1. Jennifer Sherwood amfAR, The Foundation for AIDS Research
Sex-Specific HIV Trends, Indicators and Targets for Youth
in Sub-Saharan Africa
Jennifer Sherwood
amfAR, The Foundation for AIDS Research

2. Goals
Examine HIV prevalence trends among year olds by sex from
Report the HIV prevalence ratio between young women and young men for all included countries over time
Review HIV/AIDS National Strategic Plans for inclusion of sex-disaggregated HIV indicators and targets

3. Methods
HIV prevalence data for year olds, collected by UNAIDS ( ), were downloaded via the World Bank online database for all countries in SSA
Countries were excluded from analysis if their total youth HIV prevalence was < 1%
Linear regression models for both sexes and analysis of covariance (ANCOVA) between the HIV prevalence of young men and women were built for each included country in the region and SSA overall

4. Included Countries with Youth HIV Prevalence >1% in 2013
Botswana
Nigeria
Cameroon
Rwanda
Central African Republic
South Africa
Swaziland
Tanzania
Gabon
Uganda
Guinea-Bissau
Zambia
Zimbabwe
Kenya
Lesotho
Malawi
Mozambique
Namibia

5. Limitations
Models use HIV prevalence data (incidence data not available for all countries)
Declines do not necessary reflect declines in new infections (possibly increasing mortality)
However
UNAIDS has reported that overall AIDS-related deaths declined by 39% in SSA from
HIV prevalence among young people is considered to better reflect overall trends in HIV incidence as compared to an older age group – used to track MDG2

6. Difference in rate of annual change between women and men:
-.09% (95% CI: -.10% to -.08%) p<.001*

7. Difference in rate of annual change between women and men:
1.85
W:M
Difference in rate of annual change between women and men:
-.46% (95% CI: -.51% to -.42%) p<.001*

8. 2.45
W:M
2.14
W:M
2.26
W:M
Difference in rate of annual change between women and men:
-.08% (95% CI: -.16% to 0.0%) p = .05

9. 1.86
W:M
Difference in rate of annual change between women and men:
.05% (95% CI: .03% to .08%) p<.001*

10. Gabon, 2009
Zambia, 2012

11. Results
Young women had significantly higher HIV prevalence across all included countries in SSA in all years
Overall declining prevalence among young women and men. However declines were not statistically significant in, Guinea-Bissau, Lesotho, Mozambique, South Africa, or Swaziland
Narrowing of the gender gap in HIV prevalence in most countries, with the exception of Uganda
Wide range of HIV PR W:M (5.8 : 1 vs. 1.3 : 1)

12. Review of the National Strategic Plans
Each NSP was reviewed by two researchers for:
The inclusion of specific programming to improve outcomes for women/girls
The inclusion of sex-specific indicators for the general population
The inclusion of sex-specific targets for the general population
Only for the general population - does not include sex-specific targets for PMTCT, MSM or FSW
Recorded as (yes/no) for disaggregation of data

13. Programming to Improve HIV Outcomes for Women/Girls
Examples:
Integrating sexual and reproductive health services into primary health care (South Africa)
Addressing gender-based violence
Improving services for survivors of sexual assault
Increasing access to family planning
Fistula repair (Zambia)
Providing adolescent sexual and reproductive health services
Improving school outcomes for girls and youth (Cameroon)

14. Example: Sex-Specific Indicators and Targets in Rwanda NSP (2013-2018)

15. Example: Non Sex-Specific Indicators and Targets in Gabon NSP (2013-2017)

16. Country
Years of the National Strategic Plan
HIV PR W:M in 2013
Include specific programming to improve outcomes for women/girls
Inclusion of Sex-Specific HIV Indicators
Inclusion of Sex -Specific HIV Targets
Gabon
4.75
South Africa
3.28     
Mozambique
2.26
Cameroon
2.03
Guinea-Bissau
1.90
Nigeria
1.89
Lesotho
1.86
Namibia
1.81
Uganda
1.78
Swaziland
1.75
Botswana
CAR
1.71
Kenya
1.67
Zimbabwe
1.65
Malawi
1.61
Tanzania
1.58
Rwanda
1.57
Zambia
1.33

17. Country
Years of the National Strategic Plan
HIV PR W:M in 2013
Include specific programming to improve outcomes for women/girls
Inclusion of Sex-Specific HIV Indicators
Inclusion of Sex -Specific HIV Targets
Gabon
4.75
South Africa
3.28     
Mozambique
2.26
Cameroon
2.03
Guinea-Bissau
1.90
Nigeria
1.89
Lesotho
1.86
Namibia
1.81
Uganda
1.78
Swaziland
1.75
Botswana
CAR
1.71
Kenya
1.67
Zimbabwe
1.65
Malawi
1.61
Tanzania
1.58
Rwanda
1.57
Zambia
1.33

18. Conclusion
Much room for improvement to decrease sex-disparity in HIV between young women and young men
(lowest observed ratios around: 1.3 : 1)
Age and sex-specific HIV indicators and targets are inconsistently incorporated in NSPs and should be prioritized - (notable gaps for high disparity countries)
Disaggregation allows for
More accurate tracking of the epidemic
Identification of age or sex specific gaps
Driving resources to respond to gaps
Designing programs to target needs of young women and men
Encouraging civil society organizations to form advocacy efforts around established targets

19. Thank you! Bergen Cooper Greg Millett Beirne Roose-Snyder
Brian Honermann
Susan Blumenthal
Kali Lindsey
Christina Chandra
Laura Lazar
Jack MacAllister

20. Citations UNAIDS: The Gap Report. In.; 2014.
United Nations: Indicators for Monitoring the Millenium Development Goals: 6.1 HIV prevalence among population ages years