A multidimensional analysis of HIV prevalence among young people in Sierra Leone (2008–2019) to inform inclusive policy reform

Abstract Introduction Young people aged 15–24 years drive a significant proportion of new HIV infections in sub-Saharan Africa, yet multidimensional disparities in HIV prevalence among this age group remain underexplored in Sierra Leone. This study examines temporal trends and sociodemographic inequalities in HIV prevalence among Sierra Leonean youth from 2008 to 2019 to inform equity focused policy reforms. Methods We analyzed data from the 2008, 2013, and 2019 Sierra Leone Demographic and Health Surveys, encompassing 12,087 respondents aged 15–24 years with valid HIV test results. HIV prevalence was disaggregated by age, wealth quintile, education, marital status, urban–rural residence, and region. Inequalities were quantified using six indices: Difference, Ratio, Population Attributable Risk, Population Attributable Fraction, Slope Index of Inequality, and Relative Index of Inequality. Survey weights ensured national representativeness, with 95% confidence intervals reported. Results National HIV prevalence remained stable at 1.0–1.1% (2008–2019), masking significant disparities. In 2019, prevalence was markedly higher among 20–24-year-olds (1.9% vs. 0.4% for 15–19-year-olds; Difference: − 1.5, Ratio: 0.2), wealthier quintiles (1.8% vs. 0.4% for poorest; Relative Index of Inequality: 5.0), and urban residents (1.4% vs. 0.7% rural; Difference: − 0.7). Marital status disparities were pronounced, with married/cohabiting youth at 1.7% prevalence compared to 0.4% for never-married (Population Attributable Fraction: − 59.1%). Regional disparities persisted, with Western areas highest (1.9%). Economic and marital disparities appeared to widen over time, although several subgroup estimates had overlapping confidence intervals and should therefore be interpreted cautiously. Conclusions Stable national HIV prevalence masks persistent sociodemographic disparities among young people in Sierra Leone. Targeted, structurally informed interventions addressing wealth-driven risks, early marriage, gender inequities, and urban social networks are critical to reduce HIV burden and align with UNAIDS 2030 targets.