Knowledge and perceptions about HIV among adolescent girls and young women aged 15 – 24 years: associations with HIV testing and sexual behaviour – a sub-study of the 2012 South African National HIV Household survey

Frieslaar, Farzanah

Knowledge and perceptions about HIV among adolescent girls and young women aged 15 – 24 years: associations with HIV testing and sexual behaviour – a sub-study of the 2012 South African National HIV Household survey

Master Thesis

2020

Abstract

Background. While much progress has been made, HIV remains a major global public health problem. South Africa remains home to the highest number of people living with HIV (7.1 million) in the world. Despite remarkable progress in the past decade, adolescent girls and young women aged 15-24 (AGYW) remain at higher risk of HIV exposure and infection than other groups. We do not know enough about AGYW HIV knowledge and perceptions, although it is likely an important factor to consider in AGYW's HIV risk. This paper investigates knowledge and perceptions about HIV risk behaviours and explores associations with demographic and behavioral characteristics among AGYW in South Africa. Methods. This sub-study is based on the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey, a cross-sectional population-based household survey. A multistage stratified cluster sampling approach was employed to select the study population. Multivariate logistic regression was used to determine associations or factors which were associated with HIV knowledge. Results. Among the sample of 3700 AGYW aged 15-24 years, White [OR=2.44 (95% CI: 1.48-4.03), p=0.001] and Indian [OR=3.85 (95% CI: 2.39-6.18), p=0.000] AGYW were associated with high HIV knowledge compared to Black Africans. AGYW in urban informal [OR=0.64 (95% CI: 0.45-0.90), p=0.011] and rural informal [OR=0.57 (95% CI: 0.33-0.98), p=0.043] were associated with low HIV knowledge compared to urban formal settings. AGYW in Eastern Cape [OR=0.69 (95% CI: 0.48-1.00), p=0.048], KwaZulu-Natal [OR=0.69 (95% CI: 0.48-0.99), p=0.044], North West [OR=0.50 (95% CI: 0.32-0.77), p=0.002] and Limpopo [OR=0.44 (95% CI: 0.27-0.71), p=0.001] provinces were associated with low HIV knowledge compared to AGYW in Western Cape. Unemployed AGYW were associated with low HIV knowledge [OR=0.57, p=0.001]. While AGYW with higher levels of education: grade 12 [OR=1.66 (95% CI: 1.04-2.64), p=0.034] and tertiary [OR=2.68 (95% CI: 1.47-4.89), p=0.001] were associated with high HIV knowledge. AGYW having had sex in the last 12 months were associated with high HIV knowledge [OR=1.70 (95% CI: 1.08-2.72), p=0.023]. On the contrary, having multiple sexual partners in the last 12 months was associated with low HIV knowledge [OR= 0.60 (95%CI: 0.39-0.99), p=0.045] compared to AGYW that had 1 sexual partner in the last 12 months. AGYW with a low risk of alcohol use were associated with high HIV knowledge [OR=1.4 (95% CI: 1.02-1.87), p=0.039] compared to AGYW that abstained from alcohol. The final multivariate logistic regression model showed that AGYW in urban informal settings have low HIV knowledge [aOR=0.59 (95% CI: 0.35-0.99), p=0.046] among all geotypes. Conclusion. Overall, the main findings show a lack of knowledge among AGYW across race, geotype, province and sexual activity. More specifically that low HIV knowledge was associated with AGYW who were Black South Africans, living in informal settings, from Eastern Cape, KwaZulu Natal, North West and Limpopo, unemployed, had lower levels of education, and have multiple sexual partners. However, in the final multivariate analysis, only geotype stood out, indicating that there is an HIV knowledge deficit in urban informal settings. This can be addressed through the promotion of knowledge through education, equitable and accessible availability of education and sexual and reproductive health services, and HCT and support among AGYW living in urban informal settings.