Gender disparities in comprehensive knowledge of HIV among adolescents and young adults in Ethiopia: A decomposition analysis

Female adolescents and young adults (AYAs) aged 15-24 bear up to a threefold higher burden of HIV and face nearly twice the susceptibility to infection compared with males of the same age group. A comprehensive knowledge of HIV is critical for effective prevention of the virus. However, substantial gender disparities persist in HIV knowledge. This study assessed male and female differences in comprehensive HIV knowledge among AYAs in Ethiopia and identify key drivers of these disparities. This study used a cross-sectional design with secondary data analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS). Male and female AYAs aged 15 to 24 were included in the study. Comprehensive HIV knowledge was the outcome variable. Explanatory variables included age, educational attainment, marital status, occupation, household wealth, media exposure, and region of residence. Sample weighting was applied. Descriptive statistics and multivariate decomposition analysis were conducted to assess gender disparities. The decomposition model separated differences into explained (endowments) and unexplained (coefficient effects) components. A total of 10,597 AYAs (6,143 females and 4,455 males) were included in the analysis. Only 30.5% (95% CI: 29.6, 31.4) of AYAs demonstrated comprehensive HIV knowledge, with markedly higher levels among male AYAs (39.1%) compared with female AYAs (24.33%). Urban residents had higher HIV knowledge than their rural counterparts, males (52.3%) and females (58.3%). Education and occupation were significant contributors to the knowledge difference between males and females, with individuals who had higher education or were employed showing better HIV knowledge. Internet use and media exposure also played a crucial role, with those exposed demonstrating significantly higher HIV knowledge. Gender disparities in HIV knowledge were primarily driven by education, occupation, and region. There are significant gender disparities in HIV knowledge among AYAs in Ethiopia, with males generally exhibiting higher levels of knowledge than females. The findings highlight the need for targeted HIV education programs that address these gender gaps, particularly for young women, who are more vulnerable to HIV infection. Socioeconomic factors, including education, residence, and media exposure, play a crucial role in shaping HIV knowledge. Efforts to enhance HIV knowledge through gender-sensitive interventions are crucial for improving prevention efforts and ultimately reducing HIV incidence in Ethiopia and similar contexts.