HIV prevention for South African youth: which interventions work? A systematic review of current evidence

Abstract

BackgroundIn South Africa, HIV prevalence among youth aged 15-24 is among the world's highest. Given the urgent need to identify effective HIV prevention approaches, this review assesses the evidence base for youth HIV prevention in South Africa.MethodsSystematic, analytical review of HIV prevention interventions targeting youth in South Africa since 2000. Critical assessment of interventions in 4 domains: 1) study design and outcomes, 2) intervention design (content, curriculum, theory, adaptation process), 3) thematic focus and HIV causal pathways, 4) intervention delivery (duration, intensity, who, how, where).ResultsEight youth HIV prevention interventions were included; all were similar in HIV prevention content and objectives, but varied in thematic focus, hypothesised causal pathways, theoretical basis, delivery method, intensity and duration. Interventions were school- (5) or group-based (3), involving in- and out-of-school youth. Primary outcomes included HIV incidence (2), reported sexual risk behavior alone (4), or with alcohol use (2). Interventions led to reductions in STI incidence (1), and reported sexual or alcohol risk behaviours (5), although effect size varied. All but one targeted at least one structural factor associated with HIV infection: gender and sexual coercion (3), alcohol/substance use (2), or economic factors (2). Delivery methods and formats varied, and included teachers (5), peer educators (5), and older mentors (1). School-based interventions experienced frequent implementation challenges.ConclusionsKey recommendations include: address HIV social risk factors, such as gender, poverty and alcohol; target the structural and institutional context; work to change social norms; and engage schools in new ways, including participatory learning.

A Systematic Review of Online Youth Mental Health Promotion and Prevention Interventions

“…No studies in non-English language specific to school and community basedinterventions were identified in the review process. The five systematic review articles from LMICs that were identified examined the effectiveness of HIV related lifeskills interventions [69,70] and psychosocial interventions for children and adolescents affected by armed conflict in LMICs [71][72][73]. All relevant interventions across the reviews were identified and cross-referenced with the primary articles retrieved through the electronic search.…”

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

“…This has been argued for the developing (e.g. Harrison et al 2010;Iyer, Clarke, and Aggleton 2014;Ott et al 2011;Wood and Rolleri 2014) as well as the developed world (e.g. Cushman et al 2014;Schutte et al 2014).…”

Gendered childcare norms — evidence from rural Swaziland to inform innovative structural HIV prevention approaches for young women

“…However, HIV prevention interventions have largely focused on individual behaviour change, for example, encouraging individual men and women to use condoms or abstain from sex. Continuing high rates of incident HIV in young women in Southern Africa indicate these interventions have been largely unsuccessful (Harrison, Newell, Imrie, & Hoddinott, 2010). There is increasing recognition that structural factors, which shape and constrain individuals' behaviour, must be addressed to create environments in which interventions promoting HIV protective behaviours (e.g., condom use) can be successful (Keleher & Franklin, 2008).…”