HIV prevalence remains high among youths (15-24 years old) in Sub-Saharan Africa; however, little is known regarding the association of parents and youth’s HIV status, beyond the focus on mother-to-child transmission (MTCT). We examined the association between the HIV status of the household head (HH) and the youths in the household and their risky sexual behavior, using the Population-Based HIV Impact Assessment (PHIA) surveys conducted (2015-2019) by ministries of health in collaboration with ICAP at Columbia University and CDC.
Consenting adults from randomly selected households in 10 African countries provided demographic and behavioral information and blood samples for HIV testing. We applied multivariable Poisson regression using survey weights. Variances were estimated via Taylor series linearization.
We examined data from 52,498 youths aged 15-24 and 34,051 HHs. Among HHs, 4,234 (12.4%) were HIV+ (7.3% female HHs, 5.1% male HHs). HIV prevalence among adolescents (15-19) and young adults (20-24) with an HIV+ HH was 4.7% and 13.0%, respectively. In contrast, HIV prevalence among those in the same age groups, but with the HIV- HH, was 0.9% and 2.0%, respectively. Controlling for other covariates, adolescents and young adults were more likely to be HIV+ if the HH was HIV+, with an adjusted prevalence ratio (aPR) of 3.4 (95% CI: 2.8-4.1) and 3.6 (95% CI 3.2-4.2), respectively. Moreover, females aged 15-24 had significantly higher aPR (3.6 [95% CI: 3.1-4.0]) than males (2.9 [95% CI 2.3-3.7]). Adolescents and young adults were more likely to have more than one sex partner in the 12 months before the survey if their HHwas HIV+, with aPR 1.1 (95% CI: 1.0-1.3) and 1.2 (95% CI: 1.1-1.3) respectively (Table).
The findings from 10 African countries indicate a strong association between the HIV status of the HH and the youths in the household and with more risky sexual behavior. The consistent pattern across these countries motivates focus on HIV prevention efforts for youths residing with HIV+ HHs. The difference in prevalence among youth by sex supports higher risk is due to sexual transmission rather than MTCT.