HERStory Study

Introduction

Background to AGYW programme

From 2016 to the present day, the Global Fund to Fight AIDS, TB and Malaria (the Global Fund) has invested in a combination intervention for adolescent girls and young women (AGYW) aged 10 to 24 years in priority districts in South Africa, with the aim of reducing HIV incidence, teenage pregnancy, and gender-based violence and increasing retention in school and access to economic opportunities.

A team of scientists at the South African Medical Research Council, together with colleagues from Brown University School of Public Health, the University of Cape Town, the National Institute for Communicable Diseases, and other institutions, have led the HERStory 1 and 2 studies which evaluate the AGYW programme.

HERStory 1

Study Title: HERStory 1 – An evaluation of a South African combination HIV prevention intervention for adolescent girls and young women (AGYW)

Description: The HERStory Study is an evaluation of the South African combination HIV-prevention intervention for adolescent girls and young women (AGYW). The first phase of the evaluation has been completed.

Aims/Objectives: The primary objective of the HERStory Study was to determine the intervention impact on HIV incidence. Secondary objectives include assessing the intervention impact on HIV risk behaviour, other sexually transmitted infections (STIs) and cognitions, behaviour, and social environments of AGYW.

HERStory 2

Study Title: HERStory 2 – Process evaluation of the combination HIV prevention intervention for adolescent girls and young women (AGYW), Global Fund grant period 2019 to 2022

Description: A process evaluation of the AGYW combination intervention being implemented during the 2019 to 2022 Global Fund grant period.

Aims/Objectives: The aim was to assess whether the intervention was being implemented as planned and whether the implementers were on a trajectory to achieve the outcomes, with reference to the theory of change for the intervention being delivered in the grant period 2019 to 2022.

HERStory Reseach Briefs

We are releasing a series of research briefs focusing on the findings from the HERStory studies. From 2016 to the present day, the Global Fund to Fight AIDS, TB and Malaria (the Global Fund) has invested in a combination intervention for adolescent girls and young women (AGYW) aged 10 to 24 years in priority districts in South Africa, with the aim of reducing HIV incidence, teenage pregnancy, and gender-based violence and increasing retention in school and access to economic opportunities.

The HERStory research brief series focuses on the health, education and well-being of adolescent girls and young women in South Africa. Using the findings from the studies evaluating the AGYW programme, we outline key areas of concern, summarise key findings, and outline implications for policy and practice.

The studies described in the research briefs show that innovative programmes like the donor-funded programme we have been evaluating, are showing promise. Our research identifies aspects of these programmes that are impactful and aspects that could be strengthened in the future. These programmes are making a difference to the lives of AGYW and should be strengthened and implemented widely.

When strengthening programmes for AGYW, it is important to take into consideration that our research, and much other research, shows that AGYW in these districts are vulnerable due to structural issues such as poverty, poor education systems, gender power imbalances, unresponsive public health services, and communities that might not be supportive of their needs. Programmes need to focus on these aspects of the context in which AGYW live so that AGYW can be safe, thrive, and live healthy lives.

Addressing the intersecting vulnerabilities in mental health and sexual and reproductive health amongst adolescent girls and young women in South Africa	Addressing barriers to open sexuality communication between South African adolescent girls and young women and their mothers to facilitate safe sexual and reproductive decision-making
Understanding why South African Adolescent Girls and Young Women engage in Transactional Sex and Relationships	Educational equity and transformation in a digital age: Lessons learned during the COVID-19 pandemic
COVID-19 and socio-economic mental health stressors in the lives of South African adolescent girls and young women	Safe Spaces for adolescent girls and young women (AGYW) as part of combination HIV prevention programmes in South Africa: how accessible, feasible and acceptable are they?
Relationship Dynamics, Gendered Power, and Motivations for Condomless Sex Amongst Adolescents and Young People in South Africa	Lessons learned from implementing a PrEP programme for adolescent girls and young women in South Africa
Access, use, and perceptions of contraception services among adolescent girls and young women in South Africa	“We can’t share things with our teachers”: narratives of mistrust and disconnect between South African female learners and their teachers

Reports

HERStory 1: Evaluation of a South African Combination HIV Prevention Programme for Adolescent Girls and Young Women
HERStory 1 Report 1: AGYW Survey 2017-2018	HERStory 1 Report 2: Qualitative Evaluation Component

HERStory2: Process evaluation of the combination HIV prevention intervention for adolescent girls and young women (AGYW), Global Fund grant period 2019 to 2022
HERStory2 Report 1/5: Overview of Findings and Combined Recommendations	HERStory2 Report 2/5: AGYW Survey	HERStory2 Report 3/5: Qualitative Evaluation
HERStory2 Report 4/5: Leadership and Management Evaluation	HERStory2 Report 5/5: Record Review

