Background:  South Africa, with approximately 5.5 million people infected with HIV, of whom 60% of infected adults acquire their infection before age 25, has one of the largest and fastest growing HIV epidemics worldwide. Data from national sero-prevalence surveys estimate the prevalence of HIV among 15- to 19-year-old girls to be 9.4% and among 20- to 24-year-old women, 23.9%. The marked changes in society since the transition from apartheid, with concomitant rapid rates of urbanization, disintegration of family structure, early initiation of sexual activity, a general lack of understanding of adolescent sexuality, and current youth attitudes and practices are some of the factors fuelling the epidemic. Unless adolescents are included in HIV vaccine trials, it is unlikely that they will have timely access to an effective HIV vaccine. Research conducted in Soweto, an urban South African setting, has established both adolescent and community willingness to participate in HIV vaccine trials. Factors that were rated as “very important” in determining willingness included receiving current information about HIV research; free access to voluntary counseling and testing; doing something to honor people living with or who have died from HIV/AIDS; and being protected against HIV. Parents and teachers surveyed believed the sexual debut of Soweto children to be as early as age 9; most believed that adolescents were vulnerable to HIV and did not believe that the perceived stigma of HIV vaccine trial participation would influence their decision to allow their adolescents to participate in HIV vaccine trials. Data from a longitudinal vaccine preparedness study conducted in 9- to 19-year-olds found low rates of birth control, erratic condom use, alcohol abuse, and depression. Preliminary data from this cohort indicate that, although adolescents were willing to participate in vaccine research and that they would be comfortable in referring other adolescents or family members for participation, there was still confusion about certain aspects of vaccine research, including placebo use.

Conclusions:  Taken together, these preliminary studies indicate that willingness to participate in HIV vaccine trials appears high among Soweto youth and adults. Risk reduction counseling in these trials should also focus on issues such as substance abuse, pregnancy, and depression.