In South Africa, HIV prevalence among youth aged 15-24 is among the world's highest. Given the urgent need to identify effective HIV prevention approaches, this review assesses the evidence base for youth HIV prevention in South Africa.

In KwaZulu/Natal, South Africa, the social construction of young people's sexuality reflects both a complex historical process of cultural and religious integration, as well as the contemporary resurgence of ‘traditionalism’. How do young people interpret these factors to construct and give meaning to their own sexualities? This multi‐method qualitative study examined sexuality and relationship formation among sexually experienced young people aged 14–19 in a rural sub‐district. In this setting, sexual activity is highly stigmatised, particularly for young teenage women. Dominant sexual ideologies centre on ‘good behaviour’, the idea that ‘sex is wrong’, and abstinence as a preferred prevention strategy. Young women's relationships are often hidden but sexual relationships are also an important part of the transition to adulthood. These dichotomies of love and romance versus stigma and secrecy frame young people's discourse about sexuality. A discourse about healthy sexuality is largely absent, impeding the prevention of HIV in this setting.

Background: This qualitative study investigated gender power inequalities as they contribute to relationship dynamics and HIV-serostatus disclosure among men and women living with HIV in Durban, South Africa. HIV-serodiscordance among men and women within stable partnerships contributes to high HIV incidence in southern Africa, yet disclosure rates remain low. Given the emphasis on prevention for HIV-serodiscordant couples, this research supports the urgent need to explore how best to support couples to recognize that they are part of this priority population and to access appropriate prevention and treatment. Methods: Thirty-five in-depth individual interviews were conducted with 15 HIV-positive men and 20 HIV-positive women (not couples) receiving care at public-sector clinics near Durban. A structured coding scheme was developed to investigate men’s and women’s attitudes toward HIV-serostatus disclosure and behaviors of sharing (or not sharing) HIV-serostatus with a partner. Narratives were analyzed for barriers and facilitators of disclosure through the lens of sociocultural gender inequality, focusing on reasons for non-disclosure. Results: Among 35 participants: median age was 33 (men) and 30 years (women); average years since HIV diagnosis was 1 (men) and 1.5 (women). Four themes related to gender inequality and HIV-serostatus disclosure emerged: (1) Men and women fear disclosing to partners due to concerns about stigma and relationship dissolution, (2) Suspicions and mistrust between partners underlies decisions for non-disclosure, (3) Unequal, gendered power in relationships causes differential likelihood and safety of disclosure among men and women, and (4) Incomplete or implicit disclosure are strategies to navigate disclosure challenges. Findings illustrate HIV-serostatus disclosure as a complex process evolving over time, rather than a one-time event. Conclusions: Partner communication about HIV-serostatus is infrequent and complicated, with gender inequalities contributing to fear, mistrust and partial or implicit disclosure. Relationship dynamics and gender roles shape the environment within which men and women can engage successfully in the HIV-serostatus disclosure process. Integrated interventions to reduce barriers to trustful and effective communication are needed for HIV-affected men and women in partnerships in which seeking couples-based HIV-counseling and testing (CHCT) is challenging or unlikely. These data offer insights to support HIV-serostatus disclosure strategies within relationships over time.