Sex in the Shadow of HIV: A Systematic Review of Prevalence, Risk Factors, and Interventions to Reduce Sexual Risk-Taking among HIV-Positive Adolescents and Youth in Sub-Saharan Africa

August 2017 - In Focus

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Toska, E., Pantelic, M., Meinck, F., et al. PLOS ONE (June 2017), 12(6): e0178106, doi:10.1371/journal.pone.0178106.

This review examined sexually risky behaviors among HIV-positive youth and adolescents in sub-Saharan Africa, focusing on eight outcomes that included early sexual debut, irregular condom use, and age-disparate relationships. Findings from 35 studies showed overall high rates of unprotected sex and early sexual debut among HIV-positive youth and adolescents of all ages, and increased risky behaviors among those under 19 years of age in particular. Between one-third and one-half of youth and adolescents had an older partner at their first sexual encounter, and one-fifth reported participating in transactional sex. Nearly 75 percent of pregnancies were unplanned. Across most studies, one in ten participants reported at least two partners in the past year; men were much more likely to have multiple sexual partners than women. Prevalence of genital herpes and human papillomavirus was 50 and 88 percent, respectively. The authors said that high rates of sexually risky behaviors among youth indicate a need to integrate sexual and reproductive health services into HIV programs for youth and adolescents. Psychosocial services and combined interventions may reduce sexually risky behaviors. Policies and programs should take into account the unique needs of HIV-positive adolescents to prevent onward transmission.

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