Effectiveness of Culturally Based HIV Education on Adolescents' Knowledge, Attitudes, and Intentions: A Systematic Review

Introduction: Adolescents aged 10–19 years remain a priority population in the global HIV response. UNICEF reports an almost 50% reduction in new HIV infections among adolescents aged 15–19 years since 2010, while UNAIDS estimates a 62% decline among children aged 0–14 years between 2010 and 2024.Generic HIV education often fails to shift the social norms and cultural scripts shaping adolescent sexual behaviour, and no systematic review has focused specifically on culturally based HIV education for adolescents. This review evaluated its effectiveness on knowledge, attitudes, and preventive intentions or behaviours. Methods: This systematic review is reported in accordance with PRISMA 2020; the protocol was prepared using PRISMA-P and prospectively registered in PROSPERO (CRD420261288038). PubMed/MEDLINE, ScienceDirect, EBSCOhost, the Cochrane Library, and Taylor & Francis were searched up to 1 February 2026. Eligible studies were controlled trials with random or quasi-random allocation comparing culturally tailored HIV education with a standard, non-adapted, or no-intervention control among adolescents aged 10–19 years. Two reviewers independently screened records in Rayyan, extracted data in duplicate, and appraised each trial at item level using the 13-item Joanna Briggs Institute checklist for randomised controlled trials. Because no two trials shared a common effect metric, outcome construct, and follow-up interval, meta-analysis was not defensible; findings were synthesised using Synthesis Without Meta-analysis (SWiM) principles, and certainty was appraised using GRADE domains. Results: Of 543 records, 536 were screened after deduplication and 16 full texts assessed; six trials (1994–2015) met the criteria (3,777 participants allocated; mean age 12.6–14.6 years, range approximately 11–18 years). Four trials were conducted in the United States, one in the Philippines, and one in Spain. Only two trials directly contrasted a culturally congruent version with a culturally dissimilar version of the same programme; in the remaining four, cultural tailoring was embedded within a broader programme compared with attention-matched non-HIV education, no intervention, or a second active programme. Five trials reported greater overall knowledge gains in the culturally adapted condition, while one reported no overall main effect with benefit confined to a subgroup. Five trials reported attitude/belief outcomes, with four showing favourable changes in HIV-related attitude measures; effects on intentions and behaviours were mixed, with behavioural benefits persisting to six months in one trial. At item level, no trial satisfied all 13 JBI criteria; allocation concealment and blinding were unclear or absent in most trials, and two trials did not report a random allocation sequence. Certainty of evidence was low for knowledge and attitudes and very low for intentions and behaviours. Conclusion: Across a small, geographically concentrated, and methodologically heterogeneous evidence base, culturally based HIV education was generally associated with greater gains in HIV knowledge than comparison conditions, although one direct-comparison trial reported no overall main effect, with less consistent benefits for attitudes and mixed effects on preventive intentions and behaviours. Because most included trials did not isolate cultural adaptation from concurrent differences in content, intensity, or comparator activity, these findings should be read as cautious evidence of benefit rather than as demonstrated superiority over conventional HIV education. Trials that hold content constant while varying cultural congruence, report effect estimates with confidence intervals, and measure long-term behavioural outcomes are warranted.