HIV Transmission Disparities Persist, Remain Major Challenge in Sub-Saharan Africa

Data from several surveys conducted since 2005 indicate a continuous gap in HIV prevention and transmission between adolescent females and males in sub-Saharan Africa.

Among 2 subregions of sub-Saharan Africa, adolescent females overall and adolescent females and males in urban settings continue to be disproportionately affected by HIV, according to data from 11 surveys conducted in 31 countries of Eastern and Southern Africa (n = 12) and West and Central Africa (n = 19) from 2005 to 2018.

These results were recently published in Reproductive Health. The incidence of HIV was evaluated among females and males aged 15 to 24 years, with prevalence and incidence investigated for those aged 5 to 9 and 10 to 14 years. Self-identified positive status was confirmed via additional testing.

“In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings,” the authors wrote. “This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban–rural disparities.”

For HIV prevalence among those aged 15 to 19 years in Eastern and Southern Africa, the rate was more than twice as high among girls as it was for boys: 3.3% vs 1.4%. In Southern Africa alone, overall HIV prevalence was above 5.0% in Eswatini, Mozambique, South Africa, and Lesotho.

In West and Central Africa, too, girls had a median HIV prevalence twice that of the boys: 0.7% vs 0.3%. Additionally, and in contrast, just 5 countries had a prevalence rate about 1.0% (Sierra Leone, Gabon, Cameroon, Chad and Guinea). Despite coming in far below the numbers seen in Eastern and Southern Africa, the rates prove out how adolescent girls are disproportionately affected by HIV.

Overall, for the counties that had 2 data points, rates did decrease among girls: from 5.7% to 2.6% between 2005 and 2017 in Eastern and Southern Africa and from 0.7% to 0.3% in West and Central Africa. These correspond to average annual rate reductions of 6.5% and 5.9%, respectively.

For boys, the overall rate also declined, but in in Eastern and Southern Africa only: from 2.1% to 1.2%. No declines were seen in 5 countries, while Kenya, Tanzania, and Zambia saw HIV prevalence drop more than 10% each year.

In West and Central Africa, rates were consistently low at 0.3%.

Among those aged 10 to 14 and 5 to 9 years, the following results were seen for HIV prevalence:

  • Girls 10 to 14 years in Eastern and Southern Africa: 1.0%
  • Boys 10 to 14 years in Eastern and Southern Africa: 1.3%
  • Eswatini: 4.7% (95% CI, 2.8%-6.5%) for boys vs 3.4% (95% CI, 1.8%-5.1%) for girls
  • All girls and boys aged 5 to 9 years: 1.3% and 0.9%, respectively

When comparing ages 15 to 19 and 10 to 14 years, HIV prevalence was higher in 9 countries of Eastern and Southern Africa for girls alone, while among the boys, the differences were deemed not statistically significant. For females aged 15 to 24 years, the HIV incidence, too, was higher among females than males. “Among females, 8 of 9 countries had annual HIV incidence of 0.5% or higher,” the authors wrote.

Urban and rural locations had similar gaps in HIV prevalence, although to a lesser extent. Eight countries in Eastern and Southern Africa had 2 surveys providing study data, with annual drops of 4.6% among urban females, 5.2% among rural females, 5.7% among urban males, and 4.2% among rural males—all aged 15 to 24 years. No significant changes were seen among similar age groups in West and Central Africa.

When explaining their findings, the authors emphasized that the drops in HIV prevalence among those aged 15 to 19 years, some of whom acquired HIV from their mothers, may be due to greater use of antiretroviral therapies, testing, and condoms. However, with the totals being higher for adolescent girls overall, the results also indicate “that sexual transmission is still a major issue for adolescent girls.”

“The urban–rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in Eastern and Southern African countries,” the authors concluded. “Urban adolescent girls remain at greatest risk of HIV, especially in higher prevalence countries, and need to be targeted in prevention programs.”


Cane RM, Melesse DY, Kayeyi N, et al. HIV trends and disparities by gender and urban–rural residence among adolescents in sub‑Saharan Africa. Reprod Health. 2021;18(suppl 1):120. doi:10.1186/s12978-021-01118-7

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