Risky sexual behavior and the HIV gender gap for younger adults in sub-Saharan Africa

Abstract

Background HIV/AIDS continues to persist as a major global public health issue in Africa. Within the younger adult population, adolescent girls and younger women aged 15 to 29 years have been identified as having a heightened risk of contracting HIV. Risky sexual behaviors are important drivers behind the HIV prevalence gender gap among younger adults in sub-Saharan Africa. Methods We used nationally representative survey data from three sub-Saharan African countries, Malawi, Tanzania and Zambia, to explain the relationship between HIV prevalence and having an older partner and/or having multiple partners using a logit model. We then proceeded to conduct a Blinder-Oaxaca decomposition analysis to better understand the gap drivers. Results We found that while the gender gap is driven largely by women having higher levels of risk for sexual behaviors and other risk factors in two of the study countries, this was not found in the third. We also found that different sexual behaviors vary in their riskiness across countries. Having multiple partners and having an older partner carried a similar risk with regard to younger adults contracting HIV in Malawi; in Tanzania and Zambia the risk associated with having multiple partners was greater than the risk associated with having an older partner. In all three countries the risk of being a younger adult female was higher than men, other risk factors the same. Conclusions Risky sexual behavior contributed to increased prevalence of HIV in the study countries. Policies aiming to encourage younger women to form relationships with men among their cohort would be most impactful in Malawi, where currently many younger women have partners who are more than five years their senior compared to younger men. Other policies can attempt to reduce non-monogamous relationships among younger adults, wherein multiple partners are a key driver of the HIV gender gap.