Adolescent girls who sell sex in Zimbabwe: HIV risk, behaviours and service engagement.

To reduce HIV incidence among adolescent girls who sell sex (AGSS) in Zimbabwe we need to better understand how vulnerabilities intersect with HIV infection, and how those living with HIV engage in care. In 2017, we conducted social mapping in four locations in Zimbabwe, and recruited girls aged 16 to 19 years who sell sex, using respondent driven sampling or census sampling methods. Participants completed a questionnaire and provided finger-prick blood samples for HIV antibody testing. Of 605 AGSS recruited, 74.4% considered themselves sex workers, 24.4% reported experiencing violence in the past year, 91.7% were not in school, and 83.8% had less than a complete secondary education. Prevalence of HIV increasing steeply from 2.1% among those aged 16 years to 26.9% among those aged 19 years; overall 20.2% of AGSS were HIV positive. In multivariate analysis, age, education, marital status, and violence from a client were associated with HIV. Among the 605 AGSS, 86.3% had ever tested for HIV, with 64.1% having tested in the past six months. Among AGSS living with HIV, half (50.8%) were aware of their status, among whom 83.9% reported taking antiretroviral therapy. The steep rise in HIV prevalence between 16 and 19 years, suggests the window to engage with AGSS prior to HIV acquisition is short. To accelerate reductions in incidence among AGSS, intensified combination prevention strategies that address structural factors and tailor services to the needs of AGSS are required, particularly ensuring girls enrol and remain in school. [Abstract copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.]