Vectors or Victims? High HIV transmission risk among adolescents living with HIV in a community-traced study in the Eastern Cape, South Africa
Abstract / Description:
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.