HIV in adolescents in sub-Saharan Africa.
OBJECTIVE
In this review, we summarize existing evidence on the effectiveness of different intervention approaches to HIV prevention in adolescents - focusing on studies that are either from or are relevant to sub-Saharan Africa. In addition, we include a brief review of other salient issues relevant to HIV prevention research in adolescents.


RESULTS
Although numerous adolescent behavioural HIV prevention interventions have been evaluated, few have assessed their impact on HIV endpoints or been undertaken in Africa. In the three trials from Africa, which had HIV endpoints, none of the interventions had an impact on HIV, although all affected some knowledge and attitudes and reported behaviours. In one of these trials, there was a borderline effect on herpes simplex virus-2 incidence. Adolescents have typically been excluded from trials of biological interventions, although they are likely to benefit from these interventions if found to be effective. Despite the regulatory difficulties, they must be considered for inclusion in these trials as an important target population. Although structural determinants of infection appear to be key drivers of the epidemic in young people in sub-Saharan Africa, few have been rigorously evaluated; those that have have been shown to be promising evidence for their future role in prevention.


CONCLUSIONS
Young people in sub-Saharan Africa, particularly young women, continue to bear the brunt of the HIV epidemic. Adolescents must be an important focus for HIV prevention programming and research. It is increasingly clear that multilevel approaches to prevention will be required to reduce rates of HIV in this age group.
Cowan
Frances
F
Centre for Sexual Health and HIV Research, University College London, The Mortimer Market, Capper Street, London WC1E 6AU, UK. francesmcowan@yahoo.co.uk
Pettifor
Audrey
A
D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D002986:Clinical Trials as Topic; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D006561:Herpes Simplex / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult