title: A tale of two countries: rethinking sexual risk for HIV among young people in South Africa and the United States.
abstract: OBJECTIVE
  To compare the sexual behaviors of young people in South Africa (SA) and the United States (US) with the aim to better understand the potential role of sexual behavior in HIV transmission in these two countries that have strikingly different HIV epidemics.
  
  
  METHODS
  Nationally representative, population-based surveys of young people aged 18-24 years from SA (n = 7,548) and the US (n = 13,451) were used for the present study.
  
  
  RESULTS
  The prevalence of HIV was 10.2% in SA and <1% in the US. Young women and men in the US reported an earlier age of first sex than those in SA (mean age of coital debut for women: US [16.5], SA [17.4]; for men: US [16.4], SA [16.7]). The median number of lifetime partners is higher in the US than in SA: women: US (4), SA (2); men: US (4), SA (3). The use of condom at last sex is reported to be lower in the US than in SA: women: US (36.1%), SA (45.4%); men: US (48%), SA (58%). On average, young women in SA report greater age differences with their sex partners than young women in the US.
  
  
  CONCLUSIONS
  Young people in the US report riskier sexual behaviors than young people in SA, despite the much higher prevalence of HIV infection in SA. Factors above and beyond sexual behavior likely play a key role in the ongoing transmission of HIV in South African youth, and thus should be urgently uncovered to develop maximally effective prevention strategies.
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA. apettif@email.unc.edu
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Pettifor
authors.forename: Brooke A
authors.initials: BA
authors.lastname: Levandowski
authors.forename: Catherine
authors.initials: C
authors.lastname: Macphail
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Joyce
authors.initials: J
authors.lastname: Tabor
authors.forename: Carol
authors.initials: C
authors.lastname: Ford
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Stein
authors.forename: Helen
authors.initials: H
authors.lastname: Rees
authors.forename: Myron
authors.initials: M
authors.lastname: Cohen
mesh_terms: D001294:Attitude to Health; D003075:Coitus; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010379:Peer Group; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012931:Social Environment; D013019:South Africa / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult