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.
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ABSTRACT: Gender is increasingly recognised as fundamental to understanding migration processes, causes, and consequences. In South Africa, it is intrinsic to the social transformations fueling high levels of internal migration and complex forms of mobility. Although female migration in Africa has often been characterised as less prevalent than male migration and primarily related to marriage, in South Africa, a feminisation of internal migration is underway, fueled by women's increasing labour market participation. In this paper, we report sex differences in patterns, trends, and determinants of internal migration based on data collected in a demographic surveillance system between 2001 and 2006 in rural KwaZulu-Natal. We show that women were somewhat more likely than men to undertake any migration, but sex differences in migration trends differed by migration flow, with women more likely to migrate into the area than men and men more likely to out-migrate. Out-migration was suppressed by marriage, particularly for women, but most women were not married; both men's and women's out-migrations were undertaken mainly for purposes of employment. Over half of female out-migrations (vs 35% of male out-migrations) were to nearby rural areas. The findings highlight the high mobility of this population and the extent to which gender is intimately related to the processes determining migration. We consider the implications of these findings for the measurement of migration and mobility, in particular for health and social policy and research among highly mobile populations in southern Africa. © 2013 The Authors. Population, Space and Place published by John Wiley & Sons Ltd.Population Space and Place 08/2014; [In Press](6). DOI:10.1002/psp.1794 · 1.82 Impact Factor
Article: Healthcare and livelihoods[Show abstract] [Hide abstract]
ABSTRACT: In preparing a comment on these papers, it is the commonalities I seek though I am struck by some differences. The four research projects have been located in the Agincourt health and demographic surveillance site and are floated, as it were, upon the infrastructure of this site. This highlights benefits of the longitudinal demographic surveillance resource: the ability to select particular study participants (for example those in households where deaths have occurred), and gain entree into a village community that is part of the site. Perhaps the most significant aspect of the DSS infrastructure, though, is the established relationship between ongoing surveil- lance and the community that affords researchers relatively easy access into the lives of others. It also raises the stakes and demands that research is acceptable to the community so that neither the long-term relationship nor the viability of future research endeavours is jeopardized. Managing this is a cost that DSS sites have to bear. The papers share a background of poverty, disease, death, and survival. They share the same location, the same community and are conducted over a similar time period. They are different in that they ask contrasting questions from different theo- retical and disciplinary research traditions and apply differing methodological approaches. The common location and time period makes consideration of findings in combination possible, while the multi- plicity of approaches allows a nuanced and rich insight into some aspects of community life in Agincourt. The paper by Golooba-Mutebi & Tollman tables the issue of individuals' competing underlying beliefs concerning cause and effect and how this influences their actual health-seeking behaviour (1). This is not a new finding but it has an urgent relevance because of the unprecedented impact of the HIV epidemic in Southern Africa. The need to get people into treatment and prevention programmes begs the old question of how to make programmatic interven- tions appropriate and accessible. A cursory review of articles on health-seeking behaviour in the current medical literature suggests they do not incorporate the notion of competing health belief models. The paper highlights the potentially negative impact of competing belief models on people's readiness to access care and life-saving technology in the form of antiretroviral treatment, and how professionals and role models need to take this into account. The paper by Hunter et al. (2) talks to positive aspects of traditional beliefs and knowledge: how knowledge handed down through generations can empower families to survive in situations of dire need. It also speaks to the impact of poverty and disease in eroding not only survival but the knowl- edge base required for that survival. Meeting basic needs - water and fuel - would liberate time, in particular women's time, to engage in other activities that may enrich meals as well as lives. These papers draw attention to the intersection of interventions (social grants, antiretroviral treatment) with the social norms prevailing in communities. Case & Menendez examine social grants and the positive effect they have on household survival and functioning (3). In this instance, the positive out- come of pensions for the elderly may be because the grant is placed in the hands of people who attain status with age. Social grants for the elderly dovetail with the place of gerontocracy in many sub-Saharan societies. Local norms and mores keep individuals and groups within communities in their usual,Scandinavian journal of public health. Supplement 09/2007; 69:186-7. DOI:10.1080/14034950701359496 · 1.44 Impact Factor
- Scandinavian journal of public health. Supplement 09/2007; 69:94-5. DOI:10.1080/14034950701359538 · 1.44 Impact Factor