Household and individual level factors associated with HIV infection in KwaZulu-Natal
Date
2010-04-13T10:18:21Z
Authors
Bangre, Oscar
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Abstract
Background:
Sub-Saharan Africa continues to bear the brunt of the global HIV epidemic, with the
epicentre located in Southern Africa. Of all the adult and children living with HIV globally
in 2006, two-thirds (63%) were in sub-Saharan Africa.1 The epicenter of the HIV/AIDS
epidemic in South Africa is located in the KwaZulu Natal province, where HIV incidence and
prevalence continue to remain high and this has serious implications for HIV prevention and
control programmes.
Objectives
i. To profile individuals who sero-converted during the period 2003-2007 in order to
better target interventions.
ii. To estimate the incidence rate for HIV during the period 2003 to 2007.
iii. To identify factors associated with HIV infection at individual and household levels in
Kwazulu-Natal.
Methods
This involved analysis data of a dynamic cohort study. The follow-up period was 2003-2007,
and the study was a household-based HIV sero-prevalence survey of a population in Kwazulu
Natal, South Africa, conducted by the Africa Centre for Health and Population Studies. The
cohort comprised females aged 15 to 49 and males 15 to 54 years who participated in the
baseline HIV sero-prevalence survey in 2003 and/ or subsequent surveys in 2005, 2006 and
2007. Individuals who participated in at least two surveys and had a negative HIV result on
first enrolment were included in the analysis.
Selected demographic, socio-economic, behavioural and geographic variables of the
participants were obtained from the demographic surveillance system (DSS) database of the
Africa Centre Demographic and Information System (ACDIS) for analysis.
Profiles of recently HIV sero-converters were based on these variables and descriptive
statistics used to compare the differences in sero-conversion between the different strata of
each variable. Multiple logistic regression was used to investigate the association between
variables of key interest.
Results
A total of 39, 738 individuals were surveyed for the four annual sero-prevalence surveys
conducted from 2003-2007. Of these, 41.5% (n=16,491) were HIV negative on their first
enrolment into the study, 11.6% (n=4610) were HIV positive on first enrolment, while 46.9%
(n=18,637) had either participated in just one out of the four surveys, or were non-resident at
baseline. These two categories of participants as well as those who tested HIV positive on
first enrolment were dropped from the analysis.
The final sample size used for analysis was 16,491 individuals and comprised 8,425(51.1%)
females aged 15-49 years old and 8,066 (48.9%) males aged 15-54 years old.
The incidence rate for HIV sero-conversion among the 16, 491 individuals included in the
final analysis was 11.5 per 1000PYs during the follow-up period. In other words, 539
individuals sero-converted during 46818.15 person-years (PYs) at risk from 2003-2007.
A significant proportion of the new HIV acquisitions (69.8%) occurred in households without
any recently or previously infected household member, and women had a significantly
greater risk of HIV infection(IR= 16.9 per 1000PYs; 95% CI: 15.33-18.640) compared to
men(IR=5.9; 95% CI: 4.95-6.94) in this study area.
Conclusion
The younger age bracket (24-30 years old) was associated with significantly higher risk of
HIV infection compared to the older age category. However, the age group 20-24 years bears
the greatest burden of HIV pandemic in this community. Majority of seroconverters were
rural dwellers but peri-urban dwellers had the greatest risk of HIV acquisition.
The study also showed that attendance of a school or a training facility on a full-time basis
during the follow-up period was protective for HIV acquisition compared. Also, attainment of
standard 10 to 12 level of education was associated with a greater risk of HIV
seroconversion. This can be attributed to the age of individuals at these levels of education
and the associated high risk profile of this group. Living in close proximity to primary or
secondary roads was also associated with a risk of HIV infection compared to those living far
from major roads. This could be due to the ease of mobility and potential exposure multiple
sex partners. This may be due to a desire for modern social amenities which requires
financial wherewithal, which in turn facilitates transactional sex.
Description
MSc (Med) Population-Based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, 2009
Keywords
HIV infections, social conditions, Kwa-Zulu Natal