Seroprevalence of HIV infection in rural South Africa.
ABSTRACT 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.
[Show abstract] [Hide abstract]
ABSTRACT: Introduction At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15–24 contribute a disproportionate ~30% of all new infections and seroconvert 5–7 years earlier than their male peers. This age–sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates, and preventing HIV infection in this age group is a pre-requisite for achieving an AIDS-free generation and attaining epidemic control. Discussion Adolescent girls and young women in southern Africa are uniquely vulnerable to HIV and have up to eight times more infection than their male peers. While the cause of this vulnerability has not been fully elucidated, it is compounded by structural, social and biological factors. These factors include but are not limited to: engagement in age-disparate and/or transactional relationships, few years of schooling, experience of food insecurity, experience of gender-based violence, increased genital inflammation, and amplification of effects of transmission co-factors. Despite the large and immediate HIV prevention need of adolescent girls and young women, there is a dearth of evidence-based interventions to reduce their risk. The exclusion of adolescents in biomedical research is a huge barrier. School and community-based education programmes are commonplace in many settings, yet few have been evaluated and none have demonstrated efficacy in preventing HIV infection. Promising data are emerging on prophylactic use of anti-retrovirals and conditional cash transfers for HIV prevention in these populations. Conclusions There is an urgent need to meet the HIV prevention needs of adolescent girls and young women, particularly those who are unable to negotiate monogamy, condom use and/or male circumcision. Concerted efforts to expand the prevention options available to these young women in terms of the development of novel HIV-specific biomedical, structural and behavioural interventions are urgently needed for epidemic control. In the interim, a pragmatic approach of integrating existing HIV prevention efforts into broader sexual reproductive health services is a public health imperative.Journal of the International AIDS Society 02/2015; 18(2(Suppl 1)):19408. DOI:10.7448/IAS.18.2.19408 · 4.21 Impact Factor
Scandinavian Journal of Infectious Diseases 01/1999; 31(5):459-466. DOI:10.1080/00365549950163978 · 1.64 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Data on immune mediators in the genital tract and the factors that modulate them in Sub-Saharan women are limited. Cervicovaginal lavage (CVL) samples from 430 sexually active women from Kenya, South Africa and Rwanda were analyzed for twelve soluble immune mediators using Bio-Plex™ and Meso Scale Discovery multiplex platforms as well as single ELISAs. Ten bacterial species were quantified in vaginal swab samples. Bacterial vaginosis (BV) was defined by Nugent scoring. CVL from HIV-infected women showed a clear-cut pro-inflammatory profile. Pregnant women, adolescents and women engaging in traditional vaginal practices differed in specific soluble markers compared to reference groups of adult HIV-negative women. Cervical mucus, cervical ectopy, abnormal vaginal discharge and having multiple sex partners were each associated with an increase in inflammatory mediators. Interleukin (IL)-1α, IL-1β, IL-6, IL-12(p70) and IL-8 were elevated while the IL-1RA/(IL-1(α+β) ratio decreased in women with BV. Interferon gamma-induced protein (IP)-10 was lower in BV-positive compared to BV-negative women suggesting its suppression as a potential immune evasion mechanism by BV-associated bacteria. Lactobacillus crispatus and Lactobacillus vaginalis were associated with decreased pro-inflammatory cytokines and each BV-associated species with increased pro-inflammatory cytokines. Remarkably, the in vitro anti-HIV activity of CVLs from BV-positive women was stronger than that of BV-negative women. In conclusion, we found significant associations of factors, including vaginal microbiota, which can influence immune mediators in the vaginal environment in sexually active women. These factors need to be considered when establishing normative levels or pathogenic cut-offs of biomarkers of inflammation and associated risks in African women. Copyright © 2015, American Society for Microbiology. All Rights Reserved.Clinical and vaccine Immunology: CVI 03/2015; 22(5). DOI:10.1128/CVI.00762-14 · 2.37 Impact Factor