HIV prevalence in South Africa through gender and racial lenses: results from the 2012 population-based national household survey

Abstract Background In South Africa, persistence of the HIV epidemic and associated gender and racial disparities is a major concern after more than 20 years of democratic dispensation and efforts to create a more healthy and equal society. This paper profiles HIV prevalence and related factors among Black African men and women compared to other race groups in South Africa using the 2012 population-based national household HIV survey. Methods This secondary data analysis was based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Bivariate and multiple logistic regression analysis were used to assess the relationship between HIV prevalence and associated factors by gender and racial profile. Results Overall HIV prevalence was significantly higher (p < 0.001) among both Black African males (16.6%; 95% CI: 15.0–18.4) and females (24.1%; 95% CI: 22.4–26.0) compared to their counterparts from other races. Among Black African males, increased risk of HIV was significantly associated with age group 25–49 years and those 50 years and older compared with young males 15–25 years. Among all males, reported condom use at last sex was significantly associated with increased risk of HIV. High socio-economic status (SES) and perceived risk of HIV were associated with a decreased risk of HIV. Among female condom use at last sex and ever testing for HIV was associated with increased prevalence of HIV only among Black African females. Lower prevalence of HIV was associated with marriage, tertiary education, high SES, having a partner five years younger, perceived risk of HIV, and awareness of HIV status among Black African females. Conclusion Gender and racial disparities rooted in structural and contextual inequalities remain important factors for the maintenance of the generalized HIV epidemic in the country. HIV prevention interventions need to cut across all strata of society but also target risk factors salient for specific groups. Alleviating vulnerability to HIV along gender and racial lines should also be viewed as part of a broader public health strategy.

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HIV epidemic in South Africa: A comparison of HIV epidemic patterns of two extreme provinces in South Africa

Health SA Gesondheid ◽

10.4102/hsag.v19i1.716 ◽

2014 ◽

Vol 19 (1) ◽

Author(s):

Khangelani Zuma ◽

Khanyisile Manzini ◽

Neo Mohlabane

Keyword(s):

South Africa ◽

Age Groups ◽

Secondary Data ◽

Population Based ◽

Hiv Prevalence ◽

Western Cape ◽

Age Group ◽

Recent Infection ◽

Hiv Epidemic ◽

Kwazulu Natal

Background: South Africa is experiencing one of the worst HIV epidemics, which varies by province and by districts within each province.Objective: To explore and compare HIV trends and patterns between two provinces in South Africa. Method: ‘Know your epidemic’ synthesis suggests that HIV prevalence is rising in older age groups and falling in younger people. Using secondary data analyses of population-based and antenatal care surveillance (ANC) surveys, we explored trends and patterns in HIV prevalence in KwaZulu-Natal and Western Cape.Results: Even though KwaZulu-Natal has the highest HIV prevalence in the country (15.5% compared with 3.8% in the Western Cape), there is considerable recent decline (6%) in HIV prevalence in KwaZulu-Natal, compared with a 2% increase in the Western Cape, based on ANC data, in youth aged 15 to 24 years. These results are consistent with those from a population-based survey where a decline of 0.3% in HIV prevalence in KwaZulu-Natal was observed as compared with an increase of 0.7% in Western Cape youth. Both ANC results and population-based surveys conducted in different years show a decline in HIV prevalence amongst youth in KwaZulu-Natal compared with an increase in the same age group in the Western Cape. HIV infection in this age group is associated with recent infection, thus indicating an increasing epidemic in the Western Cape compared with KwaZulu-Natal.Conclusion: Interventions aimed at curbing infections such as sexual abstinence and condom promotion in this age group need to be implemented extensively in the Western Cape. These should include HIV counseling and testing campaigns. Agtergrond: Suid-Afrika ondervind een van die ergste MIV-epedemies, wat verskil ten opsigte van elke provinsie en distrik en binne elke provinise. Doelstelling: Om MIV-voorkoms en -patrone tussen twee provinises in Suid-Afrika te ondersoek en vergelyk.Metode: ‘Ken jou epidemie’ sintese dui daarop dat die voorkomssyfer van MIV in ouer ouderdomsgroepe styg en daal by jonger mense. Ons het sekondêre data analieses van bevolkingsgebaseerde en swangerskapsorg waarnemingsopnames (ANC) gebruik om neigings en patrone in MIV-voorkoms in Kwa-Zulu Natal en die Wes-Kaap, vas te stel.Resultate: Ofskoon Kwa-Zulu Natal die hoogste voorkoms in Suid-Afrika (15.5% vergelyk met 3.8% in die Wes-Kaap) het, is daar ‘n aansienlike onlangse afname (6%) in die voorkoms van MIV in Kwa-Zulu Natal waargeneem, vergelyk met die 2% verhoging in die Wes-Kaap, gebasseer op ANC data, in jongmense in die ouderdomsgroep 15–24 jaar. Hierdie resultate is konsekwent met dié van die bevolkingsgebaseerde opname, waar ‘n afname van 0.3% in MIV-voorkoms in Kwa-Zulu Natal waargeneem is, vergelyk met ‘n toename van 0.7% in die jeug van die Wes-Kaap. Altwee die ANC-resultate en die bevolkings-gebaseerde opnames wat in verskillende jare uitgevoer is, wys ’n afname in MIV-voorkoms onder die jeug in Kwa-Zuly Natal vergelyk met ’n toename onder dieselfde ouderdomsgroep in die Wes-Kaap. MIV-infeksie onder hierdie ouderdomsgroep word verbind met ’n onlangse infeksie, wat ’n toename van die epidemie in die Wes-Kaap, vergelyk met Kwa-Zulu Natal aandui.Gevolgtrekkings: Ingryping, wat daarop gemik is om infeksies soos seksuele onthouding en die reklame van kondome vir hierdie ouderdomsgroep, behoort wyd in die Wes-Kaap geimplementeer te word. Hierdie behoort voorligtings- en toetsveldtogte in te sluit.

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Self-perceived risk of STIs in a population-based study of Scandinavian women

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053397 ◽

2018 ◽

Vol 94 (7) ◽

pp. 522-527 ◽

Cited By ~ 4

Author(s):

Sonia Guleria ◽

Mette Tuxen Faber ◽

Bo T Hansen ◽

Lisen Arnheim-Dahlström ◽

Kai-Li Liaw ◽

...

Keyword(s):

Risk Perception ◽

Condom Use ◽

Perceived Risk ◽

Population Based ◽

Low Risk ◽

Considerable Proportion ◽

Subjective Perception ◽

Cross Sectional ◽

Web Based ◽

Increased Risk

ObjectiveThis study examined the associations between current behaviours/characteristics and self-perceived risk for STIs, among randomly selected women aged 18–45 years from Denmark, Norway and Sweden.MethodA population-based, cross-sectional, questionnaire study (paper based, web based and telephone based) was conducted during 2011–2012. We compared medium–high STI risk perception with no/low risk perception. The associations were explored for women who had ever had sexual intercourse and for women with a new partner in the last 6 months using multivariable logistic regression.ResultThe overall prevalence of medium–high STI risk perception was 7.4%. It was highest among women aged 18–24 years (16.2%) and among the Danish women (8.8%). Number of new sexual partners in the last 6 months (≥3vs 0 partners, OR 14.94, 95% CI 13.20 to 16.94) was strongly associated with medium–high STI risk perception. Among women with a new partner in the last 6 months, lack of condom use increased medium–high STI risk perception (OR 1.73, 95% CI 1.52 to 1.96). Genital warts in the last year, binge drinking and being single were associated with increased risk perception and remained statistically significant after additional adjustments were made for number of new partners and condom use with new partners in the last 6 months.ConclusionSubjective perception of risk for STI was associated with women’s current risk-taking behaviours, indicating women generally are able to assess their risks for STIs. However, a considerable proportion of women with multiple new partners in the last 6 months and no condom use still considered themselves at no/low risk for STI.

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Prevalence and incidence of HIV among female sex workers and their clients: modelling the potential effects of intervention in Rwanda

BMJ Global Health ◽

10.1136/bmjgh-2020-002300 ◽

2020 ◽

Vol 5 (8) ◽

pp. e002300

Author(s):

Sabin Nsanzimana ◽

Edward J Mills ◽

Ofir Harari ◽

Placidie Mugwaneza ◽

Etienne Karita ◽

...

