# 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.

## Key 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.