show that diseases are rarely biological facts alone, which merely require a scientific or technological fix. Life, and health, is more complicated than that. 

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