Current state of the science: A systematic review of behavioral HIV interventions for south African adolescents, 2007-2012

Background: South African youth, ages 15-24, are disproportionately affected by HIV. Identifying effective HIV interventions is critical to averting HIV among these adolescents. Methods: Comprehensive electronic searches were conducted identifying relevant studies published between 2007 and 2012. Eligible studies included published South Africa-based studies that (1) targeted youth aged 9-26 with a mean age ≥12 years, (2) evaluated behavioral HIV interventions and (3) reported at least one HIV-related outcome. Each study was evaluated based on research design; intervention delivery (duration, intensity); outcomes; and strength of findings. Results: Six studies met the inclusion criteria from 576 studies identified through comprehensive searches of electronic bibliographic databases. Youth (N=14,765; >50% females; 9 to 24 yrs of age) were most often recruited through secondary schools. Interventions were typically delivered in groups over multiple sessions. Most studies focused on reducing sexual risk behaviors; two also addressed alcohol risk-taking behaviors. Interventions were generally successful at improving antecedents of behavioral change (knowledge, sexual communication) or sexual risk behaviors (delay in sexual debut, unprotected sex). Incidence of HSV-2, but not HIV, was reduced in a single study reporting biological outcomes. Studies addressing alcohol use as part of the intervention reported reductions in excessive use. Conclusions/Implications: Interventions for South African adolescents were generally successful at improving psychosocial, behavioral, and biological outcomes. Few interventions addressed alcohol use despite high rates of alcohol consumption among South African youth. Interventions targeting alcohol use are urgently needed to reduce sexual risk among adolescents living in South Africa.