Sexual behavior experiences and characteristics of male-female partnerships among HIV positive adolescent girls and young women: Qualitative findings from Zimbabwe

PLoS One. 2018 Mar 22;13(3):e0194732. doi: 10.1371/journal.pone.0194732. eCollection 2018.

Abstract

Background: New HIV infections among sub-Saharan Africa's adolescent girls and young women (AGYW, ages 15-24) greatly exceed those of their male peers. In addition, AGYW tend to acquire HIV at a much earlier age. Understanding the factors associated with HIV infection in AGYW could inform effective prevention and treatment interventions for these populations and their male sexual partners.

Methods: This qualitative study, conducted October-November 2016, was a follow on to a quantitative survey that sought to characterize male sexual partners and sexual behaviors of sexually active HIV positive AGYW in Zimbabwe. The qualitative study explored sexual behavior experiences and characteristics of male-female partnerships among the same participants. We conducted in-depth interviews with purposively sampled AGYW (16-24 years). Audio recorded qualitative data were transcribed, translated into English, and thematically coded using NVivo.

Results: 28 AGYW (n = 14 urban, n = 14 rural) took part in the in-depth interviews. 50% were 16-19 years old. Discussions with 10/11 (91%) AGYW who were reportedly infected through sex suggested that they had acquired HIV from their husbands or romantic partners. Accounts also suggested that the age difference between respondents and their male sexual partners was ≥5 years. Overall, respondents described two types of male partners: those older (''sugar daddies'', men ≥35 years old) and younger (<35 years). Respondents felt unable to suggest condom use to both older and younger partners. Evident in respondents' accounts was a general low HIV risk perception, particularly with younger men, which was largely due to poor HIV knowledge. Discussions suggested that an AGYW's relationship with either male partner was characterized by some form of violence.

Conclusions: Discussions highlighted the nature and characteristics of relationships between AGYW and their male sexual partners. Findings could inform interventions to engender risk perception among AGYW, promote female-controlled HIV prevention efforts and, foster risk-reduction among men.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Condoms / statistics & numerical data
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / psychology
  • HIV Seropositivity / epidemiology*
  • HIV Seropositivity / psychology
  • HIV-1
  • Humans
  • Male
  • Risk-Taking
  • Sexual Behavior / statistics & numerical data*
  • Sexual Partners* / psychology
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Young Adult
  • Zimbabwe / epidemiology

Grants and funding

This study was conducted by the Strengthening High Impact Interventions for an AIDS-free generation (AIDSFree) project funded by the U.S. Agency for International Development under Cooperative Agreement AID-OAA-A-14-00046 with support from the President’s Emergency Plan for AIDS Relief (PEPFAR). AIDSFree is implemented by JSI Research & Training Institute, Inc. with partners Abt Associates Inc., Elizabeth Glaser Pediatric AIDS Foundation, Encompass LLC, IMA World Health, the International HIV/AIDS Alliance, Jhpiego Corporation, and PATH (IT received the funding). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.