Stress-responsive biomarkers and sexual behaviors among young women in rural South Africa

TL;DR

This study explores how stress-related biomarkers are linked to risky sexual behaviors in young women in rural South Africa, which could increase their HIV risk.

Contribution

The study is the first to examine the longitudinal relationship between stress-responsive biomarkers and sexual behaviors in adolescent girls in high-HIV areas.

Findings

Higher CRP levels were associated with having older partners and engaging in condomless sex.

Medium and high CRP levels showed significant risk ratios for age-disparate relationships and condomless sex.

The study suggests a potential stress-inflammation-sexual behavior pathway that requires further investigation.

Abstract

Adolescence is a critical period when youth develop their decision-making skills and may engage in their first sexual encounters. Stress during this time can affect decision making; however, limited research has examined the relationship between biological stress correlates and sexual behavior among adolescent girls and young women (AGYW) in high-HIV incidence areas.

To examine whether stress-responsive biomarkers are longitudinally associated with sexual behaviors that are predictive of HIV.

We used data from a cohort of 897 AGYW nested within the HIV Prevention Trials 068 study in rural South Africa. Stress-responsive biomarkers were tested retrospectively from enrollment: C-reactive protein (CRP), herpes simplex virus type-1 (HSV-1) antibody titers, and cytomegalovirus (CMV) antibody titers. We estimated the longitudinal associations between each biomarker (2011-2012) and each behavior throughout follow-up (2011-2019; transactional sex, age-disparate partnerships, multiple partners, and condomless sex).

At enrollment, 25.4% (n = 228) had ever had sex, 7.0% (n = 63) had >1 partner, 7.9% (n = 71) had recent condomless sex, and 3.0% (n = 27) reported transactional sex. Compared to low CRP levels, medium and high CRP levels were associated with having an older partner (RR: 1.41 [95% CI, 1.08-1.84]; RR: 1.33 [95% CI, 1.02-1.74], respectively) and with condomless sex (RR: 1.40 [95% CI, 1.10-1.77]; RR: 1.42 [95% CI, 1.12-1.80], respectively).

Higher CRP levels were longitudinally associated with age-disparate relationships and condomless sex. Inflammation may increase AGYW’s engagement in these behaviors; however, future studies should examine whether there is a stress-inflammation-sexual behavior pathway, and if so, evaluate stress-reduction interventions to promote sexual well-being.

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