Keyword(s):

General Population ◽

Condom Use ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Prevalence ◽

Consistent Condom ◽

People Living With Hiv ◽

Hiv Incidence ◽

Female Sex ◽

Hiv Epidemic

BackgroundRwanda has identified several targeted HIV prevention strategies, such as promotion of condom use and provision of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) for female sex workers (FSWs). Given this country’s limited resources, understanding how the HIV epidemic will be affected by these strategies is crucial.MethodsWe developed a Markov model to estimate the effects of targeted strategies to FSWs on the HIV prevalence/incidence in Rwanda from 2017 to 2027. Our model consists of the six states: HIV-; HIV+ undiagnosed/diagnosed pre-ART; HIV+ diagnosed with/without ART; and death. We considered three populations: FSWs, sex clients and the general population. For the period 2017–2027, the HIV epidemic among each of these population was estimated using Rwanda’s demographic, sexual risk behaviour and HIV-associated morbidity and mortality data.ResultsBetween 2017 and 2027, with no changes in the current condom and ART use, the overall number of people living with HIV is expected to increase from 344,971 to 402,451. HIV incidence will also decrease from 1.36 to 1.20 100 person-years. By 2027, a 30% improvement in consistent condom use among FSWs will result in absolute reduction of HIV prevalence among FSWs, sex clients and the general population by 7.86%, 5.97% and 0.17%, respectively. While recurring HIV testing and improving the ART coverage mildly reduced the prevalence/incidence among FSWs and sex clients, worsening the two (shown by our worst-case scenario) will result in an increase in the HIV prevalence/incidence among FSWs and sex clients. Introduction of PrEP to FSWs in 2019 will reduce the HIV incidence among FSWs by 1.28%.ConclusionsContinued efforts toward improving condom and ART use will be critical for Rwanda to continue their HIV epidemic control. Implementing a targeted intervention strategy in PrEP for FSWs will reduce the HIV epidemic in this high-risk population.

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HIV decline associated with changes in risk behaviours among young key populations in Nepal: analysis of population-based HIV prevalence surveys between 2001 and 2012

International Journal of STD & AIDS ◽

10.1177/0956462416678303 ◽

2016 ◽

Vol 28 (9) ◽

pp. 864-875 ◽

Cited By ~ 3

Author(s):

Keshab Deuba ◽

Anna Mia Ekström ◽

Göran Tomson ◽

Rachana Shrestha ◽

Gaetano Marrone

Keyword(s):

Condom Use ◽

Migrant Workers ◽

Sex Workers ◽

Hiv Prevalence ◽

Capital City ◽

Key Populations ◽

Risk Behaviours ◽

The Past ◽

Increased Risk ◽

Male Labour

We assessed changes in HIV prevalence and risk behaviours among young key populations in Nepal. A total of 7505 participants (aged 16–24 years) from key populations who were at increased risk of HIV infection (2767 people who inject drugs (PWID); 852 men who have sex with men/transgender (MSM/TG); 2851 female sex workers (FSW) and 1035 male labour migrants) were recruited randomly over a 12-year period, 2001–2012. Local epidemic zones of Nepal (Kathmandu valley, Pokhara valley, Terai Highway and West to Far West hills) were analysed separately. We found a very strong and consistent decline in HIV prevalence over the past decade in different epidemic zones among PWID and MSM/TG in Kathmandu, the capital city, most likely due to a parallel increase in safe needle and syringe use and increased condom use. A decrease in HIV prevalence in 22 Terai highway districts, sharing an open border with India, was also consistent with increased condom use among FSW. Among male labour migrants, HIV prevalence was low throughout the period in the West to Far West hilly regions. Condom use by migrant workers involved with FSW abroad increased while their condom use with Nepalese FSW declined. Other risk determinants such as mean age at starting first injection, injection frequency, place of commercial sex solicitation, their mean age when leaving to work abroad did not change consistently across epidemic zones among the young key populations under study. In Nepal, the decline in HIV prevalence over the past decade was remarkably significant and consistent with an increase in condom use and safer use of clean needles and syringes. However, diverging trends in risk behaviours across local epidemic zones of Nepal suggest a varying degree of implementation of national HIV prevention policies. This calls for continued preventive efforts as well as surveillance to sustain the observed downward trend.

