Advertisement

HIV Prevention in Young People in Sub-Saharan Africa: A Systematic Review

      Abstract

      Purpose

      To systematically review and update evidence on the effectiveness of youth HIV/AIDS prevention interventions in sub-Saharan Africa (SSA) and to make evidence-based policy recommendations to guide efforts toward meeting the United Nations General Assembly Special Session HIV/AIDS goals.

      Methods

      Recent evidence (January 2005–December 2008) on the effectiveness of interventions to improve reported sexual behavior and biological outcomes among youth in SSA was assessed using the Steady, Ready, Go! (SRG) approach and synthesized with an earlier SRG review (January 1990–June 2005).

      Results

      A total of 23 studies were included following screening of approximately 1,200 citations. School-based, adult-led, curriculum-based interventions showed clear evidence of reducing reported risky sexual behavior. Interventions in health facilities increased the use of services when made accessible and more youth-friendly. In geographically defined communities, both interventions specifically targeting youth and community-wide interventions reduced reports of risky sexual behavior.

      Conclusions

      HIV prevention among youth is a top priority in SSA. The most promising interventions should be scaled-up now, with careful evaluation, while exploring supplementary interventions to impact HIV incidence.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. 2010 Report on the Global AIDS Epidemic.
        (Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS)) UNAIDS, Geneva, Switzerland2010
      2. 2009 AIDS Epidemic Update.
        (Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS)) UNAIDS, Geneva, Switzerland2009
        • Dixon-Mueller R.
        How young is “too young”?.
        Stud Fam Plann. 2008; 39: 247-262
        • UNAIDS Interagency Task Team on HIV and Young People
        Guidance brief: HIV interventions for most-at risk young people.
        UNFPA, New York2008
        • UN
        Resolution adopted by the General Assembly.
        1999 (A/RES/S-21/2: UN)
        • UN
        United Nations Millennium Declaration.
        2000 (A/RES/55/2: UN)
        • UN
        United Nations General Assembly Special Session on HIV/AIDS.
        ([Online]) (Accessed June 2, 2011)
        • UN
        A world fit for children.
        2002 (A/RES/55/2: UN)
        • UN Millennium Project
        Combating AIDS in the developing world: Task force on HIV/AIDS, malaria, TB, and access to essential medicines.
        Earthscan, London, United Kingdom2005
        • Ross D.A.
        • Dick B.
        • Ferguson J.
        Preventing HIV/AIDS in young people.
        World Health Organ Tech Rep Ser. 2006; 938: 1-13
        • Doyle A.
        • Ross D.A.
        • Maganja K.
        • et al.
        Long-term biological and behavioural impact of an adolescent sexual health intervention in Tanzania: Follow-up survey of the community-based MEMA kwa Vijana trial.
        PLoS Med. 2010; 7: e1000287
        • Ross D.A.
        • Changalucha J.
        • Obasi A.I.
        • et al.
        Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: A community-randomized trial.
        AIDS. 2007; 21: 1943-1955
        • Cowan F.M.
        • Pascoe S.
        • Langhaug L.
        • et al.
        The Regai Dzive Shiri Project: The results of a cluster randomised trial of a multi-component HIV prevention intervention for young people in rural Zimbabwe.
        AIDS. 2010; 24: 2541-2552
        • Cowan F.M.
        • Pascoe S.J.S.
        • Langhaug L.F.
        • et al.
        The Regai Dzive Shiri Project: A cluster randomised controlled trial to determine the effectiveness of a multi-component community-based HIV prevention intervention for rural youth in Zimbabwe--Study design and baseline results.
        Trop Med Int Health. 2008; 13: 1235-1244
        • Jewkes R.
        • Nduna M.
        • Levin J.
        • et al.
        Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: Cluster randomised controlled trial.
        BMJ. 2008; 337 ([see comment]): a506
        • Pettifor A.E.
        • Kleinschmidt I.
        • Levin J.
        • et al.
        A community-based study to examine the effect of a youth HIV prevention intervention on young people aged 15–24 in South Africa: Results of the baseline survey.
        Trop Med Int Health. 2005; 10: 971-980
        • Dente M.G.
        • Fabiani M.
        • Okwey R.
        • et al.
        Impact of voluntary counselling and testing and health education on HIV prevention among secondary school students in northern Uganda.
