title: Is the sexual behaviour of young people in sub-Saharan Africa influenced by their peers? A systematic review.
abstract: Adolescents in sub-Saharan Africa are highly vulnerable to HIV, other sexually transmitted infections (STIs) and unintended pregnancies. Evidence for the effectiveness of individual behaviour change interventions in reducing incidence of HIV and other biological outcomes is limited, and the need to address the social conditions in which young people become sexually active is clear. Adolescents' peers are a key aspect of this social environment and could have important influences on sexual behaviour. There has not yet been a systematic review on the topic in sub-Saharan Africa. We searched 4 databases to find studies set in sub-Saharan Africa that included an adjusted analysis of the association between at least one peer exposure and a sexual behaviour outcome among a sample where at least 50% of the study participants were aged between 13 and 20 years. We classified peer exposures using a framework to distinguish different mechanisms by which influence might occur. We found 30 studies and retained 11 that met quality criteria. There were 3 cohort studies, 1 time to event and 7 cross-sectional. The 11 studies investigated 37 different peer exposure-outcome associations. No studies used a biological outcome and all asked about peers in general rather than about specific relationships. Studies were heterogeneous in their use of theoretical frameworks and means of operationalizing peer influence concepts. All studies found evidence for an association between peers and sexual behaviour for at least one peer exposure/outcome/sub-group association. Of all 37 outcome/exposure/sub-group associations tested, there was evidence for 19 (51%). There were no clear patterns by type of peer exposure, outcome or adolescent sub-group. There is a lack conclusive evidence about the role of peers in adolescent sexual behaviour in Sub-Saharan. We argue that longitudinal designs, use of biological outcomes and approaches from social network analysis are priorities for future studies.
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom. Electronic address: Elizabeth.Fearon@lshtm.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fearon
authors.affiliation: Department of Social Science, UCL Institute of Education, University College London, 20 Bedford Way, London WC1H 0AL, United Kingdom. Electronic address: r.wiggins@ioe.ac.uk.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Wiggins
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, 2101D Mcgavran-Greenberg Hall, 135 Dauer Drive, Campus Box 7435, Chapel Hill 27599-7435, USA. Electronic address: apettif@email.unc.edu.
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Pettifor
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom. Electronic address: James.Hargreaves@lshtm.ac.uk.
authors.forename: James R
authors.initials: JR
authors.lastname: Hargreaves
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D017954:Africa South of the Sahara; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008297:Male; D010379:Peer Group; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D066262:Social Norms; D055815:Young Adult
keywords: Peer exposure; Sexual behaviour; Social networks; Sub-Saharan Africa; Systematic review; Young people