Research Outputs

HERStory 1

Peer reviewed papers

Jonas K, Duby Z, Maruping K, Harries J and Mathews C (2022) Rumours, myths, and misperceptions as barriers to contraceptive use among adolescent girls and young women in South Africa. Front. Reprod. Health 4:960089. doi: 10.3389/frph.2022.960089
Duby Z, Maruping K, Jonas K, McClinton Appollis T, Vanleeuw L and Mathews C (2022) “We can’t share things with our teachers”: Narratives of mistrust and disconnect between South African female learners and their teachers. Frontiers in Education 7:882959. https://doi.org/10.3389/feduc.2022.882959
LoVette A, Sullivan A, Operario D, Kuo C, Harrison A, Mathews C. Social resources, resilience, and sexual health among South African adolescent girls and young women: findings from the HERStory study. Cult Health Sex. 2022 Aug 12:1-15. Epub ahead of print. PMID: 35960862. DOI: 10.1080/13691058.2022.2108501
Dietrich JJ, Jonas K, Cheyip M, McClinton Appollis T, Ariyo O, Beauclair R, Lombard C, Gray GE, Mathews C. Examining the Relationship Between Psychosocial Factors with Knowledge of HIV-Positive Status and Antiretroviral Therapy Exposure Among Adolescent Girls and Young Women Living with HIV in South Africa. AIDS Behav. 2022 Jul 16. Epub ahead of print. PMID: 35841462. DOI: 10.1007/s10461-022-03759-6
Jonas, K., Lombard, C., Chirinda, W., Govindasamy, D., Appollis, T. M., Kuo, C., Gray, G., Beauclair, R., Cheyip, M., & Mathews, C. (2022). Participation in an HIV prevention intervention and access to and use of contraceptives among young women: A cross sectional analysis in six South African districts. Contraception, S0010-7824(22)00199-8. https://doi.org/10.1016/j.contraception.2022.07.005
Duby, Z., Verwoerd, W., Isaksen, K., Jonas, K., Maruping, K., Dietrich, J., Lovette, A., Kuo, C. & Mathews, C. (2022) ‘I can't go to her when I have a problem’: sexuality communication between South African adolescent girls and young women and their mothers, SAHARA-J: Journal of Social Aspects of HIV/AIDS, 19:1, 8-21, DOI: 10.1080/17290376.2022.2060295
Duby, Z., McClinton Appollis, T., Jonas, K. et al. (2020). “As a Young Pregnant Girl… The Challenges You Face”: Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa. AIDS and Behavior, 25(2), 344-353. https://doi.org/10.1007/s10461-020-02974-3
Duby, Z., Verwoerd, W., McClinton Appollis, T., Jonas, K. Maruping, K. et al. (2021) “In this place we have found sisterhood”: perceptions of how participating in a peer-group club intervention benefited South African adolescent girls and young women. International Journal of Adolescence and Youth, 26(1). https://doi.org/10.1080/02673843.2021.1898423
Duby, Z., Jonas, K. McClinton Appollis, T., Maruping, K., Dietrich, J., Vanleeuw, L. & Mathews, C. (2020) “There is no fear in me … well, that little fear is there”: dualistic views towards HIV testing among South African adolescent girls and young women, African Journal of AIDS Research, 19(3). DOI: 10.2989/16085906.2020.1799232
Duby, Z., Jonas, K., Maruping, K., McClinton Appollis, T., Vanleeuw, L., & Mathews, . From Survival to Glamour: Motivations for Engaging in Transactional Sex and Relationships Among Adolescent Girls and Young Women in South Africa. AIDS Behav (2021). https://doi.org/10.1007/s10461-021-03291-z
Duby, Z., Jonas, K. McClinton Appollis, T., Maruping, K., Dietrich, J. & Mathews, C. (2021) “Condoms Are Boring”: Navigating Relationship Dynamics, Gendered Power, and Motivations for Condomless Sex Amongst Adolescents and Young People in South Africa, International Journal of Sexual Health, 33(1). DOI: 10.1080/19317611.2020.1851334
Jonas, K., Duby, Z., Maruping, K. et al. Perceptions of contraception services among recipients of a combination HIV-prevention interventions for adolescent girls and young women in South Africa: a qualitative study. Reprod Health 17, 122 (2020). https://doi.org/10.1186/s12978-020-00970-3
Kuo, C. Dietrich, J., Slingers, N., Beauclair, R., Lombard, C., Mathews, C. An emerging substance use epidemic: Recreational use of HIV pre-exposure prophylaxis and treatment in South Africa. AIDS Patient Care and STDs. AIDS PATIENT CARE and STDs, Volume 35, Number 3. DOI: 10.1089/apc.2020.0218
Kuo, C. LoVette, A., Slingers, N., Mathews, C. Predictors of resilience among girls and young women who have experienced interpersonal violence in South Africa. Journal of Interpersonal Violence. https://doi.org/10.1177/08862605211005158
Mathews, C., Cheyip, M., Beauclair, R., Puren, A., Lombard, C., Jonas, K., Ayalew, K., Govindasamy, D., Kuo, C., Dietrich, J., Abdullah, F., & Gray, G. (2021). HIV care coverage among HIV-positive adolescent girls and young women in South Africa: Results from the HERStory Study. South African Medical Journal, 111(5), 460-468. doi:10.7196/SAMJ.2021.v111i5.15351
McClinton Appollis, T., Duby, Z., Jonas, K. et al. Factors influencing adolescent girls and young women’s participation in a combination HIV prevention intervention in South Africa. BMC Public Health 21, 417 (2021). https://doi.org/10.1186/s12889-021-10462-z
McClinton Appollis, T., Jonas, K., Beauclair, R., Lombard, C., Duby, Z. Cheyip, M., Maruping, K., Dietrich, J. & Mathews, C. (2021): Early Sexual Debut and the Effects on Well-Being among South African Adolescent Girls and Young Women Aged 15 to 24 Years, International Journal of Sexual Health. https://doi.org/10.1080/19317611.2021.1979162