        Health Policy Dev. 2005; 3: 1-11
        • Magnani R.
        • Macintyre K.
        • Karim A.M.
        • et al.
        The impact of life skills education on adolescent sexual risk behaviors in KwaZulu-Natal, South Africa.
        J Adolesc Health. 2005; 36: 289-304
        • James S.
        • Reddy P.
        • Ruiter R.A.C.
        • et al.
        The impact of an HIV and AIDS life skills program on secondary school students in KwaZulu-Natal, South Africa.
        AIDS Educ Prev. 2006; 18: 281-294
        • Smith E.A.
        • Palen L.A.
        • Caldwell L.L.
        • et al.
        Substance use and sexual risk prevention in Cape Town, South Africa: An evaluation of the healthwise program.
        Prev Sci. 2008; 9: 311-321
        • Karnell A.P.
        • Cupp P.K.
        • Zimmerman R.S.
        • et al.
        Efficacy of an American alcohol and HIV prevention curriculum adapted for use in South Africa: Results of a pilot study in five township schools.
        AIDS Educ Prev. 2006; 18: 295-310
        • Maticka-Tyndale E.
        • Wildish J.
        • Gichuru M.
        Quasi-experimental evaluation of a national primary school HIV intervention in Kenya.
        Eval Program Plann. 2007; 30: 172-186
        • Duflo E.
        • Dupas P.
        • Kremer M.
        • et al.
        Education and HIV/AIDS prevention: Evidence from a randomized Evaluation in Western Kenya.
        Massachusetts Institute of Technology [MIT], Abdul Latif Jameel Poverty Action Lab, Cambridge, MA2006
        • Miller A.N.
        • Mutungi M.
        • Facchini E.
        • et al.
        An outcome assessment of an ABC-based HIV peer education intervention among Kenyan university students.
        J Health Commun. 2008; 13: 345-356
        • Visser M.J.
        HIV/AIDS prevention through peer education and support in secondary schools in South Africa.
        Sahara J. 2007; 4: 678-694
        • Evaluation of the African Youth Alliance Program in Ghana
        Impact on sexual and reproductive health behavior among young people.
        JSI Research and Training Institute, Rosslyn, VA2007
        • Pathfinder International
        Youth-friendly services: African Youth Alliance (AYA) Ghana end of program evaluation report.
        Pathfinder, Washington, DC2005
        • WHO
        Global guidance briefs on HIV interventions for young people.
        WHO, Geneva, Switzerland2008
        • Pathfinder International
        Youth-Friendly services: African Youth Alliance (AYA) Tanzania end of program evaluation report.
        Pathfinder, Washington, DC2005
        • Evaluation of the African Youth Alliance Program in Uganda
        Impact on sexual and reproductive health behavior among Young People.
        JSI Research and Training Institute, Rosslyn, VA2007
        • Pathfinder International
        Youth-Friendly services: African Youth Alliance (AYA) Uganda end of program evaluation report.
        Pathfinder, Washington, DC2005
        • Pathfinder International
        Youth-Friendly services: African Youth Alliance (AYA) Botswana end of program evaluation report.
        Pathfinder, Washington, DC2005
      3. Madagascar (2006): HIV/AIDS TRaC study evaluating abstinence among youth (15–24 years).
        PSI, Washington, DC2007
        • Meekers D.
        • Agha S.
        • Klein M.
        The impact on condom use of the “100% Jeune” social marketing program in Cameroon.
        J Adolesc Health. 2005; 36: 530.e531
        • Plautz A.
        • Meekers D.
        Evaluation of the reach and impact of the 100% Jeune youth social marketing program in Cameroon: Findings from three cross-sectional surveys.
        Reprod Health. 2007; 4: 1
        • Fonseca-Becker F.
        • Bakadi G.
        • Sow A.
        Mobilizing communities for behavior change: HIV/AIDS and pregnancy prevention among youth in upper Guinea.
        Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Baltimore, MD2005
        • Kajubi P.
        • Kamya M.R.
        • Kamya S.
        • et al.
        Increasing condom use without reducing HIV risk: Results of a controlled community trial in Uganda.
        J Acquir Immune Defic Syndr. 2005; 40: 77-82
        • Svenson G.
        • Burke H.
        • Johnson L.
        Impact of youth peer education programs: Final results from an FHI/YouthNet Study in Zambia.
        Family Health International, Research Triangle Park2008
        • Pronyk P.M.
        • Hargreaves J.R.
        • Kim J.C.
        • et al.
        Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: A cluster randomised trial.
        Lancet. 2006; 368: 1973-1983
        • Pronyk P.M.
        • Kim J.C.
        • Abramsky T.
        • et al.
        A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants.
        AIDS. 2008; 22: 1659-1665
        • Grunseit A.
        • Kippax S.
        • Aggleton P.
        • et al.
        Sexuality education and young people's sexual behavior: A review of studies.
        J Adolesc Res. 1997; 12: 421-453
        • Speizer I.S.
        • Magnani R.J.
        • Colvin C.E.
        The effectiveness of adolescent reproductive health interventions in developing countries: A review of the evidence.
        J Adolesc Health. 2003; 33: 324-348
        • Paul-Ebhohimhen V.A.
        • Poobalan A.
        • van Teijlingen E.R.
        A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa.
        BMC Public Health. 2008; 8: 4
        • Kirby D.
        • Laris B.A.
        • Rolleri L.A.
        The impact of Sex and HIV Education Programs in Schools and Communities on Sexual Behaviors Among Young Adults.
        Family Health International, Research Triangle Park, NC2006
        • Evaluation of the African Youth Alliance Program in Tanzania
        Impact on sexual and reproductive health behavior among young people.
        JSI Research and Training Institute, Rosslyn, VA2007
        • Hayes R.J.
        • Changalucha J.
        • Ross D.A.
        • et al.
        The MEMA kwa Vijana project: Design of a community randomised trial of an innovative adolescent sexual health intervention in rural Tanzania.
        Contemp Clin Trials. 2005; 26: 430-442
        • Terris-Prestholt F.
        • Kumaranayake L.
        • Obasi A.I.N.
        • et al.
        From trial intervention to scale-up: Costs of an adolescent sexual health program in Mwanza, Tanzania.
        Sex Transm Dis. 2006; 33: S133-S139
        • CSDH
        Closing the gap in a generation: Health equity through action on the social determinants of health.
        World Health Organization, Geneva, Switzerland2008
        • Jewkes R.
        • Nduna M.
        • Levin J.
        • et al.
        A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: Trial design, methods and baseline findings.
        Trop Med Int Health. 2006; 11: 3-16
        • Hargreaves J.R.
        Additional analysis conducted for this review.
        2009
        • Jewkes R.
        • Nduna M.
        • Levin J.
        • et al.
        Evaluation of stepping stones: A gender transformative HIV prevention intervention.
        Medical Research Council, Gender and Health Research Unit, Pretoria, South Africa2007
        • Obasi A.I.
        • Cleophas B.
        • Ross D.A.
        • et al.
        Rationale and design of the MEMA kwa Vijana adolescent sexual and reproductive health intervention in Mwanza Region, Tanzania.
        AIDS Care. 2006; 18: 311-322
        • Hewett P.C.
        • Mensch B.S.
        • Ribeiro M.C.
        • et al.
        Using sexually transmitted infection biomarkers to validate reporting of sexual behavior within a randomized, experimental evaluation of interviewing methods.
        Am J Epidemiol. 2008; 168: 202-211
        • Mensch B.S.
        • Hewett P.C.
        • Gregory R.
        • Helleringer S.
        Sexual behavior and STI/HIV status among adolescents in rural Malawi: An evaluation of the effect of interview mode on reporting.
        Stud Fam Plann. 2008; 39: 321-334
        • Plummer M.L.
        • Ross D.A.
        • Wight D.
        • et al.
        A bit more truthful“: The validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods.
        Sex Transm Infect. 2004; 80: ii49-ii56
        • Kippax S.
        • Van de Ven P.
        An epidemic of orthodoxy?.
        Crit Public Health. 1998; 8: 371-386
        • Pawson R.
        Evidence-based policy: The promise of “Realist Synthesis.”.
        Evaluation. 2002; 8: 340-358
        • WHO
        Preventing HIV/AIDS in young people: Evidence from developing countries on what works.
        WHO, Geneva, Switzerland2006
      4. Trends in HIV prevalence and sexual behaviour among young people aged 15–24 years in countries most affected by HIV.
        Sex Transm Infect. 2010; 86: ii72-ii83
        • Central Statistical Office, Ministry of Health, Tropical Diseases Research Centre
        Zambia Sexual Behavior Survey.
        (et al) CSO and Macro International Inc., Calverton, MD2009
        • Gregson S.
        • Garnett G.P.
        • Nyamukapa C.A.
        • et al.
        HIV decline associated with behavior change in eastern Zimbabwe.
        Science. 2006; 311: 664-666
        • Jewkes R.K.
        • Dunkle K.
        • Nduna M.
        • Shai N.
        Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study.
        Lancet. 2010; 376: 41-48