Differences between 2008 and 2017 in HIV prevalence and risk factors among young adults aged 15-24 years in South Africa

Abstract

Background: South Africa has a high HIV burden among young people (15-24 years). This study examines the association between HIV status and behavioural risk factors and quantifies whether changes in HIV prevalence are due to shifts in risk factor distribution or their effects. Methods: Data from 8,189 young adults in the 2008 and 2017 South African National HIV Surveys were analysed, by sex. Multiple imputation addressed missing data and logistic regression assessed associations between HIV and behavioural risk factors, including intergenerational sex, transactional sex, inconsistent condom use, and number of sexual partners. Decomposition analysis examined the drivers of prevalence changes. Results: HIV prevalence declined slightly (8.7% to 7.9%) but was not statistically significant. Intergenerational sex and early sexual debut remained key predictors. The decline in HIV prevalence was mainly driven by changes in the effects of the risk factors. Conclusion: Findings highlight the need for targeted interventions addressing interlinked behaviours to reduce HIV vulnerability among young adults, with emphasis on sustaining reduction among females and addressing persistent risk factors among males.