outh Africa has the highest burden of HIV worldwide; 10.9% of the population is infected with HIV (Shisana et al., 2009). The prevalence of HIV in South Africa is highest amongst 15-24 year olds with females disproportionately affected (Shisana et al., 2009). HIV prevalence among adolescents aged 15-19 years in South Africa is estimated to be 6.7% among females and 2.5% among males (Shisana et al., 2009).

Risk factors for HIV among adolescents in South Africa include gender (Shisana et al., 2009; Wilson, Wright, Safrit, & Rudy, 2010), age (Shisana et al., 2009), substance use (Shisana et al., 2009), failure to use condom prophylaxis (Maticka-Tyndale, 2012), early sexual debut (Tenkorang, Rajulton, & Maticka-Tyndale, 2009), intergenerational sex (Wilson et al., 2010), gender inequality (Speizer et al., 2009) and low relationship power amongst females (Pettifor, Measham, Rees, & Padian, 2004). Early sexual debut is of concern because it is associated with frequent sexual intercourse, irregular contraceptive use, more sexual partners and unplanned pregnancies (Koenig et al., 2003; Pettifor, O’Brien, Macphail, Miller, & Rees, 2009). Sexual violence, including child abuse and forced sex, increases risk for HIV amongst female adolescents, because of its contribution to early sexual experiences amongst young females (Pettifor, Macphail, Rees, & Cohen, 2008; Pettifor et al., 2009). Intergenerational sex between older men and younger females contributes to early sexual debut and increases the HIV epidemic among 15-24 year old females (Pettifor et al., 2009; Shisana et al., 2009).