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Purpose: Adolescent girls are at high risk for depression and human immunodeficiency virus (HIV) acquisition. Poor mental health can increase vulnerability to risky sexual behaviours. Therefore, this study aims to determine the prevalence of depressive symptomology and explore the convergence of HIV risk factors with depressive symptoms amongst cis-gender adolescent girls and young women (AGYW) in rural KwaZulu-Natal (KZN) and peri-urban Western Cape (WC) communities in South Africa. Methods: Cross-sectional survey data from two sites in South Africa was used - the rural Vulindlela community in KZN and the peri-urban Philippi East community in the WC. Study inclusion criteria included being sexually active with at least one male partner, and not planning to relocate in the next 12 months. The PHQ-9 scale was used to determine depressive symptomology, a socio-behavioural questionnaire was used to determine sexual behaviours, odds ratios and confidence intervals derived from logistic regression models were used to explore the associations between depressive symptomology and socio-behavioural factors associated with HIV acquisition. Results: The cohort consisted of 274 adolescent girls, 38.6% from the WC site and 61.4% from the KZN site. Overall, 15.7% (43/274) of AGYW reported depressive symptoms. Participants from the peri-urban WC site were more likely to experience depressive symptoms (OR 8.34; 95% CI 3.80–18.30) compared to those living in the rural KZN site. Depressive symptoms were less likely to occur in adolescent girls between the ages of 14 to 17 as compared to those between the ages of 18 and 19 (OR 0.44; 95% CI 0.22–0.90). Socio-behavioural HIV risk factors associated with depressive symptoms include: age disparate relationships (OR 2.98; 95% CI 1.52–5.84), high (four or more) numbers of lifetime partners (OR 8.15; 95% CI 3.60–18.45) and engaging in sex under the influence of alcohol (OR 2.58; 95% CI 1.32–5.04). Multivariate analysis showed that participants from the WC site (AOR 5.25; 95% CI 1.95–14.17) had higher odds of experiencing depressive symptoms while participants with four or more lifetime partners (AOR 3.46; 95% CI 1.24–9.60) were at higher odds of experiencing depressive symptoms. Conclusion: In this cross-sectional study, depressive symptomology is associated with certain HIV risk behaviours. Longitudinal studies are required to test the causal relationship between depression and HIV acquisition and to better understand the geospatial differences observed. [ABSTRACT FROM AUTHOR]

Understanding the sexual relationships of young women is critical for preventing HIV infections. This study aimed to describe the sexual behaviour of partners, comparing the accuracy of sexual health knowledge between partners. The study took place in 2017 in KwaZulu-Natal, South Africa. Purposive sampling was used to select 18–27-year-old sexually active women. Consenting female participants completed a structured and semi-structured interview, while consenting male sexual partners identified through the female participant completed a structured questionnaire on sexual health information. Using a reflexive inductive approach and thematic analysis, we identified key discrepancies in the assumptions partners make about each other's sexual health information. Twenty-three sexual dyads were identified and four key discrepancies were identified: Age: partners either over or underestimated the age of their partners, HIV status: where partners were unaware of, or incorrectly assumed their partner's status, Lack of awareness of partner's concurrent relationships and more general knowledge of the partner's sexual health behaviours. Discussions about sexual health are mediated by relationship length, type of partner, power and perceived fidelity. While it is possible to undertake dyadic level research, ethical tensions remain. Sex-positive and egalitarian sexual health interventions that target the individual, as well as the sexual relationship, are needed. [ABSTRACT FROM AUTHOR]

Objectives: In sub-Saharan Africa, approximately 86% of HIV infections in adolescents aged 15-19 years occur among girls. Their heightened susceptibility is likely influenced by converging sociobehavioural and biological factors, although the relative contributions remain unclear. To address this, we compared known and hypothesised risk factors for HIV between cisgender adolescent girls and adult women in South Africa and evaluated the relationships between these factors and sexually transmitted infection (STI) status., Methods: This cross-sectional observational study included adolescent (n=305; 14-19 years) and adult females (n=114; 25-35 years) in two South African provinces (Western Cape (WC), KwaZulu-Natal (KZN)). Demographic and sociobehavioural data were collected by questionnaire. Colposcopy was conducted to identify cervicovaginal abnormalities, and tests for bacterial vaginosis (BV), Chlamydia trachomatis , Neisseria gonorrhoeae and Trichomonas vaginalis were performed., Results: Adults reported higher risk sexual behaviour than adolescents across multiple variables, although adolescents were more likely to have STIs than adults (62.8% vs 34.0%, respectively, p=0.0010 for WC; 42.5% vs 16.4%, respectively, p=0.0002 for KZN). Adolescents did, however, report earlier sexual debut (16 years old vs 17 years old, p<0.0001 for both sites) and KZN adolescents were more likely to use intravaginal sexual enhancers than adults (34.6% vs 20.6%, respectively, p=0.0417). Numbers of sexual partners (β-coefficient: 0.34, SE: 0.12, p=0.0054) and sex acts within the previous 3 months (β-coefficient: 0.25, SE: 0.09, p=0.0062) were associated with STIs in adolescents and trended to significance for adults. Intravaginal sexual enhancer use (KZN only; β-coefficient: 0.95, SE: 0.38, p=0.0118) and biological risk factors, including BV Nugent score (β-coefficient: 0.09, SE: 0.04, p=0.0257) and signs of cervicovaginal injury/inflammation (β-coefficient: 1.07, SE: 0.45, p=0.0171), were associated with STIs in adolescents but not adults., Conclusions: Risk factors for STIs including HIV may differ between age groups of girls and women, and mitigation interventions may need to be tailored accordingly., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)