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Background Psycho-social factors affect biological processes, including inflammation and immune response, yet their contribution to gender and socio-economic disparity of HIV is not well understood. In South Africa, 38% of new HIV infections occur in 15–24 year olds, with 3-times higher incidence among females. In this exploratory study, we examined associations between psycho-social factors and biomarkers of inflammation that may be linked to HIV acquisition in South African youth. Methods Baseline plasma and linked cross-sectional survey data were obtained from the AYAZAZI study, which enrolled 425 HIV uninfected or HIV status-unknown youth (16–24 years old; 60% female) in Durban and Soweto (2014–2016). Survey data captured social and clinical determinants of health (e.g., gender, income, food insecurity, body mass index [BMI]) and psycho-social characteristics (depression, anxiety, stress, substance use). A random, gender-stratified subset of 39 HIV-negative participants was selected. Luminex® assays were used to analyze 12 plasma biomarkers. Associations between biomarkers and social, clinical, and psycho-social factors were assessed using Spearman’s rank correlation. Results Median age was 18 (IQR: 17–20); 19/39 were female. Consistent with prior studies, high depression symptomology scores were associated with elevated pro-inflammatory (IFN-α2, IL-1α, IL-6, IL-12(p40), MIP-1s) and anti-inflammatory (IL-4, IL-10) cytokines (all p Conclusion Results indicate that psycho-social, clinical, and socio-economic challenges are associated with inflammatory biomarker levels in South African youth. This suggests a link between social determinants of health and biological factors that modulate disease risk, possibly including inflammatory conditions associated with increased HIV transmission. Further analysis is required to confirm these results and investigate their implications for HIV prevention. Disclosure No significant relationships.

Background Women around the world use intra-vaginal practices (IVPs) for varying reasons. IVPs can disrupt the vaginal microbiome and induce inflammation, increasing susceptibility to bacterial vaginosis (BV), a risk for HIV acquisition. Limited research has focused on IVPs and their correlates among adolescent girls and young women (AGYW) in South Africa, a key population for HIV prevention efforts. Methods We used cross-sectional baseline survey data from 253 HIV-negative or HIV-status unknown AGYW (16–24 years) enrolled in AYAZAZI, a community-based cohort study in Soweto and Durban, South Africa (2014–2016). We measured IVP use in the past 30 days for 11 IVPs (yes vs no) and estimated the prevalence of using ≥= 1 IVP in the past 30 days (yes vs no). Using existing literature, we identified 18 determinants of IVP use. We estimated the total causal effect of each determinant on any IVP use in the past 30 days using separate logistic regression models adjusted for confounding within the counterfactual framework of causal inference. Results Mean age was 19 years, 67.2% were in school, and 81.8% ever had sex. Overall IVP prevalence was 76.7% (59% vs 81% among those who had never vs ever had sex; p=0.016). The most common IVPs included: washing intravaginally with water only (66%), with soap (41%), and with other products including towels or sponges (41%). AGYW who reported binge drinking (aOR=7.6; 95%CI: 3.2–18.4), a higher monthly income (≥R1601 vs ≤ R400; aOR=7.4; 95%CI: 1.6–33.9), engaged in transactional sex (aOR=4.4; 95%CI: 1.0–19.1), and/or reported any symptoms of genital tract infections (aOR=4.9; 95%CI: 1.0–23.0) had higher adjusted odds of using IVPs. Conclusion Over three-quarters of South African AGYW in this study reported IVPs with differences by socio-economic, behavioral, and clinical characteristics. Further investigation of IVP motives and implications for BV and HIV acquisition risk among young women are warranted. Disclosure No significant relationships.

Background South African young women and other key populations have amongst the highest HIV incidence globally, and antiretroviral treatment (ART) initiation remains challenging. We measured HIV incidence, ART initiation, adherence, status disclosure and related support within 3 months from HIV diagnosis for youth who acquired HIV during follow-up study visits. Methods The AYAZAZI cohort study enrolled 425 self-reported HIV-negative or status-unknown 16–24 year olds from Soweto and Durban, South Africa (2014–2016). Participants completed interviewer-administered questionnaires (assessing socio-demographics, sexual behaviour and history, HIV-related service utilization, ART adherence, HIV disclosure and support) and underwent HIV rapid testing at enrolment and every 6 months for 4 visits. Results 13/425(3.1%) enrollees were HIV-infected at enrolment. 12/412(2.8%; n=5 Durban, n=7 Soweto) with median age of 19 (IQR17–21) years, acquired HIV during their first year of follow-up (IR=2.54[95%CI:1.5–4.4] per 100 person-years); 6/12 were females, 5/12(42%) identified as LGBTQ, 10/12(83%) were sexually active and 5/10(50%) used a condom at last sex.Three months after HIV diagnosis, 10/12(83%) reported they were medically advised to initiate ART, and 8/12(67%) had initiated ART. Fear of provider judgement was the most common reason for ART non-initiation (3/4;75%). A third (4/12) had not accessed any HIV-related medical or support services since diagnosis, commonly because of a disbelief of HIV test results (4/4; 100%). Of those who initiated ART, 5/8(63%) said they forgot a dose once or more per week. Eighty-three percent (10/12) had disclosed their HIV status to someone. The most common source of support related to HIV was from friends (7/12; 58%). 2/12(17%) rated that taking ART makes the risk of HIV infection a lot lower. Conclusion HIV incidence was 2.5 per 100 person-years amongst our youth cohort; immediate ART uptake and adherence was sub-optimal; awareness of HIV prevention benefits of ART was low. Biomedical technologies and improved support systems for HIV-infected youth are needed. Disclosure No significant relationships.