I hypothesize that influential social determinants for HIV-infection among young women in Sub-Saharan Africa include: gender, psychosocial circumstances, and the health system because of the unique experience of this population vis-à-vis other populations at risk of HIV infection in similar geographies.
- Gender is an important determinant because of the dominant patriarchal culture and society that limits the extent to which the sexual needs and desires of women are considered and the consequences that may occur if a woman were to take the initiative in sex, suggest condom use, or refuse sexual advances. (1)
- The health system is an important determinant because young women and adolescent girls often don’t have adequate access to the health system in general and HIV prevention and treatment services specifically. For example, there may be policies and laws which restrict their ability to access health care without the consent of a parent or guardian, specifically in relation to consent for HIV teting or access to sexual and reproductive health services. (2)
- Psychosocial circumstances are an important determinant because of the stress experiences by young women and adolescent girls during the transition to adulthood, including stress of the low status of women, increased responsibility for daily survival and increased exposure to adults with heavy alcohol consumption. (3 and 4)
- Citations
- Ramjee, G., & Daniels, B. (2013). Women and HIV in Sub-Saharan Africa. AIDS Research and Therapy, 10(1), 30. https://ucsf.idm.oclc.org/login?url=http://doi.org/10.1186/1742-6405-10-30)
- UNIADS (2014), The Gap Report: Adolescent Girls and Young Women.
- Harrison, A., Colvin, C. J., Kuo, C., Swartz, A., & Lurie, M. (2015). Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral and Structural Factors and Emerging Intervention Approaches. Current HIV/AIDS Reports, 12(2), 207–215. https://ucsf.idm.oclc.org/login?url=http://doi.org/10.1007/s11904-015-0261-0
- UNICEF, Life skills: Girls, HIV/AIDS and Education (2003). https://www.unicef.org/lifeskills/index_8657.html
Both past socioeconomic factors and neighborhood characteristics could contribute to the incidence of HIV-infection among young women in Sub-Saharan Africa.
- Growing up poor, may accelerate the age of sexual debut and increase the number of lifetime sexual partners, make sex for money more frequent, or encourage young people to accept older sexual partners (e.g. sugar daddies) all of which are associated with higher risk of HIV-infection.
- If HIV-incidence is higher in a population that lives in a neighborhood with limited mobility (e.g. people do not move from the community/geographic location into which they were born), then sexual partners will be selected from a population with a higher likelihood of infection and will pass it on.