Sex-disaggregated analysis of age-standardized human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections prevalence in Sierra Leone: insights from the World Health Organization health equity assessment toolkit data

Abstract

Background

Human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections remain critical public health challenges in Sierra Leone, with major implications for morbidity and mortality. Understanding the trends in the prevalence of these infections and identifying sex-based disparities are essential for designing effective, evidence-based interventions. This study examined the trends in age-standardized prevalence of human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections in Sierra Leone in 2000, 2005, 2010, 2015, and 2019.

Methods

A cross-sectional study design was conducted using age-standardized prevalence rates (per 100,000 population) of human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections from the World Health Organization health equity assessment toolkit database at five time points (2000, 2005, 2010, 2015, and 2019). Inequality measures, including Difference (D), Ratio (R), Population Attributable Fraction (PAF), and Population Attributable Risk (PAR), were calculated to assess absolute and relative disparities between sexes. Confidence intervals (CI) were reported for all estimates to ensure robustness of results.

Results

The age-standardized prevalence of human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections in Sierra Leone showed a steady decline, from 25,995.3 per 100,000 population in 2000 to 25,705.5 in 2019. However, sex-disaggregated analysis revealed disparities, with females consistently experiencing higher prevalence rates than males across all years. In 2019, the prevalence for females was 34,548.5 per 100,000 population (95% CI: 30,887.3–38,496.7), compared to 16,734.0 per 100,000 population for males (95% CI: 14,674.0–19,020.4). The inequality ratio remained constant at 2.1, indicating that females consistently bore more than twice the burden compared to males. The absolute difference between sexes decreased slightly over time, from 17,962.9 per 100,000 population in 2000 to 17,814.5 per 100,000 population in 2019.

Conclusions

Despite the decline in the prevalence of human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections in Sierra Leone between 2000 to 2019, sex-based disparities remain substantial, with females consistently experiencing a higher burden than males. These findings underscore the need for sex-sensitive policies and interventions to address the causes of these disparities. Strengthening health systems, promoting gender equity, and implementing targeted prevention programs are essential to reducing the overall prevalence and achieving health equity in Sierra Leone.