Unsafe Sexual Practices Among Young Women in SSA: A Systematic Review of Qualitative Research Relevant to the Development and Implementation of Effective Interventions

Background: The spread of HIV among young women in sub-Saharan Africa (SSA) is high. There is evidence that this is related to high risk sexual practice. With poor access to information, prevention and healthcare services; over 6,000 young people aged 15-24 are newly infected with HIV each day accounting for 50% of all new infections (Cleland, 1995; UNAIDS, 2008). Few empirical research studies have rigorously examined the underlying factors and impact of unsafe sex on young women's reproductive and sexual health. 
 

Objective: This systematic review of qualitative literature aimed to identify and explore factors that perpetuate unsafe sexual practice among sub-Saharan African women. SSA women's own experience and knowledge of unsafe sexual practice and the implications for the spread of STI/HIV were also explored.
 

Methods: A list of eligibility criteria was used during the conduct of this systematic review. Twelve qualitative research studies were identified as relevant for this review; these were subjected to thematic analysis. The thematic analysis involved the coding of text line-by-line; and the development of descriptive themes and the generation of analytical themes. 

Results: The major themes that emerged across the studies are social, cultural and economic pressure; gender-based power inequalities; control and negotiating power. Younger women in particular had little or no negotiating power and control in sexual and reproductive relationships, including condom use and violence.

Conclusion and Recommendations:  The review represents a largely unified picture of the situation in SSA, as regards unsafe sexual practice among the women in the region. In the bid to curb the spread of HIV/AIDS among women in SSA, it is recommended that policy makers and programme planners need to urgently implement interventions that can tackle the existing socio-cultural norms, values, and practices that promote gender inequality; power imbalance between men and women and unsafe sexual activities in SSA.