Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials

Abstract

There remains a stark mismatch between the HIV burden in youth and the number of attempts to design and test prevention interventions - only two trials report biological outcomes. More effective interventions targeting youth are needed. Attention should go to studying implementation difficulties, sex differences in responses to interventions, determinants of exposure to interventions and perhaps inclusion of other factors apart from HIV/AIDS which influence sexual behaviour.

Recommendations for cervical cancer prevention and control in Ghana: public education and human papillomavirus vaccination

“…22 A well-developed program including cervical cancer prevention can influence adolescents' altitude, knowledge and behaviour on sexual and reproductive health greatly. 18,23 Cervical cancer education could ideally begin at primary schools (late in primary school) as enrolment at primary school is high but decreases at the junior, senior and tertiary level ( Figure 1).…”

Lessons learned from a decade implementing Comprehensive Sexuality Education in resource poor settings:The World Starts With Me

“…However, evidence of the (long-term) effects of CSE on young people's protective behaviours and certainly on biomarkers, such as the prevalence of STIs/HIV and teenage pregnancies, is at most only moderately strong, often even weak (Doyle et al 2010;kirby 2007;kohler, Manhart, and lafferty 2008;UNFPA 2010;Yankah and Aggleton 2008). Reasons brought forward to explain these modest results are related to limitations in the content, implementation and delivery of educational programmes, to disabling environments and the complex cultural embeddedness of sexual behaviours, as well as to methodological problems in the studies conducted (kippax 2003;Michielsen et al 2010;Vanwesenbeeck 2011). Overall, the field has been criticised for wrongfully breathing 'pan-optimism' (lesko 2010) and for the incorrect underlying assumption that individual decision-making is the key site of risk minimisation and progress towards sexual health (Bromnick and Swinburn 2003;Dworkin and Ehrhardt 2007).…”

HIV Prevention in Youth

“…In addition to age, programs should be sensitive to the differential influence of gender roles and sexual orientation (▶ Sexual Orientation). It has been found, for example, that interventions targeting condom use (▶ Male Condoms; ▶ Female Condoms) are more effective among young men than among young women, arguably because it is harder for young women to negotiate condom use and to refuse sexual intercourse (Michielsen et al 2010).…”

“…Researchers have called for better measures of behavioral outcomes such as condom use (▶ Male Condoms; ▶ Female Condoms) (which has been measured in terms of frequency at first sexual encounter, at last sexual encounter, and numerous other ways) as well as biological markers to confirm the presence or absence of STIs and HIV (DiClemente et al 2008;Michielsen et al 2010;Pedlow and Carey 2003). More research on, and programs for, vulnerable populations such as YMSM (▶ HIV Prevention for MSM) are needed (amfAR 2010).…”