HERStory 2

Peer reviewed papers

Duby Z, Bergh K, Jonas K, Reddy T, Bunce B, Fowler C, Mathews C. "Men Rule… this is the Normal Thing. We Normalise it and it's Wrong": Gendered Power in Decision-Making Around Sex and Condom Use in Heterosexual Relationships Amongst Adolescents and Young People in South Africa. AIDS Behav. 2022 Nov 28. doi: 10.1007/s10461-022-03935-8. Epub ahead of print. PMID: 36441410. https://pubmed.ncbi.nlm.nih.gov/36441410/
Mathews C, Duby Z, Bunce B, van Blydenstein N, Bergh K, Ambrose A, Mpungu F, Jonas K. Safe spaces for beneficiaries of a combination HIV prevention intervention for adolescent girls and young women in South Africa: access, feasibility, and acceptability. BMC Public Health. 2022 May 21;22(1):1026. doi: 10.1186/s12889-022-13445-w. PMID: 35597929. https://pubmed.ncbi.nlm.nih.gov/35597929/
Duby, Z., Bunce, B., Fowler, C., Bergh, K., Maruping, K., Jonas, K., Dietrich, J., Govindasamy, D., Kuo, C. & Mathews, C. (2022). Intersections between COVID-19 and socio-economic mental health stressors in the lives of South African adolescent girls and young women. Child and Adolescent Psychiatry and Mental Health. https://doi.org/10.1186/s13034-022-00457-y
Duby, Z., Jonas, K., Bunce, B., Bergh, K., Maruping, K., Fowler, C., Reddy, T., Govindasamy, D. & Mathews, C. (2022). Navigating Education in the Context of COVID-19 Lockdowns and School Closures: Challenges and Resilience Among Adolescent Girls and Young Women in South Africa. Frontiers in Education, 7. https://doi.org/10.3389/feduc.2022.856610
Duby, Z., Jonas, K., Bunce, B., Bergh, K., Maruping, K., Fowler, C., Reddy, T., Govindasamy, D. & Mathews, C. (2022). Navigating Education in the Context of COVID-19 Lockdowns and School Closures: Challenges and Resilience Among Adolescent Girls and Young Women in South Africa. Frontiers in Education, 7. DOI:10.3389/feduc.2022.856610.

Conference outputs

Conference Abstracts

Posters/Presentations

	Narratives of Mental Health Amongst Adolescent Girls and Young Women in Five South African Provinces		Adolescent Girls’ and Young Women’s Perspectives on the Effects of Participating in a South African Combination HIV Prevention Intervention funded by the Global Fund
	Attitudes towards HIV Testing Amongst Young People in Five South African Provinces		Mental health challenges faced by adolescent girls and young women in five South African provinces: perceptions, experiences, and the impact of a combination HIV prevention intervention
	South African adolescent girls’ and young women’s communication with and support from parents and teachers: implications for sexual and reproductive health decisions		Implementation Recommendations for HIV Prevention Programmes Targeting Adolescent Girls and Young Women in South Africa
	HERStory 1: An evaluation of a South African combination HIV prevention intervention for adolescent girls and young women (AGYW) in ten South African Districts - Summary of Key Findings and Recommendations