Urgent action needed to address alarming rates of sexually transmitted infections in South Africa

Burnet researchers and their collaborators have gained new insights into some of the underlying socio-behavioural and biological factors contributing to the alarmingly high rates of HIV and sexually transmitted infections (STIs) among adolescent girls and young women in South Africa.

In this region, 86% of HIV infections in adolescents aged 15-19 years occur in girls. Young women aged 15-24 years are twice as likely to acquire HIV than men of the same age group.

The study, entitled Differences in HIV risk factors between South African adolescents and adult women and their association with sexually transmitted infections, was published in the journal Sexually Transmitted Infections today. 

The study is a collaboration between Burnet Institute, Desmond Tutu Health Foundation, the Centre for the AIDS Programme of Research in South Africa, the Human Sciences Research Council, Seattle Children’s Hospital, the University of Cape Town and the University of KwaZulu-Natal.

The study followed two cohorts, one of adolescent girls (aged 14-19 years) and one of adult women (aged 25-35 years).
Adult women reported higher-risk sexual behaviour than adolescents in the study, but adolescents were more likely to have STIs than the adult women.

More than 62% of the adolescents involved in the study, and 34% of the adult women had an STI. Most were unaware of the infection as they had no symptoms.

Lead author of the study and Deputy Program Director of the Women’s, Children’s and Adolescents’ Health program at Burnet Institute, Dr Lindi Masson, said there were a range of factors contributing to the high rates of STIs among adolescent girls and women in South Africa.

“Our research showed that a better approach to diagnosis and treatment of STIs is needed in South Africa and stronger advocacy for policy change to reduce the rates of infection,” she said.

Dr Hilton Humphries, a co-author of the study and a senior social behavioural scientist at the Human Sciences Research Council in South Africa, said there were a range of social issues that impacted the rates of HIV and STIs in adolescent girls and young women that could be addressed.

“We found that women's subjective beliefs about their perceived risk of contracting HIV and STIs significantly influenced their actions to protect themselves against infection,” he said.

Another of the study’s co-authors, Dr Pamela Mkhize, a senior lecturer in biochemistry at the University of KwaZulu-Natal, said a link was also identified between sexual activity and inflammation, which was exacerbated by the use of a variety of products used as sexual enhancers, predominantly designed to enhance male pleasure during sex.

“There is a lot of interest in sexual products in this region but there is also a significant gap in knowledge about how they can affect the health of women and adolescent girls,” she said.

“Adolescent girls are more inclined to experiment with these products than older women. For adolescent girls, it's mostly about creating a 'virgin-like' sensation, which they perceive to be more desirable for their male partners. While older women use the products for sexual stamina and to create a ‘warming’ sensation. 

“The common goal across both age groups is to please their male partners, which highlights the need for better awareness about the health impacts of these products.”

The research team is conducting further scientific studies looking at inflammatory markers and will also further investigate the impacts of sexual enhancers.

Dr Masson said that by learning more about which products were more harmful and more likely to increase the risk of infection, the research team hoped to be able to provide better guidance about the use of these products and how women and adolescent girls could better protect themselves.

“Women’s healthcare has not been prioritised and there is a lack of research and innovation to improve the health of women and girls globally. We want to see that change,” she said.

“I hope our work can instigate greater investment in solving some of the health problems for women and adolescent girls in this region.”