Trends in HIV prevalence and sexual behaviour among young people aged 15–24 years in countries most affected by HIV
- The International Group on Analysis of Trends in HIV Prevalence and Behaviours in Young People in Countries most Affected by HIV
- Correspondence to Dr Eleanor Gouws, Strategic Intelligence and Analysis Division, UNAIDS, 20 Avenue Appia, 1211 Geneva, Switzerland;
Contributors EG, PDG and RL wrote the first draft of the paper. BB provided data on sexual behaviour collected from national population based surveys. Country collaborators provided country-specific data on HIV prevalence and contributed to the country-specific analysis of trend data. EG performed the final statistical analysis. E Fadriquela assisted with the production of Figure 1. All authors contributed to the final draft of the paper.
- Accepted 3 October 2010
Objectives In 2001 the United Nations (UN) Declaration of Commitment was signed by 189 countries with a goal to reduce HIV prevalence among young people by 25% by 2010. Progress towards this target is assessed. In addition, changes in reported sexual behaviour among young people aged 15–24 years are investigated.
Methods Thirty countries most affected by HIV were invited to participate in the study. Trends in HIV prevalence among young antenatal clinic (ANC) attendees were analysed using data from sites that were consistently included in surveillance between 2000 and 2008. Regression analysis was used to determine if the UN target had been reached. Trends in prevalence data from repeat national population-based surveys were also analysed. Trends in sexual behaviour were analysed using data from repeat standardised national population-based surveys between 1990 and 2008.
Results Seven countries showed a statistically significant decline of 25% or more in HIV prevalence among young ANC attendees by 2008, in rural or urban areas or in both: Botswana, Côte d'Ivoire, Ethiopia, Kenya, Malawi, Namibia and Zimbabwe. Three further countries showed a significant decline in HIV prevalence among young women (Zambia) or men (South Africa, Tanzania) in national surveys. Seven other countries are on track, whereas four are unlikely to reach the goal by 2010. Nine countries did not have adequate data to assess prevalence trends. Indications suggestive of changes towards less risky sexual behaviour were observed in the majority of countries. In eight countries with significant declines in HIV prevalence, significant changes were also observed in sexual behaviour in either men or women for at least two of the three sexual behaviour indicators.
Conclusions Declines in HIV prevalence among young people were documented in the majority of countries with adequate data and in most cases were accompanied by changes in sexual behaviour. Further data, research and more rigorous analysis at country level are needed to understand the associations between programmatic efforts, reported behavioural changes and changes in prevalence and incidence of HIV.
The International Group on Analysis of Trends in HIV Prevalence and Behaviours in Young People in Countries most Affected by HIV: PD Ghys, E Gouws, R Lyerla (UNAIDS Geneva); JM Garcia-Calleja (WHO Geneva); B Barrerre (ICF Macro: Measure DHS, Maryland, USA); D Serrano, C Velasquez (Angola); C Deleveaux (Bahamas); W Gill, M Mmelesi (Botswana); A Niyongere (Burundi); E Mboui Bilon (Cameroun); J de D Longo, M Massanga (Central African Republic); D Guidaoussou (Chad); JP Konan Diby (Côte d'Ivoire); N Kibangou (Djibouti); Aseged Woldu (Ethiopia); F Bikoma (Gabon); N Duval, K Spring (Haiti); A Barsigo (Kenya); J Nkonyana (Lesotho); N Wandonda (Malawi).
Mozambique Multisectoral Technical Group (Mozambique): A Jonas (Namibia); I Kawu (Nigeria); M Mutagoma (Rwanda); T Mosala (South Africa); S Mndzebele, H Odido (Swaziland); YD Agbogan (Togo); J Musinguzi (Uganda); G Somi (UR Tanzania); M Gboun, D Phiri (Zambia); E Gonese, S Gregson, O Mugurungi (Zimbabwe).
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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