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Summary Background Drug therapy for people with AIDS is a humanitarian priority but prevention of HIV infection remains essential. Focusing on young single African women, we aimed to assess trends in a set of behaviours-sexual abstinence, contraceptive use, and condom use-that are known to affect the rates of HIV transmission. Methods We did a secondary analysis of public-access data sets in 18 African countries (132 800 women), and calculated changes in a set of behavioural indicators over time. We standardised these trends from nationally representative surveys to adjust for within-country changes in age, education, and type of residential location. Findings Between about 1993 and 2001, the percentage of women reporting no sexual experience changed little. During the same period, the percentage of sexually experienced women who reported no sexual intercourse in the previous 3 months (secondary abstinence) rose significantly in seven of 18 countries and the median for all 18 countries increased from 43·8% to 49·2%. Use of condoms for pregnancy prevention rose significantly in 13 of 18 countries and the median proportion increased from 5·3% to 18·8%. The median rate of annual increase of condom use was 1·41 percentage points (95% CI 1·12-2·25). In the 13 countries with available data, condom use at most recent coitus rose from a median of 19·3% to 28·4%. Over half (58·5%) of condom users were motivated, at least in part, by a wish to avoid pregnancy. Interpretation Condom promotion campaigns in sub-Saharan Africa have affected the behaviour of young single women; the pace of change has matched the rise in contraceptive use by married couples in developing countries over recent decades. Thus continuing efforts to promote condom use with emphasis on pregnancy prevention are justified. [ABSTRACT FROM AUTHOR]

Background: HIV and unintended pregnancy are major interrelated concerns in sub-Saharan Africa. Focussing on single women aged 15-24 years we assess trends in key behaviours that affect both outcomes. Methods: We performed a secondary analysis of public-access data sets from 112 surveys from 36 countries in the region, conducted between 1991 and 2015. We examined trends over 20 years in primary abstinence (virginity), secondary abstinence (no sex in past 3 months) among sexually experienced women, current use of modern contraception and condom use at most recent coitus among sexually active women. Results: Little change occurred in primary or secondary abstinence. Over the 20 year period, contraceptive use in the region rose from 14.7 to 33.4%, with significant increases observed in 18 of 30 countries with multiple surveys. Since 2001–2005, the proportion of contraceptive users reporting condoms as their method fell from 61.1 to 51.3%, while use of oral contraceptives or injectables rose from 19.9 to 24.0%. Between 1996 and 2000 and 2006–2010, condom use at last coitus rose from 21.3 to 40.5% but then plateaued. A strong correlation between condom use and national HIV prevalence was found. About half of condom users at last sex had earlier in interviews reported this method for pregnancy-prevention. Conclusions: Though condoms tend to be overlooked by both HIV and family planning agencies, their contribution to the health of single women remains central. Current efforts to promote non-barrier contraceptive methods may inadvertently increase HIV risk. Condom promotion for pregnancy-prevention should be re-invigorated by social marketing campaigns and other means. [ABSTRACT FROM AUTHOR]