​#AIDS2016: ‘Blessers’ are the engine behind the rapid spread of HIV in young women

About 60% of all new HIV infections in young South African women and teenage girls could be linked to older men, according to new research that has mapped how HIV moves and how the virus evolves throughout our lives.

By the time young women reach the age of 24, almost one in 10 is living with HIV, the 2012 Human Sciences Research Council’s latest HIV household survey found.

To understand why young women are at such high risk of HIV infection, researchers from the Centre for the Aids Programme of Research in South Africa (Caprisa) mapped the spread of HIV in Vulindlela, KwaZulu-Natal, where about a third of the population is HIV positive. Conducted among almost 10 000 people, the study analysed HIV’s genetic code in about 1 600 people who were infected with the virus. This kind of molecular sequencing allowed researchers to map whose viruses were similar at a genetic level or who had contracted the viruses from each other or another related person.

In teenage girls and young women between the ages of 15 and 24, 62.8% of HIV infections were linked to men between the ages of 25 and 40, according to Caprisa director Salim Abdool Karim. Karim released the research on Tuesday at the International Aids Conference in Durban.

When these women and girls reach their mid-20s to 40s, they start to look for different qualities in a relationship and get involved with men who are their peers.

“These women are now sleeping with men of the same age or about a year’s difference,” Karim says. “They are now trying to find their husbands and the men are trying to find their wives so this is about pairing to establish their future.”

But, by this time, many of the women are already infected with HIV. They then pass on the virus to their long-term partners.

“In effect, what we have is that many women in the 25 to 40 age group are infected with HIV and then transmit it can to the men in that same age group,” Karim explains. “Those men have liaisons with young women and [in turn] they are passing the virus on to these young women.

“This is the cycle that is driving HIV in our communities and leading to very high rates of HIV infection,” he says.

About 40% of the men who had transmitted HIV to a young woman or teenage girl in the study acquired the virus from an older woman.

The study may contradict previous 2014 research published in the Journal of Acquired Immune Deficiency Syndrome by the Africa Centre for Health and Population that argued sex with older men was not linked to HIV infection among about 2 500 young women.

Men who are involved with teenage girls or young women are often labelled “blessers” because they provide younger women with financial security from these relationships.

The latest Caprisa study did not look at why younger women had become involved with older men.

According to Karim, the Caprisa study points to the need to target HIV prevention efforts at young women and men to help break the chain of HIV transmission. He says one such strategy is to ensure that men are medically circumcised by the age of 25. Research has shown that medical circumcision reduces a man’s risk of contracting HIV through vaginal sex by about 60%.

And young women should be provided with the new, HIV prevention pill Truvada, says Karim. When taken daily, Truvada has been shown to lower the risk of contracting HIV by about 75% in heterosexual couples in which one partner was living with HIV.

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