EPIDEMIOLOGY AND HEALTH DATA INSIGHTS
Review Article
Apr 24, 2026 16 5

Understanding How Social Factors Influence Health Outcomes for Women Living with HIV in Sub-Saharan Africa: A Systematic Review

Evelyn Foster-Pagaebi 1 * ,
Buniminaki Nimi James 2,
Tamunomiebi Douglas 3,
Amavie Oboku-Aganaba 4,
Kitgak Bala Simon 5,
Pagaebi Garcia Ezeke 6,
Uchechi Ekezie 7,
Elishama Tamunomiebi Douglas 8
1 Department of Clinical Pharmacy, Niger Delta University, Bayelsa, Nigeria 2 Department of Obstetrics & Gynaecology, Dames' Infirmary Hospital and Maternity, Bayelsa, Nigeria3 Department of Program/ Management, Real Talks Concepts, Abuja, Nigeria4 Department of Programs, Knowledge Network for Disease Control and Vigilance, Lagos, Nigeria 5 Department of Research, Rural Empowerment and Climate Technology Initiative, Plateau, Nigeria6 Faculty of Science, Niger Delta University, Bayelsa, Nigeria7 Department of Emergency, Preparedness, Readiness and Response, World Health Organization, Abuja, Nigeria 8 Department of Program Implementation, Real Talks Concepts, Rivers, Nigeria * Corresponding Author
Epidemiology and Health Data Insights, 2(4), 2026, ehdi039, https://doi.org/10.63946/ehdi/18472
Publication date: Apr 24, 2026
Full Text (PDF)

ABSTRACT

Background: The health outcomes of women living with the Human Immunodeficiency Virus (HIV) in sub-Saharan Africa remain poor, despite global efforts to improve access to antiretroviral therapy. Social determinants have been identified as key factors contributing to these disparities, however, evidence remains limited. This systematic review aims to synthesize evidence on the association between social factors and health outcomes among women living with HIV in sub-Saharan Africa.
Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Peer-reviewed articles published between January 2015 and November 2025 were identified through an extensive literature search in PubMed/Medline, Web of Science, and Google Scholar. The search yielded 1,589 studies, of which 23 were included in the final analysis. A thematic approach was used to synthesize eligible studies that examined one or more social factors and reported health outcomes.
Results: Twenty-three studies were included in the review, comprising 13 quantitative (11 cross-sectional and 2 cohort) and 10 qualitative studies across sub-Saharan Africa. After quality appraisal, 20 studies were rated as high quality, while 3 were moderate. None was classified as low quality. The main social factors influencing treatment outcomes included HIV-related stigma, socioeconomic status, gender norms, intimate partner violence, healthcare access, cultural and religious beliefs, and social support. These factors were consistently linked to late testing, poor antiretroviral therapy adherence, low retention in care, low viral suppression, and adverse mental health outcomes. Conversely, social support networks, peer-based interventions, and community- and faith-based care were associated with improved ART adherence, empowerment, and quality of life.
Discussion: These findings emphasize that social determinants do not function in isolation but through interconnected structural, community, and interpersonal pathways, creating both risks and protections for health outcomes.
Conclusion: Intersecting social and structural determinants of health impact outcomes among women living with HIV in sub-Saharan Africa. Addressing these factors requires integrated, gender-responsive, and community-empowering strategies beyond biomedical treatment alone.

KEYWORDS

Women Living with HIV HIV/AIDS Social Determinants of Health Social Factors Health Outcomes Sub-Saharan Africa

CITATION (Vancouver)

Foster-Pagaebi E, James BN, Douglas T, Oboku-Aganaba A, Simon KB, Ezeke PG, et al. Understanding How Social Factors Influence Health Outcomes for Women Living with HIV in Sub-Saharan Africa: A Systematic Review. Epidemiology and Health Data Insights. 2026;2(4):ehdi039. https://doi.org/10.63946/ehdi/18472
APA
Foster-Pagaebi, E., James, B. N., Douglas, T., Oboku-Aganaba, A., Simon, K. B., Ezeke, P. G., Ekezie, U., & Douglas, E. T. (2026). Understanding How Social Factors Influence Health Outcomes for Women Living with HIV in Sub-Saharan Africa: A Systematic Review. Epidemiology and Health Data Insights, 2(4), ehdi039. https://doi.org/10.63946/ehdi/18472
Harvard
Foster-Pagaebi, E., James, B. N., Douglas, T., Oboku-Aganaba, A., Simon, K. B., Ezeke, P. G., . . . Douglas, E. T. (2026). Understanding How Social Factors Influence Health Outcomes for Women Living with HIV in Sub-Saharan Africa: A Systematic Review. Epidemiology and Health Data Insights, 2(4), ehdi039. https://doi.org/10.63946/ehdi/18472
AMA
Foster-Pagaebi E, James BN, Douglas T, et al. Understanding How Social Factors Influence Health Outcomes for Women Living with HIV in Sub-Saharan Africa: A Systematic Review. Epidemiology and Health Data Insights. 2026;2(4), ehdi039. https://doi.org/10.63946/ehdi/18472
Chicago
Foster-Pagaebi, Evelyn, Buniminaki Nimi James, Tamunomiebi Douglas, Amavie Oboku-Aganaba, Kitgak Bala Simon, Pagaebi Garcia Ezeke, Uchechi Ekezie, and Elishama Tamunomiebi Douglas. "Understanding How Social Factors Influence Health Outcomes for Women Living with HIV in Sub-Saharan Africa: A Systematic Review". Epidemiology and Health Data Insights 2026 2 no. 4 (2026): ehdi039. https://doi.org/10.63946/ehdi/18472
MLA
Foster-Pagaebi, Evelyn et al. "Understanding How Social Factors Influence Health Outcomes for Women Living with HIV in Sub-Saharan Africa: A Systematic Review". Epidemiology and Health Data Insights, vol. 2, no. 4, 2026, ehdi039. https://doi.org/10.63946/ehdi/18472

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