Vectors or Victims? High HIV transmission risk among adolescents living with HIV in a community-traced study in the Eastern Cape, South Africa
Recent genetic mapping and observational studies among sero-discordant couples suggest that HIV transmission happens when virally-unsuppressed HIV-positive people engage in high-risk sexual practices. Adolescents living with HIV report high rates of non-adherence to ART and low viral suppression. Adolescence is also a time of experimenting with sexual and romantic partnerships. This paper documents which HIV-positive adolescents are most at risk of secondary HIV transmission to their sexual partners. It analyses data from the Mzantsi Wakho baseline which included 1,060 adolescents living with HIV from the Eastern Cape province in South Africa. One in five HIV+ adolescents reported high sexual risk, over half reported high viral activity, and 12% reported both. These adolescents at high risk of HIV transmission were older, lived in rural areas and reported high vulnerabilities and high-risk relationships. Combinations of these risk factors resulted in higher HIV transmission risk, suggesting the need for multi-component interventions to address these composite vulnerabilities.
Elona is a post-doctoral research fellow at the AIDS and Society Research Unit at UCT.
She recently completed her doctorate at the University of Oxford, focusing on the sexual practices of HIV-positive adolescents as part of the Mzantsi Wakho longitudinal cohort study. She spent 2013-2014 in the Eastern Cape province in South Africa, setting up and coordinating the baseline study of the Mzantsi Wakho longitudinal cohort. She works closely with Prof. Lucie Cluver (Oxford) and Dr. Rebecca Hodes (UCT), with whom she is currently conceptualising a study on adolescent parenthood in the context of HIV and is looking forward to learning from colleagues with experience in related research and programming. Elona works closely with a wonderful team of researchers which include colleagues at the University of Cape Town, Curtin University in Australia and healthcare providers and researchers in the Eastern Cape. When not coordinating fieldwork in rural and urban Eastern Cape, Elona enjoys helping her fellow research team members facilitate workshops on health issues with youth, which sometimes include sleeping in the back of bakkies, running lots of energizers, and organising snack breaks - usually with a two-year old baby in town.