HIV and herpes simplex virus 2 incidence among adolescent girls and young women who sell sex in rural South Africa.

OBJECTIVE

We investigate the risk of acquiring HIV or herpes simplex virus type 2 (HSV-2) among young women who sell sex (YWSS) in rural South Africa.

DESIGN

A representative population-based prospective cohort study of adolescent girls and young women (AGYW).

METHODS

Between 2017 and 2019, we interviewed a random sample of AGYW (13-30 years) annually and collected dried blood spot (DBS) samples for HIV and HSV-2 serology. YWSS were defined as engaging in transactional sex and/or sex work in the past 12 months. We used Cox regression to estimate the association between selling sex and incident HIV or HSV-2 infections, using inverse probability weighting to adjust for potential confounding (age, education, rural/urban locality, socioeconomic status (SES), food insecurity, and pregnancy status).

RESULTS

Among eligible AGYW ( n  = 3846), 89.2% provided responses for at least one follow-up time-point, of whom 17% reported selling sex in the past 12 months. HIV and HSV-2 prevalence at enrolment were 21 and 37.9%, respectively and higher among YWSS at 42 and 69%, respectively. HIV incidence was 3.4/100 person-years [95% confidence interval (CI): 2.6-4.2] higher among YWSS than others (8.2 vs. 2.7/100 person-years; hazard ratio: 2.70; 95% CI: 1.83-3.99). HSV-2 incidence was 18.4/100 person-years (95% CI: 16.5-20.5), and was higher among YWSS than others (29.3 vs. 17.2/100 person-years; hazard ratio 1.83; 95% CI: 1.41-2.39). HSV-2 at baseline was associated with subsequent HIV infection (hazard ratio 6.32; 95% CI: 3.86-10.47, P  < 0.001).

CONCLUSION

HIV and HSV-2 incidence was higher among AGYW selling sex compared those who did not sell sex. These findings highlight the need for preexposure prophylaxis (PrEP) and socioeconomic support for this priority population of AGYW in rural settings.