HIV Prevention for Adolescent Women in Africa: Structural Driver Interventions
Adolescents, particularly women, are highly vulnerable to HIV infection in sub-Saharan Africa. While there have been recent declines in HIV infection among adolescents in some sub-Saharan African countries, 12-24 year old women still account for 22 % of new infections globally; increasing to 33 % in sub-Saharan Africa. In this age group, female infections are two to eight times those of young men. Historically, interventions to prevent HIV have focused on individual level characteristics such as knowledge and individual sexual practices. There has, however, been an increasing recognition that adolescents with good levels of knowledge about HIV and low reported levels of HIV risk behaviors remain at risk for HIV infection. Attention has, therefore, turned to broader contextual factors that influence risk, commonly known at structural drivers. In a 2008 Lancet series on HIV prevention, it was noted that changes to social, economic, political and environmental factors are needed to diminish specific vulnerabilities and risk for both men and women. Poverty, gender inequalities, stigma and unrestricted alcohol consumption have been identified as potential drivers of risk, impacting on specific populations to varying degrees and in multiple combinations. This chapter will document evidence for the impact of structural drivers on adolescent's HIV risk, specifically focusing on young women in sub-Saharan Africa. Despite challenges with implementing structural interventions and their assessment, there are numerous examples of interventions for adolescents that target issues such as poverty, education and gender inequalities. The chapter will conclude by identifying and discussing interventions specifically designed to address structural drivers impacting adolescent women's vulnerability.