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Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials

Michielsen, Kristiena,b; Chersich, Matthew Fa,c; Luchters, Stanleya; De Koker, Petraa; Van Rossem, Ronanb; Temmerman, Marleena

doi: 10.1097/QAD.0b013e3283384791
Epidemiology and Social

Objective: Systematically assess the effectiveness of HIV-prevention interventions in changing sexual behaviour of young people (10–25 years) in sub-Saharan Africa.

Methods: Three online databases were searched using prespecified terms. Additional articles were identified on websites of international organizations and by searching bibliographies. Randomized and nonrandomized trials of interventions aiming to reduce risk behaviour were included as well as single-arm studies reporting effects of differential exposure to an intervention. Data were extracted independently in duplicate using predefined data fields.

Results: Thirty-one studies on 28 interventions met the inclusion criteria, including 11 randomized trials. Difficulties with implementing planned activities were reportedly common and differential exposure to intervention was high. Two hundred and seventeen outcome measures were extracted: 88 early (within 1 year of intervention) and 129 late outcomes (more than 1 year after the end of the intervention). Sex education and condom promotion among youth did not increase sexual behaviour as well as risky sexual behaviour. No positive effects on sexual behaviour were detected either and condom use at last sex only increased among males [relative risk = 1.46; 95% confidence interval = 1.31–1.64]. One study reported a reduction of herpes simplex virus-2, but not HIV incidence.

Conclusion: There remains a stark mismatch between the HIV burden in youth and the number of attempts to design and test prevention interventions – only two trials report biological outcomes. More effective interventions targeting youth are needed. Attention should go to studying implementation difficulties, sex differences in responses to interventions, determinants of exposure to interventions and perhaps inclusion of other factors apart from HIV/AIDS which influence sexual behaviour.

aInternational Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium

bDepartment of Sociology, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium

cReproductive Health and HIV Research Unit, University of Witwatersrand, South Africa.

Received 22 January, 2009

Revised 14 January, 2010

Accepted 2 February, 2010

Correspondence to Kristien Michielsen, International Centre for Reproductive Health, Ghent University, De Pintelaan 185 P3, 9000 Ghent, Belgium. Tel: +32 9 332 35 64; fax: +32 9 332 38 67; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.