Health Risk Behaviour among Adolescents Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Table 2

(a) Description of health risk behaviour of ALWHIV and HIV uninfected adolescents among studies included in the meta-analysis

First author	Condom non use; % (total respondents)	Transactional sex; % (total respondents)	Risky sexual partnerships; % (total respondents)	Sexual violence; % (total respondents)
Aboki [29]	44.7 (501) of ALWHIV did not use a condom with a non-marital partner at last sex from data collected in 2012	9.5 (1,223) of ALWHIV engaged in transaction sex from data collected in 2012	9.2 (1,234) of ALWHIV had multiple non-marital partners from data collected in 2012	NA
Auvert [30]		6.3 (64) of male ALWHIV had ever given money in exchange for sex; 1.9 (446) of HIV uninfected adolescent males had ever given money in exchange for sex	16.9 (318) of ALWHIV had 2 or more current sexual relationships; 15.9 (838) of HIV uninfected adolescents had 2 or more current sexual relationships	16.9 (324) of ALWHIV ever had sex against his/her will; 7.4 (854) of HIV uninfected adolescents ever had sex against his/her will
Bakeera-Kitaka [6]	NA	NA	52.8 (19) of ALWHIV had more than 2 sexual partners	NA
Birungi [31]	53 (271) of ALWHIV who ever had sex were currently not using condoms	NA	NA	27 (242) of ALWHIV ever had sex against his/her will
Bunnell [32]	83.7 (43) of ALWHIV did not always use a condom with all most recent partners in the last 12 months	NA	NA	NA
Gavin [11]	80.3 (192) of ALWHIV did not use a condom at last sex; 80.9 (1,615) of HIV uninfected adolescents did not use a condom at last sex	37.9 (192) ALWHIV exchanged goods for sex with last partner; 31.2 (1,615) of HIV uninfected adolescents exchanged goods for sex with last partner	NA	29.9 (192) of ALWHIV were ever forced to have sex; 27.7 (1,615) of HIV uninfected adolescents were ever forced to have sex
Jaspan [12]	33.3 (15) of sexually active ALWHIV had never used a condom; 45.8 (83) of HIV uninfected sexually active adolescents had never used a condom	21.4 (14) of ALWHIV ever received a gift in exchange for sex; 12 (76) of HIV uninfected adolescents ever received a gift in exchange for sex	NA	33 (12) of female ALWHIV reported forced sex from their boyfriends; 12 (58) of HIV uninfected females reported forced sex from their boyfriends
Jewkes [13]	61.5 (26) of ALWHIV did not correctly use a condom during last sex; 58.4 (1,251) of HIV uninfected adolescents did not correctly use a condom during last sex	11.5 (26) of ALWHIV had transactional sex with a casual partner; 18.0 (1,251) of HIV uninfected adolescents had transactional sex with a casual partner	50 (26) of ALWHIV had 3 or more consenting partners in the last year; 49.4 (1,251) of HIV uninfected adolescents had transactional sex with a casual partner	11.5 (26) of male ALWHIV reported having raped a non-partner; 16.1 (1,251) of male HIV uninfected adolescents males reported having raped a non-partner
Jewkes [33]	54.4 (160) of ALWHIV did not correctly use a condom during last sex; 62.8 (1,135) of HIV uninfected adolescents did not correctly use a condom during last sex	12.7 (160) of ALWHIV had transactional sex with a casual partner; 8.2 (1,135) of HIV uninfected adolescents had transactional sex with a casual partner	22.5 (160) of ALWHIV had 3 or more consenting partners in the last year; 8.7 (1,135) of HIV uninfected adolescents had 3 or more consenting partners in the last year	15.6 (160) of female ALWHIV reported having been forced or tricked in to first sex; 15.3 (1,135) of HIV uninfected adolescent females reported having been forced or tricked in to first sex
Steffenson [36]	NA	NA	71.2 (177) of ALWHIV had at least one concurrent sexual partnership in the past 12 months; 73.1 (1,392) HIV uninfected adolescents had at least one concurrent sexual partnership in the past 12 months	NA
Test [14]	55.6 (27) of ALWHIV reported inconsistent condom use in past 6 months	57.9 (38) of ALWHIV had exchanged sex for money		22.4 (107) of ALWHIV had experienced forced sex
Konde-Lule [37]	88.6 (70) of ALWHIV report that they do not use condoms; 93.2 (453) HIV uninfected adolescents report that they do not never use condoms	NA	23.9 (67) ALWHIV had 2 or more partners in the past year; 15.4 (486) HIV uninfected adolescents had 2 or more partners in the past year	NA

NA refers to “not applicable”; total respondents refer to number of adolescents (10–19) that responded to a particular item assessing HRB.

