High risk of HIV infections among Namibian girls

JANA-MARI SMITH

Widespread exposure to abuse and violence, alcohol use and other risk factors mean that close to two-thirds of Namibian girls face one or more increased risks of acquiring HIV infection.

A recent CDC morbidity and mortality weekly report found that 62% of all adolescent girls and young women aged 13 to 24 met at least one criterion to qualify for the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) programme.

The programme, which forms part of the US President’s Emergency Plan for AIDS Relief (Pepfar), was introduced to Namibia in 2017 to help reduce new HIV infections among Namibian girls and women.

In addition to more than 60% meeting one of the DREAMS criteria, 26% of girls and young women met two or more criteria to qualify for the DREAMS programme.

Criteria include adverse childhood experiences, such as physical, emotional and sexual violence, being orphaned, and high-risk behaviours such as early alcohol use, recent heavy alcohol use, and infrequent condom use.

The CDC based their findings for DREAMS eligibility and vulnerability to HIV infection on data from the 2019 Namibia Violence Against Children and Youth Survey (VACS), which surveyed more than 4 000 respondents.

Data-based plans

The VACS data was scoured to estimate the prevalence of HIV risk factors and to identify girls and women at high risk of new infections.

The CDC noted that this data “can inform programmes and policies aimed at improving the well-being of these adolescent girls and young women and help control the HIV epidemics in these countries.”

The data analysis showed that the highest prevalence of having at least one criterion was observed among adolescent girls aged 13 to 14 years (71%), followed by young women aged 20 to 24 years (63%).

“Even among the group with the lowest prevalence (aged 15 to 19 years), 57% had at least one DREAMS criterion. In addition, 28% of those aged 13 to 14 years, 28% of those aged 15 to 19 years, and 23% of those aged 20 to 24 years met two or more criteria,” the authors pointed out.

Among girls aged between 13 and 14, the most common DREAMS eligibility criteria identified were experiencing physical or emotional violence (50%), experiencing early alcohol use (21%), and having been orphaned (19%).

Among girls and young women aged 15 to 19 years, common criteria included being orphaned (23%), experiencing lifetime sexual violence (19%), and being out of school (18%).

For young women aged between 20 and 24, the most common qualifying criteria included infrequent condom use in the past 12 months (39%), ever experiencing sexual violence (26%), and recent heavy alcohol use (18%).

The link between violence and the risk of acquiring HIV is associated with risk-taking behaviours and health consequences, including mental health problems, substance use, maternal health problems, and chronic diseases, all of which complicate HIV management, the study notes.

Working on the VACS data has “helped guide efforts to expand and adapt DREAMS and violence prevention and response programming in the country,” the authors noted.

DREAMS is based on a multiple intervention approach, that address the multiple needs of adolescent girls and young women at risk for acquiring HIV.

These interventions include HIV and violence prevention programming, post-violence care services, HIV testing, preexposure prophylaxis, parenting/caregiver support, and a combination of socio-economic approaches.

“This multi-pronged approach can, in turn, lead to reductions in HIV risk behaviours, exposure to violence, and HIV and violence-related outcomes.”