271011 Sexual violence among adolescent girls in urban Zimbabwe: Social drivers and associations with HIV and Herpes simplex virus type-2 (HSV-2) infection

Tuesday, October 30, 2012 : 2:30 PM - 2:50 PM

Asuka Leslie, MBBS MSc DFPH , Department of Infection & Population Health, University College London, London, United Kingdom
Judith Glynn, BM BCh MA MSc PhD FRCP , Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
Sian Floyd, BSc MSc , Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
Auxillia Machingura Nyagadza , Nicoz Diamond Building, Biomedical Research and Training Institute, Harare, Zimbabwe
Simon Gregson, DPhil , School of Public Health, Imperial College London, London, United Kingdom
Isolde Birdthistle, MSc PhD , Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
Studies have documented links between sexual violence and HIV, however, there is limited understanding of the risks among adolescent girls. This analysis aimed to measure the prevalence of sexual violence, identify social drivers and examine associations with HIV/HSV-2 among adolescent girls in Zimbabwe. A sero-epidemiological survey was conducted in 2004. From a random sample of 1,283 14 to 19-year-old females, 863 consented to interviews and 839 to HIV/HSV-2 testing. Sexual violence was assessed by a range of social determinants and associations with HIV/HSV-2 using multivariable logistic regression. 115 girls reported coerced sex (13.4%; n=861); 96 (11.1%) were physically forced. Sexual violence was more prevalent in those who left school early (adjusted OR 3.47, 95% confidence interval (CI)1.75-6.89) and paternal orphans (aOR 2.10, CI 1.09-4.05).109 girls (14.8%) were either HIV or HSV-2 positive or co-infected. Of those who reported sexual violence, 31.6% were HIV/HSV-2-positive, compared to 12.3% in girls who did not (aOR 2.68, CI 1.52-4.74). Among girls who reported sex, HIV/HSV-2 prevalence was similar in those who had experienced sexual violence (42.9%) and those who had not (40.3%; aOR 1.31, CI 0.67-2.55). Girls who did not report forced sex were more likely to be married (p<0.001). Experiences of sexual violence were high among this population. In contexts of high HIV prevalence, sexual violence may constitute an important risk pathway; however, adolescents may also be at risk within partnerships described as consensual. Prevention programmes should therefore consider the different risk pathways for those who do and do not consent to sex.

Learning Areas:
Protection of the public in relation to communicable diseases including prevention or control
Social and behavioral sciences

Learning Objectives:
1. List some of the social drivers of sexual violence in adolescents girls in Zimbabwe that our study showed were important 2. Discuss the challenges of measuring sexual violence 3. Discuss the association the evidence for the association between sexual violence and HIV and HSV-2 infection 4. Evaluate the methods used in this study and whether they were appropriate 5. Formulate ideas about sexual violence prevention in adolescent girls 6. Formulate ideas about HIV prevention in adolescent girls in a context of high prevalance

Keywords: HIV/AIDS, Adolescents, International

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an academic clinical fellow in public health medicine. I was a Study Physician for Emory University's HIV clinical trial site in Rwanda and have worked for Family Health International, focusing on research capacity-building and family planning study protocol development. I recently completed an MSc in Epidemiology at the London School of Hygiene & Tropical Medicine, where my thesis explored the risks and consequences of sexual coercion among female adolescents in Zimbabwe.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.