Sex in the shadow of HIV: A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa

BackgroundEvidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa.MethodsStudies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10–24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted.Results610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n = 35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored ConclusionSexual risk-taking among HIV-positive adolescents and youth is high, with inconclusive evidence on potential determinants. Few known studies test secondary HIV-prevention interventions for HIV-positive youth. Effective and feasible low-cost interventions to reduce risk are urgently needed for this group.研究背景 撒哈拉以南非洲地区HIV阳性青少年与青年的性行为风险相关研究证据亟待补充。本系统综述（systematic review）整合了当前关于该地区HIV阳性青少年与青年性行为风险的流行现状、相关影响因素以及风险降低干预措施的已有研究成果。 研究方法 本研究通过电子数据库、灰色文献（grey literature）、参考文献追溯以及与研究者联络的方式进行文献检索，并遵循系统综述与元分析（meta-analysis）首选报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南开展研究。纳入标准为：研究对象为10~24岁的HIV阳性人群，报告了以下8项结局指标中的至少一项：初次性行为过早、安全套使用不规范、存在年长性伴侣、交易性行为、多性伴、醉酒状态下发生性行为、性传播感染以及妊娠，且研究实施地点为撒哈拉以南非洲地区的定量研究。两名研究者对所有研究流程进行预试验，独立完成文献筛选与数据提取，并对存在的分歧进行协商解决。由于各研究报告的性行为风险发生率及相关影响因素存在异质性，本研究未进行元分析。 研究结果 初步检索得到610篇潜在相关的文献标题/摘要，进而对其中251篇文献进行全文审查。最终纳入42篇文献（共35项研究），涉及撒哈拉以南非洲13个国家的13536名HIV阳性青少年与青年的一项或多项性行为相关情况。其中17项横断面研究（cross-sectional study）分析了与性行为风险相关的个体、人际、家庭、社会结构以及HIV相关影响因素。然而，多数研究结果之间存在不一致，且多数研究的评分情况[原文此处存在排版疏漏]。 研究结论 HIV阳性青少年与青年的性行为风险发生率较高，但目前关于其潜在影响因素的研究证据尚不明确。现有针对HIV阳性青年的HIV二级预防干预措施相关研究较少。该人群亟需安全可行且低成本的风险降低干预手段。