HIV risk reduction interventions for youth in sub-saharan Africa in a theoretical perspective: Gaps in theory and the “relational-situational” factor

Young people (15-24 years) are a vulnerable group for HIV infection, half of the new infections occurring in this group. Through rationalizing sexual behavior, theories serve as a solid ground for HIV risk-reduction interventions. Reviews on other population groups/regions have shown that theory-based interventions can be more effective. This review studies the use of theory in HIV prevention interventions for youth in sub-Saharan.

Online databases were searched for evaluations of HIV risk reduction interventions for youth in sub-Saharan. 39 articles, reporting on 36 interventions, met the inclusion criteria.

There are few evaluations of HIV-prevention programs, relative to the size of the problem. Long-term impact (>1 year) is measured by only 2 studies.

Twelve theories were referred to 28 times in 23 articles. Social Cognitive Theory (10) and Health Belief Model (5) dominate. There is no direct link between theory and the impact of interventions. Eleven articles measure all constructs of the theory on which the intervention is based, unfortunately using a variety of indicators giving proof of a poor conceptualization of theoretical constructs. None of the articles studied correlations between measured theoretical determinants and reported behavior, a missed chance for insights in the validity/utility of theories for sexual behavior of African youth.

The main gap in measuring the outcome of behavioral interventions is that concepts can be interpreted subjectively, reducing comparability between interventions. Gaps in theory are: 1) absence of specific theoretical concepts/measures for adolescents; 2) ignorance of the interpersonal factor and the social context.

Sexual behavior of young people in sub-Saharan cannot be predicted, nor changed by the current dominant constructs of health psychological theories. Efforts should be intensified to incorporate interpersonal and social aspects in behavioral theory for youth. Current behavioral theories could benefit from complementation with sociological theories.