Associations Between Substance Use, Sexual Violence, Mental Distress, and Sexual HIV Risk Behaviors Among Adolescent Girls and Young Women in Lesotho.

Adolescent girls and young women (AGYW) are disproportionately burdened by new HIV infections in eastern and southern Africa. Data on co-occurrence of behavioral risk factors and associations with sexual HIV risk behaviors can inform layered and targeted HIV prevention efforts. Using nationally representative data of AGYW aged 13-24 years from the 2018 Lesotho Violence Against Children and Youth Survey, we categorized the population into distinct adversity groups comprised of different pattens of sexual violence exposure, substance use, and moderate/severe mental distress. We estimated associations of adversity groups with infrequent condom use and past-year multiple sexual partners. We observed significant associations between some groups and infrequent condom use and multiple sexual partners. Interventions to prevent sexual violence and substance use, in particular, may help reduce sexual HIV risk behaviors and thus HIV prevalence among this population in Lesotho.