Combined impact of sexual risk behaviors for HIV seroconversion among women in Durban, South Africa: implications for prevention policy and planning.

The objective of this study was to estimate the joint impact of demographic and sexual risk behaviors on HIV acquisition. A total of 2,523 HIV seronegative women were recruited through three community based studies in Durban, South Africa. Point and interval estimates of partial population attributable risk (PAR) were used to quantify the proportion of HIV seroconversions which can be prevented if a combination of risk factors is eliminated from a target population. More than 80% of the observed HIV acquisitions were attributed to five risk factors: lack of cohabitation, frequency of sex, sexually transmitted infections (STIs), incidence of pregnancy and not being employed/no income. Structural factors such as minimizing migratory patterns by ensuring cohabitation of partners, access to treatment of STIs, income generation and safe sex negotiation skills are likely to play an important role in future prevention strategies.