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

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 (13-30years) 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 12months. 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 12months. 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.