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Hiding in the shadows of the HIV epidemic: obesity and hypertension in a rural population with very high HIV prevalence in South Africa

Journal of Human Hypertension ◽

10.1038/sj.jhh.1002308 ◽

2007 ◽

Vol 22 (3) ◽

pp. 236-239 ◽

Cited By ~ 44

Author(s):

T Bärnighausen ◽

T Welz ◽

V Hosegood ◽

J Bätzing-Feigenbaum ◽

F Tanser ◽

...

Keyword(s):

South Africa ◽

Rural Population ◽

Hiv Prevalence ◽

Hiv Epidemic ◽

Very High

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Potential Utility of Routine Programmatic Data in Monitoring National and State-Level HIV Epidemic in Nigeria: Data Triangulation Analysis

10.1101/734293 ◽

2019 ◽

Author(s):

Debem Henry ◽

Aminu Yakubu ◽

Mukhtar Ahmed ◽

Gwamna Jerry ◽

Dalhatu Ibrahim

Keyword(s):

Pearson Correlation ◽

National Level ◽

State Level ◽

Population Based ◽

Hiv Prevalence ◽

Reproductive Age ◽

World Health ◽

Linear Regression Models ◽

Epidemic Control ◽

Hiv Epidemic

AbstractNigeria relies on data from periodic resource-intensive surveys such as antenatal HIV seroprevalence sentinel surveys (ANC-HSS) and population-based National AIDS and Reproductive Health Surveys (NARHS) for its HIV control efforts. Nigeria has not explored the use of readily available routine programmatic data (RPD) to easily inform and monitor epidemic control efforts at local settings in near real time. This study aimed to determine the utility of RPDs (Prevention of Mother-To-Child Transmission [PMTCT] and HIV Testing and Counseling [HTC]) as a proxy for monitoring HIV epidemic in Nigeria. Using World Health Organization 12 step triangulation procedures, we compared state-level seropositivity data from PMTCT and HTC programs to HIV prevalence data from NARHS and ANC-HSS reports in relevant pairs from 2010 to 2014 in Nigeria. The study population was pregnant women and general population. We abstracted relevant data from PEPFAR Nigeria data source and published national survey reports. We compared visual (scatterplots and maps) patterns and trends, and performed Pearson correlation and univariate linear regression models of the estimates for best matched/contiguous years for which data were available. Correlation between PMTCT2014 and ANC-HSS2014 was positive and significant (R=0.7,p<0.001). ANC-HSS2014 and HTC2014 were slightly correlated (R=0.4,p<0.05). Significant correlation was observed between ANC-HSS2010 and PMTCT2013 (R=0.8,p<0.001) and between ANC-HSS2010 and HTC2013 (R=0.6, p<0.001). All RPD sources and ANC-HSS indicated a decreasing trend in national HIV prevalence in Nigeria. PMTCT2014 data showed strong capability of predicting HIV prevalence in ANC-HSS2014 in regression model (B=2.09,p<0.0001). Use of routine PMTCT data in monitoring HIV prevalence among women of reproductive age could be more valid and reliable in local settings than the use of HTC data. Use of RPD to monitor national and sub-national-level HIV epidemic in between national surveys in Nigeria could maximize program resources, and promote a more responsive and efficient actions toward epidemic control.

