Gender disparities in HIV infections: A narrative review of the persistent vulnerability of adolescent girls in Sub-Saharan Africa

Abstract

The human immunodeficiency virus (HIV) epidemic in Sub-Saharan Africa (SSA) disproportionately affects adolescent girls and young women (AGYW), who face a risk of infection up to three times higher than their male peers. SSA accounts for 65% of the global HIV burden, with Eastern and Southern Africa showing particularly high rates. The aim of this study was to examine the persistent gender disparities in HIV infections, focusing on the biological, social, and structural drivers of AGYW’s heightened vulnerability. Biological factors such as immature cervical development and hormonal influences intersect with social determinants, including gender inequality, cultural norms, and economic pressures. These factors reduce young women’s ability to negotiate safer sexual practices and increase reliance on transactional relationships with older partners. Despite initiatives such as determined, resilient, empowered, AIDS-free, mentored, and safe (DREAMS) and Education Plus, barriers such as stigma, gender-based violence, and limited access to youth-friendly sexual and reproductive health services persist. Addressing these disparities requires multi-level, gender-responsive interventions that strengthen healthcare access, expand female-controlled prevention options, and promote education and economic empowerment. Closing the gender gap in HIV outcomes will demand sustained policy commitment and community engagement tailored to the needs of adolescent girls in SSA.