Andrew Tomita1, Alain M Vandormael, Till Bärnighausen, Tulio de Oliveira, Frank Tanser. 1. *College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, South Africa; †Africa Health Research Institute, University of KwaZulu-Natal, Congella, South Africa; ‡Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; §Institute for Public Health, University of Heidelberg, Heidelberg, Germany; ‖Centre for the AIDS Programme of Research in South Africa (CAPRISA), Congella, South Africa; and ¶School of Nursing and Public Health, University of KwaZulu-Natal, Congella, South Africa.
Abstract
BACKGROUND: Few population-based multilevel studies have quantified the risks that social context poses in rural communities with high HIV incidence across South Africa. We investigated the individual, social, and community challenges to HIV acquisition risk in areas with high and low incidence of HIV infection (hotspots/coldspots). METHODS: The cohort (N = 17,376) included all HIV-negative adults enrolled in a population-based HIV surveillance study from 2004 to 2015 in a rural South African community with large labor migrancy. Multilevel survival models were fitted to examine the social determinants (ie, neighborhood migration intensity), community traits (ie, HIV prevalence), and individual determinants of HIV acquisition risk in identified hotspots/coldspots. RESULTS: The HIV acquisition risk (adjusted hazard ratio [aHR] = 1.05, 95% confidence interval [CI]: 1.01 to 1.09) was greater in hotspots with higher neighborhood migration intensity among men. In women, higher neighborhood migration intensity (aHR = 1.02, 95% CI: 1.01 to 1.02) was associated with a greater HIV acquisition risk, irrespective of whether they lived in hotspot/coldspot communities. HIV acquisition risk was greater in communities with a higher prevalence of HIV in both men (aHR = 1.07, 95% CI: 1.03 to 1.12) and women (aHR = 1.03, 95% CI: 1.01 to 1.05), irrespective of hotspot/coldspot locations. CONCLUSION: HIV acquisition risk was strongly influenced by gender (ie, young women), behavior (ie, sexual debut, contraception, circumcision), and social determinants. Certain challenges (ie, community disease prevalence) for HIV acquisition risk impacted both sexes, regardless of residence in hotspot/coldspot communities, whereas social determinants (ie, neighborhood migration intensity) were pronounced in hotspots among men. Future intervention scale-up requires addressing the social context that contributes to HIV acquisition risk in rural areas with high migration.
BACKGROUND: Few population-based multilevel studies have quantified the risks that social context poses in rural communities with high HIV incidence across South Africa. We investigated the individual, social, and community challenges to HIV acquisition risk in areas with high and low incidence of HIV infection (hotspots/coldspots). METHODS: The cohort (N = 17,376) included all HIV-negative adults enrolled in a population-based HIV surveillance study from 2004 to 2015 in a rural South African community with large labor migrancy. Multilevel survival models were fitted to examine the social determinants (ie, neighborhood migration intensity), community traits (ie, HIV prevalence), and individual determinants of HIV acquisition risk in identified hotspots/coldspots. RESULTS: The HIV acquisition risk (adjusted hazard ratio [aHR] = 1.05, 95% confidence interval [CI]: 1.01 to 1.09) was greater in hotspots with higher neighborhood migration intensity among men. In women, higher neighborhood migration intensity (aHR = 1.02, 95% CI: 1.01 to 1.02) was associated with a greater HIV acquisition risk, irrespective of whether they lived in hotspot/coldspot communities. HIV acquisition risk was greater in communities with a higher prevalence of HIV in both men (aHR = 1.07, 95% CI: 1.03 to 1.12) and women (aHR = 1.03, 95% CI: 1.01 to 1.05), irrespective of hotspot/coldspot locations. CONCLUSION:HIV acquisition risk was strongly influenced by gender (ie, young women), behavior (ie, sexual debut, contraception, circumcision), and social determinants. Certain challenges (ie, community disease prevalence) for HIV acquisition risk impacted both sexes, regardless of residence in hotspot/coldspot communities, whereas social determinants (ie, neighborhood migration intensity) were pronounced in hotspots among men. Future intervention scale-up requires addressing the social context that contributes to HIV acquisition risk in rural areas with high migration.
Authors: K J Sikkema; J A Kelly; R A Winett; L J Solomon; V A Cargill; R A Roffman; T L McAuliffe; T G Heckman; E A Anderson; D A Wagstaff; A D Norman; M J Perry; D A Crumble; M B Mercer Journal: Am J Public Health Date: 2000-01 Impact factor: 9.308
Authors: Myron S Cohen; Ying Q Chen; Marybeth McCauley; Theresa Gamble; Mina C Hosseinipour; Nagalingeswaran Kumarasamy; James G Hakim; Johnstone Kumwenda; Beatriz Grinsztejn; Jose H S Pilotto; Sheela V Godbole; Sanjay Mehendale; Suwat Chariyalertsak; Breno R Santos; Kenneth H Mayer; Irving F Hoffman; Susan H Eshleman; Estelle Piwowar-Manning; Lei Wang; Joseph Makhema; Lisa A Mills; Guy de Bruyn; Ian Sanne; Joseph Eron; Joel Gallant; Diane Havlir; Susan Swindells; Heather Ribaudo; Vanessa Elharrar; David Burns; Taha E Taha; Karin Nielsen-Saines; David Celentano; Max Essex; Thomas R Fleming Journal: N Engl J Med Date: 2011-07-18 Impact factor: 91.245
Authors: Mark N Lurie; Brian G Williams; Khangelani Zuma; David Mkaya-Mwamburi; Geoff Garnett; Adriaan W Sturm; Michael D Sweat; Joel Gittelsohn; Salim S Abdool Karim Journal: Sex Transm Dis Date: 2003-02 Impact factor: 2.830
Authors: Alain Vandormael; Tulio de Oliveira; Frank Tanser; Till Bärnighausen; Joshua T Herbeck Journal: J Epidemiol Community Health Date: 2017-11-24 Impact factor: 3.710
Authors: Andrew Tomita; Alain Vandormael; Till Bärnighausen; Andrew Phillips; Deenan Pillay; Tulio De Oliveira; Frank Tanser Journal: AIDS Date: 2019-03-01 Impact factor: 4.177
Authors: Adam Akullian; Anna Bershteyn; Daniel Klein; Alain Vandormael; Till Bärnighausen; Frank Tanser Journal: AIDS Date: 2017-07-31 Impact factor: 4.177
Authors: Andrew Tomita; Catherine M Smith; Richard J Lessells; Alexander Pym; Alison D Grant; Tulio de Oliveira; Frank Tanser Journal: Sci Rep Date: 2019-07-24 Impact factor: 4.379
Authors: Alain Vandormael; Diego Cuadros; Adrian Dobra; Till Bärnighausen; Frank Tanser Journal: BMC Public Health Date: 2020-08-06 Impact factor: 3.295
Authors: Alain Vandormael; Adam Akullian; Mark Siedner; Tulio de Oliveira; Till Bärnighausen; Frank Tanser Journal: Nat Commun Date: 2019-12-02 Impact factor: 14.919