International Center for Research on Women, Washington, DC, USA.
Hera Solutions, Baltimore, MD, USA.
J Int AIDS Soc. 2020 Sep;23 Suppl 5(Suppl 5):e25562. doi: 10.1002/jia2.25562.
While HIV index testing and partner notification (PN) services have the potential to reach adolescent girls and young women (AGYW) aged 15 to 24 and their sexual partners in need of HIV testing services, the potential social harms have not yet been studied. This commentary highlights the risks of this approach, including intimate partner violence (IPV), stigma and discrimination, and outlines an urgent research agenda to fully understand the potential harms of PN for AGYW, calling for the development of mitigation strategies.
A substantial evidence base exists demonstrating the feasibility, acceptability and effectiveness of index testing and partner notification for adults aged 18 years and older in low- and middle-income countries (LMICs), particularly for men, and for adults who are married/cohabiting and referring a current sexual partner. AGYW who are most vulnerable to HIV infection in LMICs do not reflect these demographics. Instead, they are often in age-disparate partnerships, have limited negotiating power within relationships, experience high rates of violence and face economic challenges that necessitate transactional sex. PN services may be particularly difficult for adolescent girls under 18 who face restrictions on their decision making and are at increased risk of rape. Adolescent girls may also face coercion to notify partners due to unequal power dynamics in the provider-adolescent client relationship, as well as judgemental attitudes towards adolescent sexual activity among providers.
As index testing and PN with AGYW is already being rolled out in some LMICs, research is urgently needed to assess its feasibility and acceptability. Implementation science studies should assess the availability, accessibility, acceptability and quality of HIV PN services for AGYW. Qualitative studies and routine monitoring with age-disaggregated data are critical to capture potential social harms, PN preferences and support needs for AGYW aged 15 to 17, 18 to 20 and 21 to 24. To mitigate potential harms, PN methods should prioritize confidentiality and avoidance of adverse outcomes. Healthcare providers should be trained to conduct routine enquiry for IPV and provide first-line support. Support services for AGYW living with HIV and survivors of violence should be implemented alongside HIV PN.
虽然 HIV 指数检测和伴侣通知（PN）服务有可能接触到 15 至 24 岁的青少年女孩和年轻女性（AGYW）及其需要 HIV 检测服务的性伴侣，但尚未研究其潜在的社会危害。本评论强调了这种方法的风险，包括亲密伴侣暴力（IPV）、耻辱和歧视，并概述了一个紧迫的研究议程，以充分了解 PN 对 AGYW 的潜在危害，呼吁制定缓解策略。
大量证据表明，在中低收入国家（LMICs），针对 18 岁及以上成年人，特别是男性，以及已婚/同居并推荐当前性伴侣的成年人，进行指数检测和伴侣通知是可行、可接受和有效的。在 LMICs 中最容易感染 HIV 的 AGYW 并不符合这些人口统计特征。相反，他们通常处于年龄不匹配的伴侣关系中，在关系中谈判能力有限，经历高暴力率，并面临需要性交易的经济挑战。PN 服务可能特别困难，因为未满 18 岁的青少年女孩在决策方面受到限制，并且面临更高的强奸风险。青少年女孩也可能由于提供者-青少年客户关系中的权力不平衡，以及提供者对青少年性活动的评判态度，而被迫通知伴侣。
由于在一些 LMICs 中已经推出了针对 AGYW 的指数检测和 PN，因此迫切需要研究来评估其可行性和可接受性。实施科学研究应评估为 AGYW 提供 HIV PN 服务的可用性、可及性、可接受性和质量。定性研究和常规监测，结合年龄分组数据，对于捕捉潜在的社会危害、PN 偏好和支持 15 至 17、18 至 20 和 21 至 24 岁的 AGYW 的需求至关重要。为了减轻潜在危害，PN 方法应优先考虑保密性和避免不良后果。应培训医疗保健提供者进行常规的 IPV 询问，并提供一线支持。应在 HIV PN 的同时为 AGYW 提供艾滋病毒感染和暴力幸存者的支持服务。
