In South Africa, adolescent girls and young women (AGYW) are at risk of poor mental health, HIV infection and early pregnancy. Poor mental health in AGYW is associated with increased sexual risk behaviours, and impeded HIV testing and care. Using in-depth interviews and focus group discussions, we explored subjective experiences of mental health and sexual and reproductive health (SRH) amongst 237 AGYW aged 15–24 years in five South African districts. Respondents shared narratives of stress, emotional isolation, feelings of depression, and suicidal ideation, interconnected with HIV, pregnancy and violence in relationships. Findings show that AGYW in South Africa face a range of mental health stressors and lack sufficient support, which intersect with SRH challenges to heighten their vulnerability. Framed within the syndemic theory, our findings suggest that South African AGYW’s vulnerability towards early pregnancy, HIV infection and poor mental health are bidirectional and interconnected. Considering the overlaps and interactions between mental health and SRH amongst AGYW, it is critical that mental health components are integrated into SRH interventions.

在南非，少女和年轻女性 (AGYW) 面临心理健康状况不佳、感染艾滋病毒和早孕的风险。 AGYW 心理健康状况不佳与性危险行为增加有关，并阻碍了艾滋病毒检测和护理。通过深入访谈和焦点小组讨论，我们探讨了南非五个地区 237 名 15-24 岁 AGYW 的心理健康以及性和生殖健康 (SRH) 的主观经历。受访者分享了有关压力、情绪孤立、抑郁情绪和自杀意念的叙述，这些都与艾滋病毒、怀孕和人际关系中的暴力有关。调查结果显示，南非的 AGYW 面临一系列心理健康压力，并且缺乏足够的支持，这与性健康和生殖健康挑战交织在一起，加剧了他们的脆弱性。在流行病理论的框架内，我们的研究结果表明，南非 AGYW 对早孕、艾滋病毒感染和心理健康状况不佳的脆弱性是双向且相互关联的。考虑到 AGYW 中心理健康与 SRH 之间的重叠和相互作用，将心理健康内容纳入 SRH 干预措施至关重要。