The role of economic factors and risky behavior for youth and young adults in the HIV epidemic in 29 low- and middle-income countries

Abstract

# Background Using cross-sectional data from recent Demographic and Health Surveys (DHS) in 29 low- and middle-income countries, this study examined how youth and young adults (15-24 years) differ from older adults in human immunodeficiency virus (HIV) prevalence, knowledge and attitudes, risk taking, and economic vulnerability to the epidemic. # Methods Using individual DHS data from 403,000 adults, logistic regression modeling was used to examine prevalence, knowledge, attitudes, and risky behaviors in 27 sub-Saharan African and two Caribbean countries. As DHS lacks a cohort design, we used inverse probability weighting (IPW) rather than the DHS sampling weights to adjust sample weights for selection bias, which reflects the fact that wealthier persons tend to live longer with HIV, making it appear that higher wealth is a risk factor for HIV prevalence. # Results As in older adults, HIV prevalence among younger adults varies enormously across countries. Prevalence in adults ages 15-24 varies from lows of < 0.3% (Niger, Ethiopia, Senegal, Burundi, The Gambia, Burkina Faso) to over 20 times higher in countries such as Zambia, Mozambique, and Lesotho. Multivariate results show that prevalence among youth and young adults is largely due to: (1) the high prevalence among young women, and (2) for both genders, the influence of family poverty in regions of high wealth inequality. We confirm previous studies showing that all women, including women 15-24 have far higher risk of HIV infection than comparable males. They develop faster physically, and our study data show that they are sexually active earlier, and that young women engage in more risky behaviors than young men. # Conclusions Though one might imagine that HIV infections of young adults is due to more risky behaviors, our findings do not support this. Controlling for demographics and economic status, younger adults show better risk behavior than older adults for all three risky behaviors we study here. One important risk factor for the youth and young adults, both male and female, is being poor and living in regions with high wealth inequality, suggesting the need for continued targeting programs to reduce HIV risk for young men and young women separately, and concentrating those programs geographically in high wealth inequality areas.