Behavioural and Structural Determinants of HIV Persistence in the Democratic Republic of the Congo: A Documentary Analytical Study (2000–2024)

Abstract

Abstract

HIV remains a major public health concern in the Democratic Republic of the Congo (DRC). Although adult HIV prevalence in the Democratic Republic of the Congo remains comparatively moderate in sub-Saharan Africa, transmission persists. Understanding behavioural and structural drivers is essential for sustainable epidemic control. A documentary analytical study was conducted using national survey data (DHS), surveillance reports, and publications from UNAIDS and the WHO (2000–2024). Studies were selected following PRISMA principles. Multivariate logistic regression estimates were extracted and synthesized. Population attributable fractions were estimated for major modifiable determinants. The results indicate that, adult HIV prevalence ranged between 1.1% and 1.3% nationally, with higher rates among women (1.6%) compared to men (0.9%). Multiple sexual partnerships (AOR=2.82), inconsistent condom use (AOR=2.36), early sexual debut (AOR=1.88), and residence in conflict-affected provinces (AOR=1.74) were independently associated with HIV infection. Approximately 47% of infections were attributable to modifiable behavioural factors. In conclusion, HIV persistence in the DRC is sustained by interacting behavioural and structural vulnerabilities. Stabilized prevalence should not be interpreted as epidemic control. Integrated gender-sensitive, youth-focused, and conflict-adapted prevention strategies are urgently required.