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

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. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This work was partially funded by the Medical Research Council [Grant number MR/M025454/1] to AA. This award is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under MRC/DFID concordant agreement and is also part of the EDCTP2 program supported by the European Union. The authors are also grateful for the support of the Sub-Saharan African Network for TB/HIV – 1 Research Excellence (SANTHE), a DELTAS Africa Initiative [grant number DEL –15 – 006] to AH. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS) s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [grant number 107752/Z/15/Z] and the UK government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This is a systematic review and meta analysis. The data relating to this manuscript is from published research articles I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors