Magut, F; Mazibuko, L; Mthiyane, N; Harling, G; Baisley, K; Zuma, T; Dreyer, J; ... Shahmanesh, M; + view all Magut, F; Mazibuko, L; Mthiyane, N; Harling, G; Baisley, K; Zuma, T; Dreyer, J; Okesola, N; Behuhuma, O; Herbst, C; Smit, T; Seeley, J; Floyd, S; Birdthistle, I; Cowan, F; Hargreaves, JR; Chimbindi, N; Shahmanesh, M; - view fewer (2025) Hiv and herpes simplex virus 2 incidence among adolescent girls and young women who sell sex (YWSS) in rural south africa: A population-based cohort study. AIDS 10.1097/QAD.0000000000004255.

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Abstract

OBJECTIVE: We investigate the risk of acquiring HIV or 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 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, 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(py) (95%CI: 2.6–4.2) higher among YWSS than others (8.2 vs 2.7/100py; Hazard Ratio [HR]: 2.70; 95%CI: 1.83–3.99). HSV-2 incidence was 18.4/100py (95%CI: 16.5–20.5), and was higher among YWSS than others (29.3 vs 17.2 100py; HR: 1.83; 95%CI 1.41–2.39). HSV-2 at baseline was associated with subsequent HIV infection (HR: 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 PrEP and socio-economic support for this priority population of AGYW in rural settings.

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