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COVID19 vaccine intentions in South Africa: health communication strategy to address vaccine hesitancy

BMC Public Health ◽

10.1186/s12889-021-12196-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Umakrishnan Kollamparambil ◽

Adeola Oyenubi ◽

Chijioke Nwosu

Keyword(s):

South Africa ◽

Perceived Risk ◽

National Income ◽

Population Group ◽

Face Mask ◽

Communication Strategy ◽

African Population ◽

Vaccine Hesitancy ◽

Vaccine Acceptance ◽

Black African

Abstract Background Vaccine hesitancy is emerging as a significant challenge in many parts of the world in the fight against the COVID19 pandemic. The continued infection amongst the unvaccinated can lead to a heightened risk of further virus mutation, exposing even those vaccinated to new virus strains. Therefore, there are social benefits in minimising vaccine hesitancy. The objective of this study is to assess the level of COVID19 vaccine hesitancy in South Africa, identify the socio-economic patterns in vaccine hesitancy and highlight insights from the national survey that can inform the development of a COVID-19 vaccination acceptance communication campaign. Methods The study uses the nationally representative National Income Dynamics Study - Coronavirus Rapid Mobile Survey (NIDS-CRAM) survey. The analysis combines univariate and bivariate statistics, as well as multivariate regression models like binomial/ordinal and multinomial logit. Results The study finds that vaccine acceptance is lower than that of non-pharmaceutical intervention like face-mask use. Only 55% fully accept the vaccine, while a further 16% are moderately accepting of vaccines. Together, vaccine acceptance is estimated at 70.8%, and vaccine hesitancy against COVID19 is estimated at 29.2% amongst the adult South African population. The study has identified the perceived risk of infection with the mediating role of efficacy as a key predictor of vaccine intention. Higher awareness of COVID19 related information and higher household income are correlated with lower vaccine hesitancy. The non-black African population group has significantly high vaccine hesitancy compared to black Africans. Conclusions There are other significant differences across socio-economic and demographic variables in vaccine hesitancy. From a communication perspective, it is imperative to continue risk messaging, hand in hand with clearer information on the efficacy of the vaccines.

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237Spatial distribution and correlates of HIV prevalence in South Africa

International Journal of Epidemiology ◽

10.1093/ije/dyab168.475 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Jabulani Ncayiyana ◽

Griffin Bell ◽

Ari Solomon ◽

Micheal Emch

Keyword(s):

South Africa ◽

Logistic Regression ◽

Hiv Infection ◽

Sexual Debut ◽

Hiv Infections ◽

Hiv Prevalence ◽

Spatial Clusters ◽

Spatial Scan Statistic ◽

Targeted Interventions ◽

Hiv Epidemic

Abstract Background South Africa has a high HIV prevalence and generalized HIV epidemic. It is now well established that the HIV epidemic and its drivers are highly heterogeneous, even in generalized HIV epidemic settings. Methods This study uses data from South African HIV/AIDS, Behavioural Risks, Sero-status, and Mass Media Impact (SABSSM), 2005, 2008 and 2012 surveys. To identify spatial clusters, we used the spatial scan statistic method in SaTScan, assuming discrete Poisson distributions. Poisson regression models were used to explore the municipality-level correlates of HIV prevalence and a logistic regression model was used to determine individual-level correlates of HIV infection. Results Between 2005 and 2012, There was significant geographical variation in estimated HIV prevalence (range = <1.0%–27.5%). Eight, five and six significant overlapping high-risk spatial clusters of high HIV prevalence were detected in 2005, 2008 and 2012, respectively. HIV prevalence is clustered in the central and north-eastern regions of South Africa. Living in municipalities with high percentage of black South Africans, higher poverty index, higher population aged 25-49, and higher early sexual debut were associated with HIV prevalence, while living in municipalities with higher percentage male circumcision and a high percentage married were associated with low risk of HIV. Logistic regression revealed race, sex and mobility as correlates of HIV infection. Conclusions HIV prevalence is highly spatially heterogenous and affected by various municipal-level factors. Key messages Identification of the spatial clusters of HIV prevalence and contextual factors should inform targeted interventions that are necessary to bringing HIV infections under control.

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Older Adults Vastly Overestimate Both HIV Acquisition Risk and HIV Prevalence in Rural South Africa

Archives of Sexual Behavior ◽

10.1007/s10508-021-01982-1 ◽

2021 ◽

Author(s):

Eva van Empel ◽

Rebecca A. de Vlieg ◽

Livia Montana ◽

F. Xavier Gómez-Olivé ◽

Kathleen Kahn ◽

...

