HIV Vulnerability Typologies Among Adolescent Girls and Young Women in Lesotho: A Population-Based, Cross-Sectional, Latent Class Analysis

Adolescent girls and young women ages 15-29 years (AGYW) living in Lesotho experience a disproportionate HIV burden. Using a household-based national survey in Lesotho, we conducted a three-step latent class analysis to identify typologies of AGYW most vulnerable to HIV infection. We first classified AGYW into HIV vulnerability groups based on self-reported sexual behaviors, then identified associations between typology and HIV diagnosis. HIV vulnerability behaviors included early sexual debut, condomless sex, multiple sexual partners in the past year, sex with partners they do not know the status of or are living with HIV, age disparate sex, use of contraceptives, and having children. Across all age groups, we found that HIV vulnerability typologies could be described as low vulnerability, high vulnerability, and parous. As AGYW age, they engage in more types of higher vulnerability sexual behaviors; interventions to reduce this risk should start at a younger age. Our findings emphasize the importance of implementing and scaling up biomedical strategies such as pre-exposure prophylaxis.