To establish the prevalence of HIV infection in rural South Africa and to investigate demographic factors that influence this prevalence.
An anonymous HIV seroprevalence survey was performed in conjunction with a population-based malaria surveillance programme.
The rural area of northern Natal/KwaZulu, South Africa.
A total of 5023 black African participants were recruited by malaria surveillance agents during house-to-house visits; each house in an endemic malaria area is visited approximately once every 6 weeks. Participants included 4044 healthy and 979 febrile individuals (i.e., suspected of having malaria).
HIV-1 and HIV-2 serological status, degree of mobility, age and sex.
Sixty of the 5023 blood specimens were confirmed to be HIV-1-antibody-positive by Western blot, an overall prevalence of 1.2% (95% confidence interval, 0.9-1.5). None of the specimens was positive for HIV-2 antibodies. After adjusting for age, presence of fever and migrancy, women had a 3.2-fold higher prevalence of HIV-1 infection than men. HIV-1 infection was approximately three times more common among subjects who had changed their place of residence recently (2.9 versus 1.0%, P < 0.01).
The prevalence of HIV-1 infection is higher among women than men resident in rural Natal/KwaZulu, South Africa. This is at least in part the result of oscillatory migration, particularly of men who work in urban areas but have families and homes in rural areas. Migration is associated with a higher prevalence of HIV-1 infection, suggesting that improving social conditions so that families are not separated and become settled in their communities is one way to help reduce the spread of HIV-1.
"Perhaps as a result, the literature on migration and HIV has largely focused on risks to male labour migrants and their non-migrant female partners or migrants overall (Jochelson et al., 1991; Bwayo et al., 1994; Nunn et al., 1995; Hope, 2000; Lurie et al., 2003). Those measuring HIV risks to women via their direct involvement in migration, however, have documented high acquisition and transmission risks among female migrants (Abdool Karim et al., 1992; Pison et al., 1993; Boerma et al., 2002; Zuma et al., 2003; Lydie et al., 2004; Kishamawe et al., 2006; Camlin et al., 2010). Previous research in the population for this study found higher HIV prevalence among recent female migrants than among male migrants or non-migrants of either sex. "
"In addition some authors have implied that dealing with migration was fundamental to HIV control in Southern Africa
[23,44]. Calls were made to “bring the labour market closer to rural settings to arrest this phenomenon (migration’s impact on HIV spread)”
[Show abstract][Hide abstract] ABSTRACT: Background
Correctly identifying the determinants of generalized HIV epidemics is crucial to bringing down ongoing high HIV incidence in these countries. High rates of migration are believed to be an important determinant of HIV prevalence. This study has two aims. Firstly, it evaluates the ecological association between levels of internal and international migration and national peak HIV prevalence using thirteen variables from a variety of sources to capture various aspects of internal and international migration intensity. Secondly, it examines the relationship between circular migration and HIV at an individual and population-level in South Africa.
Linear regression was used to analyze the association between the various measures of migration intensity and peak national HIV prevalence for 141 countries and HIV prevalence by province and ethnic group in South Africa.
No evidence of a positive ecological association between national migration intensity and HIV prevalence was found. This remained the case when the analyses were limited to the countries of sub-Saharan Africa. On the whole, countries with generalized HIV epidemics had lower rates of internal and external migration. Likewise, no association was found between migration and HIV positivity at an individual or group-level in South Africa.
These results do not support the thesis that migration measured at the country level plays a significant role in determining peak HIV prevalence.
"Since the beginning of 2003, HIV infection status of adults has been determined through a separate annual sero-surveillance . HIV prevalence in this population has steadily increased since the early 1990s [13,14] to 21·5% in 2004. Overall, 27% of female and 13·5% of male residents were HIV-infected in 2004, HIV prevalence was highest in the five-year age groups of 25-29 years in women (51%) and 30-34 years in men (44%). "
[Show abstract][Hide abstract] ABSTRACT: KwaZulu-Natal is the South African province worst affected by HIV and the focus of early modeling studies investigating strategies of antiretroviral treatment (ART) delivery. The reality of antiretroviral roll-out through primary care has differed from that anticipated and real world data are needed to inform the planning of further scaling up of services. We investigated the factors associated with uptake of antiretroviral treatment through a primary healthcare system in rural South Africa.
Detailed demographic, HIV surveillance and geographic information system (GIS) data were used to estimate the proportion of HIV positive adults accessing antiretroviral treatment within northern KwaZulu-Natal, South Africa in the period from initiation of antiretroviral roll-out until the end of 2008. Demographic, spatial and socioeconomic factors influencing the likelihood of individuals accessing antiretroviral treatment were explored using multivariable analysis.
Mean uptake of ART among HIV positive resident adults was 21.0% (95%CI 20.1-21.9). Uptake among HIV positive men (19.2%) was slightly lower than women (21.8%, P = 0.011). An individual's likelihood of accessing ART was not associated with level of education, household assets or urban/rural locale. ART uptake was strongly negatively associated with distance from the nearest primary healthcare facility (aOR = 0.728 per square-root transformed km, 95%CI 0.658-0.963, P = 0.002).
Despite concerns about the equitable nature of antiretroviral treatment rollout, we find very few differences in ART uptake across a range of socio-demographic variables in a rural South African population. However, even when socio-demographic factors were taken into account, individuals living further away from primary healthcare clinics were still significantly less likely to be accessing ART.
BMC Public Health 09/2010; 10(1):585. DOI:10.1186/1471-2458-10-585 · 2.26 Impact Factor
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