HIV 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 of HIV. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban–rural disparities. Methods HIV prevalence data at ages 15–19 years were obtained for 31 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Country medians and average annual rates of changes were used to summarize the trends for two subregions in sub-Saharan Africa, Eastern and Southern Africa and West and Central Africa, which largely correspond with higher and lower HIV prevalence countries. 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 eastern and Southern Africa from 5.7 to 2.6% during 2005–2015 (country median), corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1 to 1.2%. Changes were also observed in West and Central Africa where median HIV prevalence among girls decreased from 0.7 to 0.4% (average annual rate of reduction 5.9%), but not for boys (0.3%). 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 in both subregions, and since the urban–rural declines were similar, the gaps persisted during 2005–2015. Conclusions HIV prevalence among adolescents declined in almost all countries during the last decade, in both urban and rural settings. The urban–rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in Eastern and Southern African countries.

Exploring computer-aided health decision-making on cervical cancer interventions through deliberative interviews in Ethiopia

“…Hence, there might be a higher prevalence in urban areas with a higher prevalence of HIV infections and a higher number of unsafe sexual encounters. This has been seen in work by Maulide Cane and colleagues, who demonstrate that with the verification of higher HIV prevalence in urban areas among young women and men than in rural areas in sub-Saharan Africa 34 .…”

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis

“…Furthermore, substance abuse may be a major factor in poor adherence in this age group. Studies have attributed the decrease in ART adherence among older adolescents to the diminishing support from care-givers during the transition from childhood to young adult and lack of second line ART especially in resource limited settings [ 42 , 118 – 120 ]. However, the findings reported lower VLS rates compared to 2012 findings where VLS was at 84% in low- and middle-income countries yet was in consistent with findings of a systematic review reporting 59% in SSA [ 121 ].…”

Prevalence of untreated HIV and HIV incidence among occupational groups in Rakai, Uganda: a population-based longitudinal study, 1999-2016

“…The shifting distribution of the occupational makeup in our study population away from agriculture likely reflects the increasing urbanization happening across the African continent [45]. Little data exists on the impact of urbanization on HIV transmission; however, in sub-Saharan Africa, HIV prevalence and incidence have been reported to be higher in urban than in rural centers [46,47]. This has been attributed to factors such as relative affluence in urban centers, increased social interaction, and higher-risk behaviors such as transactional sex and concurrent sexual partnerships [48][49][50].…”