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Understanding and Addressing the Multi-Level Influences on the Use of HIV Prevention Strategies among Young Women in Sub-Saharan Africa

NAMHC Concept Clearance

Presenter

Pim Brouwers, Ph.D.
Division of AIDS Research

Goal

This initiative aims to: (1) enhance our understanding of the multiple factors that influence HIV prevention strategy use among adolescent girls and young women in sub-Saharan Africa, by looking at the multiple levels of influence on adolescent girls and young women’s behavior (i.e., individual, peer, partner, family, and community, as well as cultural and social norms) that may influence uptake and adherence; and, (2) develop and test novel interventions to address these factors and enhance the uptake and adherence to HIV prevention strategies among adolescent girls and young women in sub-Saharan Africa (SSA).

Rationale

HIV incidence remains high among adolescent girls and young women in SSA, even within clinical trial settings. However, uptake and adherence to HIV prevention strategies (condoms, PrEP, microbicides, etc.) in this population is low. Researchers have started to identify factors underlying the low rates of use and adherence to HIV prevention strategies among adolescent girls and young women. Initial data indicate that a woman’s partner’s either implicit or explicit approval of product use plays a role in her ability to use HIV prevention strategies. Additionally, within clinical trials, women often underestimate their actual risk of acquiring HIV and experience stigma in their communities for using antiretroviral-based products to prevent HIV. Nevertheless, we lack insight into the combined impact of factors from multiple levels of influence; such insight is needed to inform the development of future intervention trials and the eventual uptake of efficacious products.

This initiative aims to increase our understanding of the factors associated with the uptake and adherence to current HIV prevention strategies, as well as future product development and will develop interventions to overcome these barriers. The initiative was developed through an ongoing collaboration between NIMH and the National Institute of Allergy and Infectious Disease (NIAID) and follows a meeting that the two Institutes held on September 4-5, 2014 in partnership with the Microbicide Trials Network (MTN) entitled “The role of relationships in HIV prevention among young women in Africa.”

This initiative would aim to support research to understand the factors associated with the uptake of and adherence to HIV prevention strategies for adolescent girls and young women in SSA, and to develop interventions to improve uptake and adherence in this population. Efforts may include, but are not limited to research to:

  • Enhance measurement, both within and outside of the clinical trial setting, of partner dynamics, behaviors, and social and cultural norms that influence HIV risk and product use.
  • Improve understanding of the impact of mental health (depression in particular), substance use, and stigma on the uptake of HIV prevention strategies.
  • Develop interventions to address factors associated with the low uptake and adherence to HIV prevention strategies.

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