Fearon Elizabeth, Wiggins Richard D, Pettifor Audrey E, Hargreaves James R
Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
Department of Social Science, UCL Institute of Education, University College London, 20 Bedford Way, London WC1H 0AL, United Kingdom.
Soc Sci Med. 2015 Dec;146:62-74. doi: 10.1016/j.socscimed.2015.09.039. Epub 2015 Oct 9.
Adolescents in sub-Saharan Africa are highly vulnerable to HIV, other sexually transmitted infections (STIs) and unintended pregnancies. Evidence for the effectiveness of individual behaviour change interventions in reducing incidence of HIV and other biological outcomes is limited, and the need to address the social conditions in which young people become sexually active is clear. Adolescents' peers are a key aspect of this social environment and could have important influences on sexual behaviour. There has not yet been a systematic review on the topic in sub-Saharan Africa. We searched 4 databases to find studies set in sub-Saharan Africa that included an adjusted analysis of the association between at least one peer exposure and a sexual behaviour outcome among a sample where at least 50% of the study participants were aged between 13 and 20 years. We classified peer exposures using a framework to distinguish different mechanisms by which influence might occur. We found 30 studies and retained 11 that met quality criteria. There were 3 cohort studies, 1 time to event and 7 cross-sectional. The 11 studies investigated 37 different peer exposure-outcome associations. No studies used a biological outcome and all asked about peers in general rather than about specific relationships. Studies were heterogeneous in their use of theoretical frameworks and means of operationalizing peer influence concepts. All studies found evidence for an association between peers and sexual behaviour for at least one peer exposure/outcome/sub-group association. Of all 37 outcome/exposure/sub-group associations tested, there was evidence for 19 (51%). There were no clear patterns by type of peer exposure, outcome or adolescent sub-group. There is a lack conclusive evidence about the role of peers in adolescent sexual behaviour in Sub-Saharan. We argue that longitudinal designs, use of biological outcomes and approaches from social network analysis are priorities for future studies.
撒哈拉以南非洲地区的青少年极易感染艾滋病毒、其他性传播感染（STIs）以及意外怀孕。关于个体行为改变干预措施在降低艾滋病毒发病率和其他生物学结果方面有效性的证据有限，而解决年轻人开始性活跃所处社会环境问题的必要性是显而易见的。青少年的同龄人是这一社会环境的关键因素，可能对性行为产生重要影响。撒哈拉以南非洲地区尚未对该主题进行系统综述。我们检索了4个数据库，以查找在撒哈拉以南非洲地区开展的研究，这些研究对至少一种同龄人接触与性行为结果之间的关联进行了校正分析，且样本中至少50%的研究参与者年龄在13至20岁之间。我们使用一个框架对同龄人接触进行分类，以区分可能产生影响的不同机制。我们找到了30项研究，并保留了11项符合质量标准的研究。其中有3项队列研究、1项事件发生时间研究和7项横断面研究。这11项研究调查了37种不同的同龄人接触-结果关联。没有研究使用生物学结果，所有研究都是一般性地询问同龄人，而非具体关系。研究在理论框架的使用和同龄人影响概念的操作化方法上存在异质性。所有研究都发现，至少有一种同龄人接触/结果/亚组关联存在同龄人与性行为之间关联的证据。在所有测试的37种结果/接触/亚组关联中，有19种（51%）存在证据。在同龄人接触类型、结果或青少年亚组方面没有明显模式。关于同龄人在撒哈拉以南非洲青少年性行为中的作用，缺乏确凿证据。我们认为，纵向设计、生物学结果的使用以及社会网络分析方法是未来研究的重点。
