Assessing HIV vulnerability among young women in South Africa: A comparison of three risk assessment tools
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: ABSTRACT Background Young women in sub-Saharan Africa remain disproportionately affected by HIV. However, self-perceived HIV risk may not align with reported sexual behaviors or other dimensions of risk. Behavioral measures, such as the Balloon Analogue Risk Task (BART), may capture risk-taking propensity not reflected in conventional self-report measures. We compared self-perceived HIV risk, behavior-based HIV risk, and behavioral risk-taking propensity among young women in KwaZulu-Natal, South Africa. Methods We conducted a cross-sectional survey between July and November 2025 among self-reported HIV-negative women aged 18–30 years in KwaZulu-Natal, South Africa. We assessed self-perceived HIV risk using the Perceived Risk of HIV Scale (PRHS), behavior-based HIV risk using the Vaginal and Oral Interventions to Control the Epidemic (VOICE) Risk Score, and behavioral risk-taking propensity using the Balloon Analogue Risk Task (BART). Spearman’s rank correlation coefficients were used to examine correlations between the three measures. Results Among 250 participants, median age was 22 years (IQR 20-25), all identified as Black, and 53.6% were attending school or college. Overall, 42.0% were classified as high risk by VOICE, 6.0% by PRHS, and 33.1% of participants with complete BART data were in the highest tertile of risk-taking propensity. Mean age differed across VOICE categories ( p = 0.036), but not PRHS ( p = 0.111) or BART categories ( p = 0.698). PRHS categories were associated with anal intercourse, oral intercourse, consistent condom use, ever having sold sex, and age-disparate partnerships (all p < 0.05). VOICE categories were not significantly associated with the assessed sexual behaviors, while BART categories were associated with vaginal intercourse in the past month ( p = 0.042). Correlations between PRHS, VOICE, and BART were weak and non-significant (Spearman’s ρ = −0.050 to 0.038; all p > 0.05). Conclusions These findings highlight the importance of distinguishing between reported HIV risk behaviours, perceived HIV risk, and behavioural risk-taking propensity when assessing HIV vulnerability among young women. For HIV prevention programmes, reliance on a single measure may not adequately capture the different dimensions of vulnerability. Integrating behavioural assessments with discussions of perceived risk and individual circumstances may help inform more responsive, person-centred HIV prevention services, including PrEP counselling. Further research is needed to establish how these measures can best complement one another in prevention service delivery.
Source: medRxiv
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7224937945