Multi-level and multi-faceted factors in adolescent girls' vulnerability to HIV/AIDS: Community perspectives from Botswana, Malawi, and Mozambique

In sub-Saharan Africa, adolescent girls are 3-5 times more likely than adolescent boys to be living with HIV/AIDS. A recent review of the literature found no study that had examined girls' vulnerability to HIV/AIDS from the perspective of community members or girls themselves. A qualitative study conducted in November-December 2008 relied on 12 focus group discussions (FGDs) in Botswana, 12 in Malawi, and 11 in Mozambique, divided between urban and rural sites. FGDs were grouped thusly: adolescent girls (ages 10-14; 15-19), adolescent boys (14-19), adult women (20-49), adult men (20-49), and community leaders. Study participants defined “girls' vulnerability to HIV” as susceptibility to unprotected sexual relationships, primarily relationships that are transactional and age-disparate, which are sometimes forced. Some adolescent girls asserted individual agency was involved as girls may seek transactional sex; others reported coerced or forced sex. While most groups indicated that individually focused prevention programs are still needed, the preponderance of comments identified socio-economic disparities – insufficient economic, educational, socio-cultural, and legal support for adolescent girls living – as the primary drivers of the epidemic. The findings reveal an understanding that girls' vulnerability is multi-level and multi-faceted, thus implicitly recognizing the need for a systems approach. These findings reflect the urgent need to provide viable economic opportunities for girls and their families, enhance community efficacy to protect girls, and strengthen law enforcement related to alcohol restrictions and sexual violence. The findings from this study support policies and programs that strengthen and augment structural interventions as integral to HIV prevention.