Factors associated with HIV infection among Adolescent Girls and Young Women aged 15-24 years enrolled in Adolescent Girls and Young Women program in Southern Province, Rwanda, 2025

In the landscape of global health, few challenges are as persistent or as deeply personal as the spread of human immunodeficiency virus, or HIV. This virus attacks the body's immune system, and without treatment, it can lead to a condition that leaves the body vulnerable to other serious illnesses. For decades, public health efforts have focused on understanding who is most at risk and why. In many parts of the world, particularly in sub-Saharan Africa, young women between the ages of fifteen and twenty-four face a disproportionate burden of new infections. These young women often navigate a complex web of social and economic pressures that make it difficult to protect themselves. Researchers know that factors like poverty, lack of education, and violence play a role, but the specific mix of causes can vary from one region to another. To design effective programs that actually stop the virus from spreading, health officials need a clear, local picture of what is happening on the ground. They need to know not just how many young women are infected, but exactly which circumstances are pushing them toward infection so that help can be targeted where it is needed most.

In the Southern Province of Rwanda, a team of researchers set out to uncover these specific circumstances among a group of young women already engaged with a government support program. The study focused on 1,275 adolescent girls and young women, all between the ages of fifteen and twenty-four, who were enrolled in a routine health initiative designed to support them. The researchers visited thirty-five different health centers across the province, selecting participants in a systematic way to ensure the group represented the broader population of young women in the program. They gathered information through detailed interviews, asking about the participants' lives, their relationships, their history of violence, their education, and their knowledge of HIV. By comparing the lives of those who were living with HIV against those who were not, the team could identify which factors were most strongly linked to the infection.

The results revealed a sobering reality: among the young women in this program, fifteen point six percent were living with HIV. This rate is significantly higher than the national average for the general population, highlighting the intense vulnerability of this specific group. The study did not just count the cases; it traced the paths that led to them. The researchers found that young women who had lost one or both parents were more than twice as likely to be living with HIV compared to those with living parents. This suggests that the loss of family support creates a gap that leaves young women exposed to risks they might otherwise avoid. Similarly, those who had experienced gender-based violence, particularly sexual violence, faced a much higher risk. The data showed that women who had been subjected to sexual violence were nearly three times more likely to be infected than those who had not faced such trauma.

Perhaps the most powerful predictor of infection was found in the realm of relationships and personal safety. The study showed that young women who could not consistently use condoms with their primary partners were almost seven times more likely to be living with HIV. This inability to protect themselves was not just a matter of choice; it was often tied to a lack of power in the relationship. The researchers found that women who felt they could not refuse sex without a condom were more than four times as likely to be infected. This lack of agency was a critical thread running through the data. Furthermore, the study identified that believing HIV could be cured was a dangerous misconception, linked to a much higher likelihood of infection. This suggests that when young women think the virus is a temporary or treatable condition, they may not take the necessary steps to prevent it in the first place. Other factors, such as a history of injecting drugs and a history of other sexually transmitted infections, also stood out as significant risks.

The researchers also looked at whether things like education level or employment status were the main drivers, but the data told a different story. While unemployment was common among the participants, it was not the primary factor distinguishing those with HIV from those without. Instead, the picture that emerged was one of interconnected vulnerabilities: the loss of parental support, the trauma of violence, the inability to negotiate safe sex, and the spread of misinformation. The study makes it clear that these issues do not exist in isolation. A young woman who is an orphan and has experienced violence is often in a situation where she has little control over her sexual health, making her highly susceptible to the virus. The findings suggest that simply providing medical services is not enough; interventions must also address the deep social and psychological barriers that prevent these young women from protecting themselves. By focusing on psychosocial support, strengthening the ability of young women to say no to unsafe sex, and correcting dangerous myths about the virus, health programs can begin to turn the tide. The study concludes that to truly reduce HIV infections among this group, efforts must be integrated, addressing the root causes of vulnerability rather than just the symptoms.