{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:16:12Z","timestamp":1788243372344,"version":"build-2803163510"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000866","name":"International AIDS Vaccine Initiative","doi-asserted-by":"publisher","award":["AI0622"],"award-info":[{"award-number":["AI0622"]}],"id":[{"id":"10.13039\/100000866","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite national declines in HIV prevalence, adolescent girls and young women (AGYW) in India remain disproportionately vulnerable to sexually transmitted infections (STIs), including HIV. This vulnerability stems from a convergence of biological, social, and structural factors, including early marriage, gendered expectations, poverty, and limited access to sexual and reproductive health (SRH) information and services. While prior research has documented these determinants, few studies explore how they intersect and evolve to shape AGYW\u2019s lived experiences of risk, particularly within the general population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study used an adapted socio-ecological framework (which conceptualizes how structural, community, and individual-level factors interact to influence health and vulnerability) to examine the pathways of vulnerability to STIs and HIV among AGYW aged 16\u201324 in two urban regions: Delhi NCR and Mumbai. Data were collected through 42 in-depth interviews (IDIs), 4 focus group discussions (FGDs), and 18 key informant interviews (KIIs) with health providers, NGO staff, and program implementers. Reflexive thematic analysis was applied, guided by deductive codes from the eco-social model and inductive insights from participants\u2019 narratives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Findings show that AGYW\u2019s vulnerability is shaped by interconnected macro (e.g., early marriage, patriarchal norms), meso (e.g., school-based silences, provider bias), and micro (e.g., relationship coercion, low self-efficacy) level factors. Although some AGYW had SRH knowledge, stigma, lack of autonomy, and unsupportive environments often constrained its use. Married and low-income AGYW were particularly disadvantaged, while non-governmental organizations (NGOs) played an important but uneven role\u2014offering crucial safe spaces for awareness and support, yet limited by inconsistent coordination and resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AGYW\u2019s vulnerability to STIs\/HIV in urban India is produced through dynamic and intersecting structural, institutional, and interpersonal constraints. Addressing these requires integrated, gender-sensitive interventions that promote agency, reduce stigma, and foster collaboration between NGOs and public systems. Programs must go beyond awareness to reshape the environments in which AGYW make sexual health decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336593","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T18:22:24Z","timestamp":1764008544000},"page":"e0336593","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unpacking vulnerability to sexually transmitted infections (STIs)\/human immunodeficiency virus (HIV) among adolescent girls and young women in India: A qualitative study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3207-8393","authenticated-orcid":true,"given":"Sohini","family":"Paul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radhika","family":"Dayal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1726-9992","authenticated-orcid":true,"given":"Anupam Joya","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuhika","family":"Seth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sowmya","family":"Ramesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niranjan","family":"Saggurti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"pone.0336593.ref001","article-title":"Annual report 2021\u201322","author":"National AIDS Control Organization","year":"2022","journal-title":"Ministry of Health and Family Welfare, Government of India"},{"key":"pone.0336593.ref002","article-title":"National Family Health Survey (NFHS-5), 2019\u201321: India","author":"International Institute for Population Sciences (IIPS) & ICF","year":"2021"},{"issue":"2","key":"pone.0336593.ref003","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/17441692.2014.986169","article-title":"Sexual and reproductive health and rights of adolescent girls: evidence from low- and middle-income countries","volume":"10","author":"KG Santhya","year":"2015","journal-title":"Glob Public Health"},{"issue":"4","key":"pone.0336593.ref004","first-page":"273","article-title":"HIV and domestic violence: intersections in the lives of married women in India","volume":"36","author":"S Desai","year":"2005","journal-title":"Stud Fam Plann"},{"issue":"1","key":"pone.0336593.ref005","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ijgo.2009.06.009","article-title":"HIV vulnerabilities of sex-trafficked Indian women and girls","volume":"107","author":"J Gupta","year":"2009","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0336593.ref006","first-page":"579","article-title":"Male migration and risky sexual behavior in rural India: Is the place of origin critical for HIV prevention programs?","volume":"12","author":"N Saggurti","year":"2012","journal-title":"BMC Public Health"},{"key":"pone.0336593.ref007","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jir539","article-title":"Police-related experiences and HIV risk among female sex workers in Andhra Pradesh, India","volume":"204","author":"JT Erausquin","year":"2011","journal-title":"J Infect Dis"},{"key":"pone.0336593.ref008","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/00333549101250S412","article-title":"The context of economic insecurity and its relation to violence and risk factors for HIV among female sex workers in Andhra Pradesh, India","volume":"125","author":"E Reed","year":"2010","journal-title":"Public Health Rep"},{"issue":"1","key":"pone.0336593.ref009","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1080\/14681990600920770","article-title":"Sexual attitudes and practices in North India: A qualitative study","volume":"22","author":"D Bhugra","year":"2007","journal-title":"Sex Relation Ther"},{"issue":"1","key":"pone.0336593.