Epidemiology of Intimate Partner Violence Among Adolescent Girls and Young Women Accessing HIV Pre-Exposure Prophylaxis in South Africa, 2019–2022

Abstract

Background: Eradicating all types of violence against girls and women is one of the United Nations Sustainable Development Goals targets (1). Yet, not much research has focused on intimate partner violence (IPV) among this demographic in South Africa (SA). This is despite IPV being a known significant contributor to morbidity and mortality among adolescent girls and young women (AGYW) globally (2,3). In addition to a substantial burden of IPV, AGYW face an intersecting vulnerability to HIV (4). Identifying the prevalence and factors associated with IPV among AGYW accessing HIV pre-exposure prophylaxis (PrEP) is critical for informing the development of protective strategies. Understanding these factors may provide insight on effective interventions to support and care for AGYW affected by IPV, while also promoting the initiation and sustained use of HIV PrEP. Methods: A cross-sectional study analysed data from 1811 AGYW aged 15-24 years who accessed HIV pre-exposure prophylaxis (PrEP) at 12 study sites in SA. Past three months prevalence and patterns (self-reported experience of emotional, physical, financial and/or sexual IPV) data were collected using a standardized interviewer-administered questionnaire adapted from the World Health Organization Study on Women’s health and Domestic Violence Against Women. Frequencies and proportions were used to summarise the prevalence of the various forms of IPV. Logistic regression was used to identify factors associated with any IPV. Results: The overall prevalence of any IPV among AGYW was 9.2% (N=1811). Emotional, physical, financial and sexual IPV had a prevalence of 5.5%, 4.1%, 3.9% and 2.2% among AGYW respectively. Completing tertiary education or more (Adjusted odds ratio (AOR) 1.79, 95% confidence interval (CI) 1.02-3.14), drug use (AOR 1.96, 95% CI 1.08-3.55), sex under the influence of alcohol or drugs (AOR 1.93, 95% CI 1.28-2.90), PrEP use stigma (AOR 1.47, 95% CI 1.02-2.10), depression symptoms (AOR 1.85, 95% CI 1.28-2.66), not having vaginal sex (AOR 0.11, 95% CI 0.01-0.79), transactional sex (AOR 2.19, 95% CI 1.21-3.98), social V support structure (AOR 0.71, 95% CI 0.50-1.02) living in urban informal areas (AOR 2.45, 95% CI 1.59-3.76) or living in rural areas (AOR 2.12, 95% CI 1.19-3.78) and living in City of Tshwane district in Gauteng province (AOR 1.75, 95% CI 1.14-2.68) or Nelson Mandela Bay district in the Eastern Cape province (AOR 0.21, 95% CI 0.10-0.44) were all significantly associated with IPV. Conclusion: IPV proves to be a growing health concern among AGYW. In this study, emotional IPV was identified as the most prevalent type among AGYW. There is a potential intersecting need for interventions which address mental health, substance use, PrEP use stigma, transactional sex and IPV among AGYW. Interventions require collaboration between communities, health and legal departments to provide easily attainable, confidential and reliable services that address IPV and support AGYW. This study identifies key factors for developing targeted IPV interventions. It should be seen as one of the initial stages of a process that will require substantial further research on AGYW’s experience of IPV to find evidence of its impact on their health outcomes.