Center for Communication and Engagement Research, RTI International, Research Triangle Park, NC, USA.
Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
AIDS Behav. 2024 Dec;28(12):4274-4282. doi: 10.1007/s10461-024-04470-4. Epub 2024 Sep 3.
Transactional sex and sexual relationships with older partners increase HIV risk in adolescent girls and young women (AGYW), yet little is known about how these behaviors co-evolve over time. We characterize temporal patterns of transactional sex and age-disparate relationships among AGYW in South Africa. Longitudinal data are from a randomized controlled trial (HPTN 068) of school-aged, HIV-negative, AGYW who attended ≥ 3 study visits. We used group-based trajectory modeling to identify trajectories of transactional sex and age-disparate relationships (partner ≥ 5 years older) in the last year and assessed the interrelationship (conditional probability) between both trajectories. At baseline, median age was 14 years, 14.5% of girls were sexually active, and transactional sex (2.1%) and age-disparate relationships were uncommon (2.7%). We identified two trajectories for transactional sex ("low" [81.9%] and "increasing" [18.1%]) and two for age-disparate relationships ("low" [91.7%] and "increasing" [8.3%]). In a separate joint trajectory analysis, nearly a third (28%) had increasing trajectories for both transactional sex and age-disparate relationships, but most (53%) had a low trajectory of both outcomes. Baseline reporting of early sexual debut, depression, and inequitable gender norms were highest in the increasing transactional sex group. Prior pregnancy, early sexual debut, and IPV were highest among those with increasing age-disparate relationships. AGYW who engage in transactional sex or age-disparate partnerships in early adolescence are more likely to experience sustained engagement in both behaviors as they transition to adulthood, increasing HIV risk. Engaging girls early may maximize effectiveness of behavioral and biomedical HIV prevention efforts.
性交易和与年长伴侣的性关系会增加青少年女孩和年轻妇女（AGYW）感染 HIV 的风险，但人们对这些行为随时间如何共同演变知之甚少。我们描述了南非 AGYW 中性交易和年龄差异关系的时间模式。纵向数据来自一项针对学龄期、HIV 阴性、AGYW 的随机对照试验（HPTN 068），这些女孩参加了≥3 次研究访问。我们使用基于群组的轨迹建模来识别过去一年中性交易和年龄差异关系（伴侣≥5 岁以上）的轨迹，并评估这两个轨迹之间的相互关系（条件概率）。在基线时，中位年龄为 14 岁，14.5%的女孩有性行为，性交易（2.1%）和年龄差异关系（2.7%）不常见。我们确定了性交易的两种轨迹（“低”[81.9%]和“增加”[18.1%]）和两种年龄差异关系的轨迹（“低”[91.7%]和“增加”[8.3%]）。在单独的联合轨迹分析中，近三分之一（28%）的人同时具有性交易和年龄差异关系的增加轨迹，但大多数（53%）的人两种结果都处于低轨迹。在性交易增加组中，报告性早期开始、抑郁和不平等性别规范的比例最高。在年龄差异关系增加组中，怀孕、性早期开始和 IPV 比例最高。在青春期早期从事性交易或年龄差异关系的 AGYW 更有可能随着成年期的过渡而持续参与这两种行为，从而增加 HIV 风险。尽早接触女孩可能会最大限度地提高行为和生物医学 HIV 预防措施的效果。