Keyword(s):

South Africa ◽

Perceived Risk ◽

Hiv Prevalence ◽

Sub Saharan Africa ◽

Baseline Survey ◽

Home Based ◽

Estimated Risk ◽

Sub Saharan ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition

AbstractPerceptions of HIV acquisition risk and prevalence shape sexual behavior in sub-Saharan Africa (SSA). We used data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa baseline survey. Data were collected through home-based interviews of 5059 people ≥ 40 years old. We elicited information on perceived risk of HIV acquisition and HIV prevalence among adults ≥ 15 and ≥ 50 years old. We first describe these perceptions in key subgroups and then compared them to actual estimates for this cohort. We then evaluated the relationship between sociodemographic characteristics and accurate perceptions of prevalence in regression models. Finally, we explored differences in behavioral characteristics among those who overestimated risk compared to those who underestimated or accurately estimated risk. Compared to the actual HIV acquisition risk of < 1%, respondents vastly overestimated this risk: 35% (95% CI: 32–37) and 34% (95% CI: 32–36) for men and women, respectively. Respondents overestimated HIV prevalence at 53% (95% CI: 52–53) for those ≥ 15 years old and 48% (95% CI: 48–49) for those ≥ 50 years old. True values were less than half of these estimates. There were few significant associations between demographic characteristics and accuracy. Finally, high overestimators of HIV prevalence tested themselves less for HIV compared to mild overestimators and accurate reporters. More than 30 years into the HIV epidemic, older people in a community with hyperendemic HIV in SSA vastly overestimate both HIV acquisition risk and prevalence. These misperceptions may lead to fatalism and reduced motivation for prevention efforts, possibly explaining the continued high HIV incidence in this community.

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Trends and correlates of HIV prevalence among adolescents in South Africa: evidence from the 2008, 2012 and 2017 South African National HIV Prevalence, Incidence and Behaviour surveys

AIDS Research and Therapy ◽

10.1186/s12981-021-00422-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Musawenkosi Mabaso ◽

Goitseone Maseko ◽

Ronel Sewpaul ◽

Inbarani Naidoo ◽

Sean Jooste ◽

...

Keyword(s):

South Africa ◽

Hiv Infection ◽

Transition To Adulthood ◽

Educational Institution ◽

Age Groups ◽

Hiv Prevalence ◽

Cross Sectional ◽

Factors Associated ◽

Increased Risk ◽

And Gender

Abstract Background Adolescents are at increased risk of HIV infection compared to other age groups. There is an urgent need for strategic information that will inform programmes to reduce risk and vulnerability to HIV and reverse the pattern of increasing HIV infection as they transition to adulthood. This paper analysed trends and factors associated with HIV prevalence among adolescents in South Africa using the national HIV population-based household surveys conducted in 2008, 2012 and 2017. Methods All three surveys used a multistage cross-sectional design. A trend analysis was conducted to assess the differences in HIV prevalence and covariates overtime using P-trend Chi-squared statistic. Univariate and multivariate logistic regression models were used to determine factors associated with HIV prevalence. Results Overall there was a significant increase in HIV prevalence among adolescents aged 12–19 years from 3.0% (n = 2892) in 2008 to 3.2% (n = 4829) in 2012 and 4.1% (n = 3937) in 2017 (p = 0.031). The odds of being HIV positive among adolescents aged 12–19 years was significantly higher among females [AOR = 2.24; 95% CI (1.73–2.91); p < 0.001] than males, those residing in KwaZulu-Natal province [AOR = 2.01; 95% CI (1.-3.99); p = 0.027] than Northern Cape, and those who did not attend an educational institution and were unemployed [AOR = 2.66; 95% CI (1.91–3.67); p < 0.001] compared to those attending an educational institution. The odds were significantly lower among Whites [AOR = 0.29; 95% CI (0.09–0.93); p = 0.037], Coloureds [AOR = 0.21; 95% CI (0.11–0.37); p ≤ 0.001] and Indian/Asian [AOR = 0.08; 95% CI (0.02–0.34); p = 0.001] population groups than Black Africans. Conclusion The observed increasing trend and gender disparities in HIV prevalence suggests an urgent need for age appropriate and gender specific HIV interventions tailored and targeted at identified drivers of HIV infection among adolescents.

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