July 13, 2011 - A new study led by researchers at the Johns Hopkins Bloomberg School of Public
Health shows that community members correlate an increase in HIV vulnerability among adolescent girls with weak structural support systems.
While adolescent girls are three to four times more likely than adolescent boys to be living with HIV/AIDS in sub-Saharan Africa, few
studies have examined the reasons community members believe girls are so vulnerable to HIV. The findings are published in the
journal Social Science & Medicine .
Carol Underwood, PhD, lead author of the study and assistant professor at the Bloomberg School of Public
Health's Department of Health, Behavior and Society ,
explained, "This study represents one of the few efforts to explore community members' perceptions of vulnerability to HIV.
It is unique because it offers insights into developing an HIV response that is grounded in the views of communities most
affected by HIV/AIDS rather than a response based primarily on perspectives from the outside."
Underwood directed the Gender Initiative on Girls' Vulnerability to HIV (Go Girls! Initiative), an intervention informed
by this study and carried out by the Bloomberg School of Public Health's Center for
Communication Programs . The Go Girls! Initiative used focus group discussions with adolescent girls and boys, adult men and
women and community opinion leaders, in Botswana, Malawi and Mozambique to develop social, gender, and behavior change
communication approaches to reduce adolescent girls' susceptibility to HIV infection.
The study found that structural factors, especially insufficient economic, educational, socio-cultural and legal support
for adolescent girls, were identified as the root causes of girls' vulnerability to HIV through exposure to unprotected sexual
relationships, primarily relationships that are transactional and age-disparate. This finding is in line with current HIV
prevention practice, which advocates for combination prevention that comprises biomedical, behavioral and structural interventions.
"Nevertheless, while greater attention is being paid to the importance of structural interventions in HIV prevention
efforts," cautions Underwood, "most efforts still focus on the individual and disregard the complex socio-economic context where
the infections are occurring, a situation which must be met with nuanced and multi-level responses."
"We found that both adolescents and adults in HIV-affected communities highlighted structural interventions, behavioral
interventions, and testing-in that order-for prevention," she said.
Community members explicitly called for policies and interventions to strengthen cultural, economic, educational and legal structures
to protect girls, findings that were used to develop the interventions implemented by the Go Girls! Initiative.
Authors of "Structural Determinants of
Adolescent Girls' Vulnerability to HIV: Views from Community Members in Botswana, Malawi and Mozambique" include Underwood,
Joanna Skinner, Nadia Osman and Hilary Schwandt.
Funding for the research was provided by the President's Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for
International Development (USAID).
SOURCE:John Hopkins Bloomberg School of Public Health
Tim Parsons, director of Public Affairs,