Factors associated with HIV infection among sexually experienced adolescents in Africa: a pooled data analysis

The article examines the factors associated with HIV status among adolescents aged 15-19 years in 13 African countries: Côte d'Ivoire, Democratic Republic of Congo, Guinea, Kenya, Liberia, Mali, Malawi, Rwanda, Sierra Leone, Swaziland, Tanzania, Zambia and Zimbabwe. The data were derived from demographic and health surveys or AIDS indicator surveys conducted between 2004 and 2009. The levels of HIV prevalence among adolescents varied considerably across the countries. There was significantly higher HIV prevalence among female adolescents as compared with their male counterparts. For male adolescents, circumcision was the only variable significantly associated with HIV status. Nonetheless, the data suggest that the association between male circumcision and HIV status may be exaggerated. Indeed, regional-level random effects became insignificant once male circumcision was introduced into the estimated models, indicating a strong correlation between unmeasured regional-level factors and male circumcision. For female adolescents, multiple sexual partnerships, time elapsed since sexual debut, marital status, household wealth, and the regional prevalence of male circumcision were strongly and positively associated with HIV status. Moreover, for female adolescents there appear to be significant unmeasured variables operating at the regional level which influence the levels of HIV infection. The implications of the findings for HIV-prevention programming, policy and research are discussed.