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

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.