{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T23:19:29Z","timestamp":1793747969571,"version":"4.6.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>High HIV prevalence among adolescent girls and young women (AGYW) in South Africa is driven by multiple interacting psychosocial risks. Some of these risks include socioeconomic deprivation, poor educational outcomes, poor mental health, alcohol and drug use which are associated with HIV-infection and sexual risk behavior. This article seeks to deepen our understanding of the role of psychosocial and behavioral factors in the HIV epidemic among AGYW.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional survey (<jats:italic>n<\/jats:italic>\u202f=\u202f18,296) targeting AGYW aged between 12 and 24\u202fyears old was undertaken in four districts in KwaZulu-Natal and Gauteng. The analysis used descriptive statistics and hierarchical multiple binary logistic regressions that were disaggregated by age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age is 18 (SD:4) years old. Displaying depressive symptoms had increased odds of being HIV positive among the 15-19-year-old age group of AGYW (AOR: 1.12, 95% CI: 1.05\u20131.18, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). For the 20-24-year olds, increased substance use was associated with a higher likelihood of being HIV positive (AOR: 1.10, 95% CI: 1.03\u20131.17, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.01) and those who experienced Intimate Partner Violence (IPV) were more likely to be HIV positive (AOR: 1.41, 95% CI: 1.08\u20131.85, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Our findings indicate a lower prevalence of depressive symptoms in the two adolescent groups (12\u201315\u202fyears old and 15\u201319\u202fyears old) than in the older group (20\u201324\u202fyears old); nevertheless, depressive symptoms increased the likelihood of being HIV positive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study suggests that HIV interventions are likely to be beneficial if they address individual HIV risk factors such as poor mental health challenges and IPV. However, due to the cross-sectional design, causality or temporal sequencing\u2014particularly in bidirectional relationships such as depression and HIV\u2014cannot be established. Interpretations should therefore be made with caution.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1620084","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T05:29:34Z","timestamp":1756186174000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Psychosocial and behavioral factors associated with HIV among adolescent girls and young women in DREAMS districts in South Africa: cross-sectional survey"],"prefix":"10.3389","volume":"13","author":[{"given":"Kaymarlin","family":"Govender","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Beckett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Mukuku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherie","family":"Cawood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Khanyile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarylee","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Cowden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Puren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e429","DOI":"10.1016\/S2352-3018(21)00069-2","article-title":"Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies","volume":"8","author":"Risher","year":"2021","journal-title":"Lancet HIV"},{"key":"ref2","year":""},{"key":"ref3","volume-title":"South African national HIV prevalence, incidence, behaviour and communication survey, 2017: towards achieving the UNAIDS 90\u201390-90 targets","author":"Simbayi","year":"2019"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0153969","DOI":"10.1371\/journal.pone.0153969","article-title":"Individual and population level impact of key HIV risk factors on HIV incidence rates in Durban, South Africa","volume":"11","author":"Ramjee","year":"2016","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"435","DOI":"10.2105\/AJPH.2009.159723","article-title":"Rethinking gender, heterosexual men, and women's vulnerability to HIV\/AIDS","volume":"100","author":"Higgins","year":"2010","journal-title":"Am J Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.1007\/s10461-012-0217-y","article-title":"The disproportionate high risk of HIV infection among the urban poor in sub-Saharan Africa","volume":"17","author":"Magadi","year":"2013","journal-title":"AIDS Behav"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s12939-019-1055-6","article-title":"HIV prevalence in South Africa through gender and racial lenses: results from the 2012 population-based national household survey","volume":"18","author":"Mabaso","year":"2019","journal-title":"Int J Equity Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"37","DOI":"10.2989\/16085900509490340","article-title":"Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa","volume":"4","author":"Hallman","year":"2005","journal-title":"Afr J AIDS Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1057\/sth.2014.14","article-title":"Poverty and HIV\/AIDS in Africa: specifying the connections","volume":"13","author":"Mufune","year":"2015","journal-title":"Soc Theor Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1111\/j.1540-6237.2009.00650.x","article-title":"Gendered epidemiology: sexual equality and the prevalence of HIV\/AIDS in sub-Saharan Africa*","volume":"90","author":"Ni\u00ebns","year":"2009","journal-title":"Soc Sci Q"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1007\/s10461-017-1706-9","article-title":"Gender norms, gender role conflict\/stress and HIV risk behaviors among men in Mpumalanga, South Africa","volume":"22","author":"Gottert","year":"2018","journal-title":"AIDS Behav"},{"key":"ref12","volume-title":"UNESCO Fixing the Broken Promise of Education for All: Findings from the Global Initiative on Out-of-School Children Montreal UNESCO Institute for Statistics","year":"2015"},{"key":"ref13","volume-title":"School dropout: Patterns, causes, changes and policies. 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