Youth-focused interventions that address context-specific economic and social determinants of HIV and SRH risk have proliferated recently, with encouraging impacts on both HIV/SRH and gender-related outcomes, though most interventions prioritise individual rather than structural change, impeding their 'gender transformative' potential.
Key Findings
Methods
A realist review identified 33 eligible interventions with gender-transformative mechanisms targeting HIV and sexual and reproductive health outcomes among adolescents and young people.
Interventions were eligible if they sought to achieve HIV/STI prevention, sexual behaviour or pregnancy outcomes among young people by enhancing agency, resources and social norms supportive of gender transformation.
The review used a programme theory to guide data extraction and synthesis.
Interventions were categorised by strategy and recorded for impacts on health and/or gender-related outcomes.
The 33 interventions represented diverse programme strategies and outcomes.
Results
Economic strengthening was the most common central strategy among the identified gender-transformative interventions.
Economic strengthening was the central strategy in 13 of 33 interventions.
Community-based mobilisation for norms change was the second most common strategy (n=7).
School-based educational curricula was the third most common strategy (n=6).
Most interventions used a combination approach rather than a single strategy.
Results
The majority of identified interventions achieved 'dual effects', meaning positive effects on both health and gender-related outcomes.
24 of 33 interventions achieved 'dual effects' — positive effects on both health and gender-related outcomes.
15 interventions achieved dual effects specific to HIV prevention.
12 interventions reported positive impacts on condom use alongside improved agency or gender norms.
Few evaluations measured or found impacts on HIV/STI incidence specifically.
Background
Gender inequalities continue to drive new HIV and STI infections at rates too high to achieve global goals, with adolescent girls and young women at disproportionate risk.
In high HIV-burden jurisdictions, adolescent girls and young women face disproportionate risk of HIV and STIs.
Social and systemic barriers also impede the engagement of young men and gender minorities with health services.
The review was motivated by the need to identify approaches that address gender transformation and remove structural barriers limiting prospects for adolescents and young people.
Discussion
Most interventions prioritise individual rather than structural change, which impedes their 'gender transformative' potential.
Despite encouraging impacts on HIV/SRH and gender-related outcomes, the review found that most interventions focus on individual-level change.
This individual focus was identified as a limitation on achieving full gender transformation.
The authors noted that truly gender-transformative potential requires addressing structural-level determinants.
This finding was identified as a key gap despite the proliferation of youth-focused interventions addressing economic and social determinants.
Discussion
Youth-focused interventions addressing context-specific economic and social determinants of HIV and SRH risk have proliferated recently with encouraging impacts.
The review noted recent growth in the number of youth-focused interventions targeting economic and social determinants of HIV and SRH risk.
Encouraging impacts were observed on both HIV/SRH outcomes and gender-related outcomes.
The authors described this as boding 'well for empowering strategies to achieve HIV and STI reduction targets among adolescents and young people, and broader SRH goals.'
Despite proliferation, gaps remain in measurement of HIV/STI incidence outcomes.
What This Means
This research review examined programs designed to reduce HIV and other sexually transmitted infections among young people by addressing gender inequality. Researchers analyzed 33 programs from around the world that tried to improve young people's sexual and reproductive health by changing gender norms, increasing economic resources, and building young people's ability to make their own decisions. The most common type of program provided economic support (like cash transfers or livelihood training), followed by community programs aimed at changing social norms, and school-based education curricula.
The review found encouraging results: about three-quarters of the programs (24 out of 33) showed positive effects on both health outcomes and gender-related outcomes — such as improved attitudes toward gender equality or increased decision-making power for young women. Twelve programs specifically showed that participants used condoms more often alongside improvements in gender attitudes or personal agency. However, very few programs actually measured whether they reduced new HIV or STI infections directly, which is the ultimate goal.
This research suggests that combining economic support with efforts to change gender norms and build young people's agency can improve both health behaviors and gender equality simultaneously. However, the review also found that most of these programs focus on changing individuals rather than tackling the deeper structural inequalities — like discriminatory laws, economic systems, or health service barriers — that put young people at risk in the first place. This gap means that even well-designed programs may fall short of their full potential to transform gender inequality and reduce HIV among adolescents and young people globally.
Gourlay A, Walker D, Singh S, Mata M, Birdthistle I. (2025). Gender-transformative HIV and SRHR programme approaches for adolescents and young people: a realist review to inform policy and programmes.. BMJ global health. https://doi.org/10.1136/bmjgh-2023-014363