(b) Description of health risk behaviour of ALWHIV and HIV uninfected adolescents among studies included in the narrative review

First author	Condom non-use	Transactional sex	Risky sexual partnerships	Alcohol & Drug use	Early sex debut	Others
Auvert [30]	82.5 (325) of ALWHIV reported condom non-use at first sex; 75.9 (854) HIV uninfected adolescents reported condom non-use at first sex	NA	NA	28.9% of 325 ALWHIV drank alcohol at least once a month	25.5% of 325 ALWHIV had first sex at 15 or less years	6.2% of 258 female ALWHIV engaged in dry sex practices; 22.5% of 62 male ALWHIV did not wash their penis at least once a day; 3.9% of 359 HIV uninfected female adolescents engaged in dry sex practices; 11.4% of 491 HIV uninfected males did not wash their penis at least once a day
Bakeera-Kitaka [6]	NA	NA	NA	NA	42.1% of 19 ALWHIV initiated sex at below 15 years	NA
Birungi [31]						63% of 87 ALWHIV did not use a method to prevent infection or reinfection at first sex; 48% of the ALWHIV did not use any form of contraception in current or previous relationship
Gavin [11]	NA	NA	4.7% of 192 ALWHIV reported more than 3 lifetime sexual partners; 1.4% of 1,615 HIV uninfected adolescents reported more than 3 lifetime sexual partners	5.6% of 192 ALWHIV drank alcohol in past month; 4.5% of 1,615 HIV uninfected adolescents drank alcohol in past month	Mean age at sex initiation was 16.4 years (SD: 0.14) among ALWHIV; Mean age at sex initiation was 16.2 years (SD: 0.10) among HIV uninfected adolescents	NA
Jaspan [12]	NA	NA	Mean number of 1.8 life partners among the ALWHIV; Mean number of 0.7 life partners among the HIV uninfected adolescents	NA	NA	NA
Jewkes [13]	NA	NA	NA	30.8% of 26 ALWHIV reported problem alcohol drinking; 53.8% of 26 ALWHIV reported ever using drugs; 25.8% of 1,251 HIV uninfected adolescents reported problem alcohol drinking; 38.1% of 1,251 HIV uninfected reported ever using drugs	Median age sex initiation was 14.7 years (IQR: 12.9–16.2) among ALWHIV; (i) Median age sex initiation was 14.7 years (IQR: 12.9–16.2) among HIV uninfected adolescents	NA
Jewkes [33]	NA	NA	NA	3.8% of 160 ALWHIV reported problem alcohol drinking; 5% of 160 ALWHIV reported ever using drugs; 3.5% of 1,135 HIV uninfected adolescents reported problem alcohol drinking; 6.3% of 1135 HIV uninfected adolescents reported ever using drugs	NA	6.2% of 160 female ALWHIV engaged in dry sex practices; 4.1% of 1,135 female HIV uninfected adolescents engaged in dry sex practices
Lane [34]	NA	aOR = 0.8 for HIV infection among male sex purchasers	aOR = 0.3 for HIV infection among males with 6 or more partners in past year	aOR = 1.2 for HIV infection among males that had sex under influence of alcohol; aOR = 1.3 for HIV infection among males that had sex under influence of drugs	NA	NA
Mhalu [35]	aOR = 2.7 for having unprotected sex at last sexual contact among ALWHIV of 15–19 vs 20–24 years	NA	aOR = 1.2 for engaging in multiple sexual partnerships among ALWHIV of 15–19 vs 20–24 years	NA	NA	NA
Test [14]	NA	NA	NA	61% of 18 ALWHIV drank alcohol within 6 hours prior to sex	Median age sex initiation was 17 years (IQR: 15–18)	NA

NA refers to “not applicable”; aOR: adjusted odds ratio; statistically significant; not statistically significant; IQR: interquartile range SD: standard deviation.