What question did this study set out to answer?

This study aims to explore how social and structural factors contribute to the vulnerability of young adults to HIV infection in South Africa.

May 25, 2026Open Access

Social and structural factors associated with vulnerability to HIV infection among young adults in South Africa

Key Points

This study aims to explore how social and structural factors contribute to the vulnerability of young adults to HIV infection in South Africa.
Mixed-methods approach combining qualitative interviews and a quantitative household-based survey
Participants aged 18-24 from four provinces in South Africa
Adjusted odds ratios (aOR) used to analyze predictors of self-reported HIV infection
STI diagnosis in a lifetime is strongly associated with increased HIV risk (aOR 13.68; p < .001)
Inconsistent condom use correlates with higher infection risk (aOR 6.27; p < .01)
Effective communication about condom use and higher education levels decrease infection chances (aOR .08 and .04; p < .001 and p < .05)

Abstract

There is increasing focus on social and structural factors following the marginal success of individual-level strategies for HIV prevention. While there is evidence of decreased HIV prevalence among young individuals in South Africa, there is still a need to monitor HIV incidence and prevalence in this vulnerable group as well as track and prevent high-risk sexual behavior(s). This study investigated the social and structural factors that shape the context of vulnerability to increased risk of exposure to HIV infection. A mixed-methods approach including qualitative and quantitative design components was employed. Young adults in the age group 18-24 were interviewed from four provinces in South Africa. The qualitative results produced strong support for the effectiveness of loveLife's HIV prevention programs. The household-based survey results showed that the strongest predictors of self-reported HIV infection (indicating a greater chance of being infected) using adjusted odds ratios (aOR) are: being diagnosed with an STI in a lifetime (aOR 13.68 95% Confidence Interval (CI) 4.61-40.56; p < .001), inconsistent condom use (aOR 6.27 95% CI 2.08-18.84; p < .01), and difficulty in accessing condoms (aOR 2.86 95% CI 1.04-7.88; p < .05). The strongest predictors that indicated a decreased chance of being infected with the HI virus are: talking with partner about condom use in the past 12 months (aOR .08 95% CI .02-.36; p < .001) and having a grade 8 (aOR .04 95% CI .01-.66; p < .05) and higher educational level (aOR .04 95% CI .01-.43). These results show that social and structural factors serve as risk and protective factors for HIV prevention among young people. Intervention programs need to continue to focus on effective communication strategies and healthy relationships. Structural adjustments have to be made to encourage school attendance. Finally, social/health policies and health service delivery have to also be refined so that young people have access to youth friendly health services.

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