Exploring HIV Risk Factors, Risk Perception, and Risk-Taking among Adolescent Girls and Young Women in Rural South Africa

Adolescent girls and young women (AGYW) face a disproportionately high risk of HIV acquisition, with biological susceptibility, sexual risk behaviours, and structural factors contributing to this vulnerability. Despite these risks, AGYW often perceive themselves as being at low risk of HIV acquisition, which can hinder engagement with HIV prevention services. This study seeks to explore the complex landscape of HIV risk among AGYW in the high HIV-burden setting of uMkhanyakude district, rural KwaZulu-Natal, South Africa. Specifically, this study aims to explore the correlations between self-reported behavioural risk factors, self-perceived risk, and risk-taking propensity among AGYW. We will use a cross-sectional design, recruiting a representative sample of n=150 AGYW aged 18-30 years from the AHRI demographic surveillance area. Performance of the Balloon Analogue Risk Task (BART), which is a measure of risk-taking propensity, will be assessed, alongside two self-reported measures that assess HIV risk behaviour and HIV risk perception. Findings from this study will provide critical insights into the correlations and differences between AGYWs “objective” HIV risk factors based on sexual behaviour, subjective self-perceived risk, and appetite for risk taking, which may influence risky sexual behaviours. Furthermore, the feasibility of the BART as a tool to measure risk-taking propensity in this population is a novel approach to understanding AGYWs likelihood of risk-taking behaviour. Therefore, this study will inform the development of tailored HIV prevention strategies for AGYW in the district, addressing the unique challenges they face in the context of rural South Africa’s high HIV burden.