Determining HIV Risk for Adolescent Girls and Young Women (AGYW) in Relationships with “Blessers” and Age Disparate Partners: A Cross-Sectional Survey in Four Districts in South Africa

Background: HIV incidence among adolescent girls and young women (AGYW) remains high, with their male partners a prominent factor in sustaining these elevated rates. Partnership characteristics remain important metrics for determining HIV risk, with evidence indicating that AGYW engaged in transactional and age-disparate relationships facing greater HIV exposure. This study examines the risk posed to AGYW in a relationship with a “Blesser” only, defined as male who provides his female partner with their material needs or desires in exchange for a sexual relationship and age-disparate (5 or more years older). Methods: A cross -sectional household based representative sample of AGYW (aged between 12–24 years) were enrolled in the study (n=18 926) from the districts of City of Johannesburg and Ekurhuleni in the Gauteng province and the Districts of eThekwini and uMgungundlovu in the province of KwaZulu-Natal (KZN) in South Africa between March 13, 2017 to June 22, 2018. Participants completed a structured questionnaire and provided finger-prick blood samples for laboratory measurements. Our analysis used descriptive statistics and multiple binary logistic regressions accounting for survey weights, clustering and stratification. Findings: Whilst all relationships exposed AGYW to potential HIV risk, multiple binary logistic regression analysis revealed that AGYW in a relationship with a Blesser and an age disparate partner were more likely to be HIV positive (AOR: 3.12, 95% CI: 1.76-5.53, p <0.001), diagnosed with an STI (AOR: 4.60, 95% CI: 2.99-7.08, p <0.001), had 2 or more sexual partners in the previous 12 (AOR: 6.37, 95% CI: 3.85-10.54, p <0.001), engaged in sexual activity at age 15 or younger (AOR: 3.67, 95% CI: 2.36-5.69, p <0.001) and more likely to have ever been pregnant (AOR: 2.60, 95% CI: 1.24-5.45, p <0.05) than those not in a relationship with a Blesser and age-disparate partner. Conclusion: Different relationships present different HIV to AGYW. AGYW who had engaged in relationships with both a Blesser and an age-disparate partner were at greater HIV risk when examined against these relationships independent of one another. The data reveals the compounded HIV risk of being in both a transactional and age-disparate relationship.