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0261757","article-title":"Assessment of the quality of sexual and reproductive health services delivered to adolescents at Ujala clinics: A qualitative study in Rajasthan, India","volume":"17","author":"R Dayal","year":"2022","journal-title":"PLoS One"},{"key":"pone.0336593.ref011","volume-title":"An introduction to grounded theory","author":"K Charmaz","year":"2017"},{"key":"pone.0336593.ref012"},{"issue":"3","key":"pone.0336593.ref013","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1017\/S0021932022000220","article-title":"Attitude towards negotiating safer sexual relations: Exploring power dynamics among married couples in India","volume":"55","author":"D Vishwakarma","year":"2023","journal-title":"J Biosoc Sci"},{"issue":"10","key":"pone.0336593.ref014","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1136\/jech.55.10.693","article-title":"A glossary for social epidemiology","volume":"55","author":"N Krieger","year":"2001","journal-title":"J Epidemiol Community Health"},{"key":"pone.0336593.ref015","unstructured":"National AIDS Control Organization. Annual report 2019\u201320. Ministry of Health and Family Welfare, Government of India. 2020."},{"key":"pone.0336593.ref016","unstructured":"MoHFW | Home [Internet]. 2020 [cited 2020 May 22]. Available from: https:\/\/www.mohfw.gov.in\/"},{"key":"pone.0336593.ref017","volume-title":"Constructing grounded theory","author":"K Charmaz","year":"2014","edition":"2"},{"key":"pone.0336593.ref018","volume-title":"The SAGE handbook of qualitative research","author":"NK Denzin","year":"2011","edition":"4"},{"issue":"5","key":"pone.0336593.ref019","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s10488-013-0528-y","article-title":"Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research","volume":"42","author":"LA Palinkas","year":"2015","journal-title":"Adm Policy Ment Health"},{"issue":"1","key":"pone.0336593.ref020","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1214\/aoms\/1177705148","article-title":"Snowball Sampling","volume":"32","author":"LA Goodman","year":"1961","journal-title":"Ann Math Statist"},{"issue":"6","key":"pone.0336593.ref021","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"6","key":"pone.0336593.ref022","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1093\/fampra\/13.6.522","article-title":"Sampling for qualitative research","volume":"13","author":"MN Marshall","year":"1996","journal-title":"Fam Pract"},{"key":"pone.0336593.ref023","volume-title":"Guidelines on ethical issues in public health surveillance","author":"World Health Organization WHO","year":"2011"},{"issue":"3","key":"pone.0336593.ref024","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/1468794107078515","article-title":"Doing sensitive research: what challenges do qualitative researchers face?","volume":"7","author":"V Dickson-Swift","year":"2007","journal-title":"Qual Res"},{"issue":"2","key":"pone.0336593.ref025","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/1468794112468475","article-title":"Now I see it, now I don\u2019t: researcher\u2019s position and reflexivity in qualitative research","volume":"15","author":"R Berger","year":"2013","journal-title":"Qual Res"},{"issue":"1","key":"pone.0336593.ref026","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How Many Interviews Are Enough?","volume":"18","author":"G Guest","year":"2006","journal-title":"Field Methods"},{"issue":"2","key":"pone.0336593.ref027","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"pone.0336593.ref028","volume-title":"Thematic analysis: A practical guide","author":"V Braun","year":"2021"},{"issue":"3","key":"pone.0336593.ref029","doi-asserted-by":"crossref","first-page":"333","DOI":"10.9745\/GHSP-D-15-00126","article-title":"What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Evidence on Interventions Commonly Accepted as Best Practices","volume":"3","author":"V Chandra-Mouli","year":"2015","journal-title":"Glob Health Sci Pract"},{"issue":"1","key":"pone.0336593.ref030","first-page":"112","article-title":"Gender-transformative interventions for sexual and reproductive health in sub-Saharan Africa: lessons from implementation","volume":"17","author":"CC Okigbo","year":"2020","journal-title":"Reproductive Health"},{"issue":"2","key":"pone.0336593.ref031","article-title":"The health and wellbeing of young people living in urban slums of Nairobi, Kenya: context, challenges, and opportunities","volume":"10","author":"CW Kabiru","year":"2022","journal-title":"Lancet Glob Health"},{"issue":"3","key":"pone.0336593.ref032","first-page":"312","article-title":"Inequalities in reproductive health service access among the urban poor in Manila: implications for adolescent sexual health","volume":"15","author":"CC David","year":"2019","journal-title":"Asian Popul Stud"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336593","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T18:22:29Z","timestamp":1764008549000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336593"}},"subtitle":[],"editor":[{"given":"Geng-Feng","family":"Fu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0336593","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]}}}