HIV prevalence and associated factors among adolescent boys and young men in South Africa: 2017 nationally representative household-based population survey

There is growing recognition that adolescent boys and young men (ABYM) have been left behind in the HIV response and are under-represented in HIV services, leading to poor outcomes across the HIV care cascade. Improved understanding of the HIV epidemic in this population is important for engaging ABYM in the HIV response. This study examined HIV prevalence and associated factors among ABYM aged 15 to 24 years using the 2017 South African National HIV Prevalence, Incidence, Behaviour and Communication Survey. The data were collected using a multi-stage stratified cluster randomised sampling design. Descriptive statistics were used to summarise the study sample and HIV prevalence. A multivariate backward stepwise logistic regression model was used to determine factors associated with HIV prevalence. Variables with a significance level of p<0.2 were retained in the final model. Adjusted ORs (AORs) with 95% CI and a p value 0.05 were used to determine the level of statistical significance. Of 3544 ABYM interviewed and tested, 47.8% (n=1 932) were aged 15 to 19 years and 52.2% (1612) were aged 20 to 24 years. Overall, 4.8% (95% CI 3.9 to 5.9) were HIV positive, translating to 230 585 ABYM living with HIV in 2017. The odds of being HIV positive were significantly lower among ABYM with tertiary education level (AOR=0.06 (95% CI 0.01 to 0.50), p=0.009), those who were employed (AOR=0.34 (95% CI 0.14 to 0.81), p=0.015) and those who had previously tested for HIV and were aware of their status (AOR=0.29 (95% CI 0.10 to 0.83), p=0.015). These findings suggest the need to diversify the HIV response to include the implementation of social policies to reduce structural challenges such as low educational attainment and unemployment. They also underscore the importance of promoting the uptake of HIV testing and awareness as the entry point to the treatment and care cascade among ABYM.