Desmond Tutu HIV Foundation awarded Grant to protect South African adolescent Girls and Young Women from STIs

The Desmond Tutu HIV Foundation has recently been awarded grant, titled “A multilevel comprehensive HIV prevention package for South African adolescent girls and young women” to improve support and communication between girls and young women and their mothers or other female caregivers.

The Desmond Tutu HIV Foundation at the University of Cape Town (UCT) is working on an encouraging new programme designed to help reduce the incidence of sexually transmitted infections (STIs), including HIV, among girls and young women.

Co-investigator on the study, Professor Linda-Gail Bekker explained that, “The Informed, Motivated, Aware and Responsible about AIDS (IMARA) programme, an evidence-based comprehensive HIV-prevention package designed by the University of Illinois at Chicago (UIC) in the United States, will be adapted for a South African context.”

Bekker further said, “We know it is really critical to empower young women to be able to protect themselves. There is also some evidence to show that family support is key, especially from an older female relative, such as a mother, an aunt or older sister.”

She also said, “However often the adolescent doesn’t know how to reach out and the older relative also struggles to make contact on these issues. People need help in having these often tricky conversations.”

Bekker explained that the grant will be conducted in two phases. Phase 1 will take the already developed IMARA programme and adapt it for the South African context in a pilot study involving 50 daughter–mother pairs.

Bekker said, “STIs are an easier outcome to track than HIV. Although both result from unprotected sex, STIs occur more frequently than HIV. We urgently need to find solutions for young women and adolescent girls in this region. Every week almost 2 000 young women and girls in South Africa get infected with HIV.”

IMARA will explore this more deeply, and hopefully provide guidance, according to Bekker, who is also the chief operating officer of the Desmond Tutu HIV Foundation.

The study is one of several international projects in Africa and Brazil that are part of the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H).

The UIC received a two-year, $1.2 million grant from the National Institutes of Health (NIH) to tailor the programme in South Africa, while UCT is the implementing partner.

The IMARA programme includes education about STIs, including HIV, as well as communication skills that are designed to strengthen the mother/female caregiver–daughter bond. It also focuses on the importance of healthy peer and romantic relationships, effective parental monitoring and developing positive decision-making skills.

Professor of Medicine and Psychology at UIC and principal investigator on the grant, Professor Geri Donenberg said, “It is vital that this primary relationship in a young girl’s life remains strong and positive, with open lines of communication. Often the adolescent doesn’t know how to reach out and the older relative also struggles to make contact on these issues. People need help in having these often tricky conversations.”

Donenberg further said, “This has positive effects on the health of both of them, including, as we have shown, reducing the likelihood of acquiring a sexually transmitted infection. Recognising that context really matters, this is an important phase and will be done in partnership with communities linked to the Desmond Tutu HIV Foundation.”

The programme also encourages participants to consider how the media and its portrayal of young women influences their behaviour, and how those behaviours may affect health outcomes.

In a randomised controlled study in Chicago, IMARA reduced the risk of new STIs by 45% among black girls aged 14 to 18 years old, compared to the control group.

Apart from helping to prevent STIs, the programme is also designed to increase HIV testing and linkage to care at clinics among South African adolescent girls and their female caregivers.

In the second phase they will randomise 525 daughter–mother/caregiver pairs to the now adapted IMARA programme.

Participants will be tested for HIV and other STIs at the beginning of the study, and at six and 12 months after enrolment. HIV counselling and testing and PrEP (pre-exposure prophylaxis) will be offered at each assessment. Participants interested in PrEP or who test positive for an STI, including HIV, will receive treatment at the Desmond Tutu HIV Foundation.

According to the Joint United Nations Programme on HIV/AIDS, an estimated 1.6 million people aged 15 and older worldwide were newly infected with HIV in 2017. South Africa has the largest HIV epidemic in the world, and adolescent girls and young women acquire HIV at twice the rate of their male peers.