Sexual Behavior among Emerging Adults in Africa: A Systematic Review and Meta-Analysis

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 1 or more of 7 SBs were reviewed. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SB was explored. Risk factors were synthesized using a modified socioecological model. Results Overall, 143 studies were analyzed. Noncondom use had the highest pooled prevalence (47% [95% confidence interval {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 with their male counterparts. In 4 of the 7 outcomes, alcohol/drug use was the most common risk factor. Conclusions Sexual behavior was common among EmA and differentially higher in emerging female adults. Noncondom use had the highest pooled prevalence, which may contribute to the transmission of HIV and other sexually transmitted infections. Interventions targeting emerging female adults and alcohol/drug use may reduce SB, which may in turn mitigate transmission of HIV and other sexually transmitted infections among EmA in Africa.