Sexual behavior among emerging adults in Africa: a systematic review and meta-analysis

Abstract

Background Estimates on sexual behavior (SB) among emerging adults (EmA) is varied in literature, which presents a challenge when designing targeted interventions. We aimed to summarize literature on prevalence and risk factors of SB among EmA in Africa. Methods A search for studies published in PubMed, Embase and Psych Info by March 2023 was done. Studies involving EmA (18–25 years), conducted in Africa and reporting one or more of seven SB were reviewed. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SB was explored. Risk factors were synthesized using a modified socio-ecological model. Results Overall, 143 studies were analyzed. Non-condom use had the highest pooled prevalence (47% [95% CI: 42-51]), followed by study-defined SB (37% [95% CI: 25-50]) and concurrency (37% [95% CI: 21-54]), multiple sex partners (31% [95% CI: 25-37]), younger age at sexual debut (26% [95% CI: 20-32]), age disparate relationships (24% [95% CI: 17-32]) and transactional sex (19% [95% CI: 13-26]). Heterogeneity was partially explained by sex, with female participants having higher pooled prevalence estimates compared to their male counterparts. In four of the seven outcomes, alcohol/drug use was the most common risk factor. Conclusions SB was common among EmA and differentially higher in emerging female adults. Non-condom use had the highest pooled prevalence, which may contribute to the transmission of HIV and other sexually transmitted infections (STIs). Interventions targeting emerging female adults and alcohol/drug use may reduce SB, which may in-turn mitigate transmission of HIV and other STIs among EmA in Africa.