HIV among out-of-school youth in Eastern and Southern Africa: a review

Abstract

The overall decline of the HIV epidemic in Sub-Saharan Africa conceals how the HIV burden has shifted to fall on areas that have been more difficult to reach. This review considers out-of-school youth, a category typically eluding interventions that are school-based. Our review of descriptive studies concentrates on the most affected region, Southern and Eastern Africa, and spans the period between 2000 and 2010. Among the relatively small but increasing number of studies, out-of-school youth was significantly associated with risky sexual behavior (RSB), more precisely with early sexual debut, high levels of partner concurrency, transactional sex, age-mixing, low sexually transmitted infection (STI)/HIV risk perception, a high lifetime number of partners, and inconsistent condom use. Being-in-school not only raises health literacy. The in-school (e.g., age-near) sexual network may also be protective, an effect which the better-studied (and regionally less significant) variable of educational attainment cannot measure. To verify such double effect of being-in-school we need to complement the behavioral research of the past decade with longitudinal cohort analyses that map sexual networks, in various regions.

Keywords:

• review
• HIV/AIDS
• out-of-school youth
• Sub-Saharan Africa
• risky sexual behavior

Acknowledgements

Thanks are due to UNFPA for sponsoring the review. We are indebted to an anonymous referee for one invaluable reference.

Notes

1. The association is admittedly hard to ascertain since symptoms of HIV infection can be subsumed under disability due to its broad definition. Respondents with disabilities also score low on HIV status awareness (Shisana et al., 2009, p. 4, 51).