Adolescent Girls and Young Women Profile
A more comprehensive version of this profile can be downloaded using the “PDF Download” button.
In a snapshot: They are caught between finding her own way and fitting in.
Adolescent girls and young women (AGYW) in sub-Saharan Africa struggle with many of the pressures familiar to young adults all over the world. They want to fit in with their friends, even as they are testing out new rules and standards for their emerging adulthood.
AGYW are disproportionately affected by HIV.
In some countries, their risk is nearly four times higher than it is for young men. 1 Girls whose economic situations are the most precarious are often at the greatest risk. 2 Unprecedented unemployment rates, a young woman’s ability to attend school, and the overall HIV incidence rates in her area influence her risk. Drug and alcohol abuse exacerbate risk, and some ethnic tribal practices are also thought to increase it, although the direct association remains unconfirmed. 3
Complex cultural and economic factors inhibit AGYW’s sexual and health agency.
AGYW experience a lack of personal agency—often as a result of early sex, marriage, and childbearing—as well as pressure to have sex while being stigmatized for being sexually active. 4 Intimate partner violence is another factor. 5
Safe sex is not considered a preventative health measure.
AGYW consider eating healthy, exercising, sleeping under a mosquito net, and good personal hygiene to be effective methods of maintaining their general health. Over 50% rely on prayer to stay healthy and 20% rely on herbal or traditional medicines. When they seek care, most are likely to visit a government hospital. 4
AGYW are often in transactional relationships in which both parties expect the male partner to dictate sexual conditions.
There is a “sponsor” trend in sub-Saharan Africa of older men offering to fund a lavish lifestyle for a girl or young woman in exchange for sex: 60% receive money, 25% receive gifts, and 15% receive both from their main partners. 6
Intergenerational sex, the common practice of having multiple partners, and peer pressure also contribute to risky behaviors and new HIV infections.
It is common for girls to place high value on abstinence before marriage. 7 , 8 While AGYW don’t report multiple concurrent partners themselves, they often say it is the norm among their friends. 9
AGYW have a low perceived risk of HIV.
Many believe that their peers are at far higher risk of contracting HIV than they are—only 24% consider themselves at personal risk. Those who do consider themselves at risk cite inconsistent condom use and not knowing if their partners are faithful as primary reasons, but the immediate cost of insisting on condom use often outweighs the distant reward of remaining HIV-free. 4 , 10
AGYW are unable to speak openly about sexual health issues in relationships.
The majority of AGYW (52%) have never discussed sexual and reproductive health with their main sexual partner, and an even larger portion (68%) have never discussed it with other (secondary) sexual partners. 6
Men can play a vital role in PrEP uptake and adherence.
For many AGYW, relationships are highly valued. 11 AGYW seek symbols of loyalty and commitment even in casual relationships, and sometimes PrEP can be seen as a symbol of distrust. 12
Understanding how PrEP works and fits into their lives is important.
It’s essential to keep in mind that not only are AGYW being introduced to a new product, but they need to figure out how to integrate it into their life and routines, which can be in constant flux. 12
Some AGYW may need to “try” PrEP before committing to it.
There is often considerable drop-off of oral PrEP use after one month of use amongst AGYW (about half did not persist in the South Africa POWER study), potentially revealing that the first month on oral PrEP is the most critical in terms of providing support and reassurance. 9
Framing PrEP in a way that is relevant to AGYW is critical.
Empathizing with and addressing their concerns and perceptions helps them make a confident choice and better yet, communicate that choice to others. 12
Give AGYW a reason to care.
Leverage moments and relatable stories that make risks feel real in their lives, especially in situations when they are considering their health proactively or feel at risk (like when going in for health tests or following a health scare). 12
A more detailed, comprehensive version of this audience profile, including their relationship to high risk activities and sexual and reproductive health, can be downloaded here.
For a sample demand creation strategy and information on the best media and tactics to reach AGYW, check out the Communications Fast Tracker.
National AIDS and STI Control Programme. Prevalence among women and men aged 15-24 years. In: Kenya AIDS Indicator Survey 2012: Final Report. Nairobi, Kenya: NASCOP; 2014. http://nacc.or.ke/kais-2012-final-report. Accessed January 3, 2018.
Stakeholder interview for the OPTIONS Landscape Analysis, 2016.
World Health Organization. Health risks of female genital mutilation (FGM). World Health Organization website. http://www.who.int/reproductivehealth/topics/fgm/health_consequences_fgm/en. Accessed January 3, 2018.
Market Intelligence Report: Kenya. https://www.prepwatch.org/wp-content/uploads/2018/05/OPTIONS_AGYW_April2018.pdf. Published April 20, 2018. Accessed December 22, 2018.
Abrahams N, Jewkes R, Martin LJ, Mathews S, Vetten L, Lombard C. Mortality of women from intimate partner violence in South Africa: a national epidemiological study. Violence Vict. 2009;24(4):546-56.
Characterization of male sexual partners of AGYW in Lesotho. Jhpiego, DREAMS. 2017. (Unpublished)
Adaji SE, Warenius LU, Ong’any AA, Faxelid EA. The attitudes of Kenyan in-school adolescents toward sexual autonomy. Afr J Reprod Health. 2010;14(1):33-41.
Garsd J, Crossan A. What it means in South Africa when you are #blessed. Public Radio International. August 10, 2017. https://www.pri.org/stories/2017-08-10/what-it-means-south-africa-when-you-are-blessed. Accessed January 18, 2019.
POWER Study Team. Prevention Options for Women Evaluation Research (POWER) Formative Work Report. https://www.prepwatch.org/wp-content/uploads/2017/09/POWER_FormativeWork.pdf. Published August 10, 2017. Accessed January 3, 2018.
HIV Prevention Market Manager. Breaking the Cycle of Transmission: Increasing adoption of and adherence to effective HIV prevention among high-risk adolescent girls and young women. March 2019 (unpublished).
Lanham M, Wilcher R, Montgomery ET, et al. Engaging male partners in women’s microbicide use: evidence from clinical trials and implications for future research and microbicide introduction. J Int AIDS Soc. 2014;17(3 suppl2):19159. doi:10.7448/IAS.17.3.19159.
The Dapivirine Ring design guide. https://www.avac.org/sites/default/files/resource-files/dap_ring_HCG.pdf. Published July 2017. Accessed January 18, 2019.