Sexual risk-taking behavior amongst emerging adults in Africa: a systematic review and meta-analysis

Abstract Background Incidence of HIV and other sexually transmitted infections (STIs) among emerging adults (EmA) is high in some African settings. Estimates on sexual risk-taking behavior (SRTB) among EmA is varied in literature, which presents a challenge when designing targeted interventions. We aimed to review and summarize literature on prevalence and risk factors of SRTB among EmA in Africa. Methods A search for studies published in PubMed, Embase and Psych Info involving EmA (18 – 25 years), conducted in Africa and reporting one or more SRTB was done. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SRTB was explored by sex, geographic region, year of publication and outcome definition. Risk factors were synthesized using a modified socio-ecological model. Results Overall, 117 studies were analyzed. Non-condom use had the highest pooled prevalence (46.0% [95% CI: 14.0-51.0]), followed by study-defined SRTB (37.0% [95% CI: 23.0 -51.0]), concurrency (35.0% [95% CI: 19.0-53.0]), multiple sex partnerships (30.0% [95% CI: 24.0-37.0]), younger age at sexual debut (25.0% [95% CI: 19.0-31.0]), age disparate relationships (24.0% [95% CI: 17.0-32.0]) and transactional sex (17.0% [95% CI: 11.0-24.0]). In four of the seven outcomes, heterogeneity was partially explained by sex, with female participants having higher pooled prevalence estimates compared to their male counterparts. In four of the seven outcomes, alcohol/drug use was the most common risk factor. Conclusions SRTB was common among EmA and differentially higher in emerging female adults. Non-condom use had the highest pooled prevalence, which may contribute to the propagation of HIV and other STIs in this population. Interventions targeting emerging female adults and alcohol/drug use may reduce SRTB, which may in-turn mitigate propagation of HIV and other STIs among EmA in Africa.