HIV Prevalence Trends and Disparities by Gender and Urban-rural Residence Among Adolescents in Sub-saharan Africa

Abstract

Background In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban-rural disparities. Methods HIV prevalence data were obtained for 30 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Countries were grouped into 2% or higher and lower than 2% HIV prevalence among girls 15–19 years in the first survey. Country medians and average annual rates of changes were used to summarize the trends. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban-rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results HIV prevalence among girls 15–19 years declined in the higher HIV prevalence group from 5.7–2.6% during 2005–2015, corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1–1.2% in the higher prevalence group. Smaller changes were observed in the lower prevalence country group where median HIV prevalence among girls decreased from 0.7–0.4% (average annual rate of reduction 5.9%). Girl – boy differences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts, and all experienced similar declines during 2005–2015. Condom use and HIV testing increased among adolescents in both higher and lower prevalence countries, but indicators of sexual activity showed little change over time. Conclusions HIV prevalence declined in almost all countries during the last decade, in both urban and rural settings, for both sexes. The urban-rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in eastern and southern African countries.

Using the Implementation Research Logic Model as a Lens to View Experiences of Implementing HIV Prevention and Care Interventions with Adolescent Sexual Minority Men—A Global Perspective

“…1 However, a recent review of HIV trends across 25 sub-Saharan African countries showed a promising downward trend in HIV prevalence among both male and female adolescents. 2 The study also found a difference in HIV prevalence based on population density, with adolescents residing in urban areas having at least 1.5 times higher HIV prevalence than counterparts residing in rural areas. 2 All in all, given that Africa is the only continent where the youth population continues to rise and accounts for the majority of new HIV cases, prioritizing adolescents in the HIV response in sub-Saharan Africa is of the utmost importance.…”