Sub-Saharan Africa contains
more than 60% of all HIV infections worldwide. HIV prevalence was currently
estimated to be at least 15% in KwaZulu-Natal and the epidemic is described as
hyper-endemic.
Knowledge of spatial clustering of risk factors which are linked
to new HIV infections is important for prioritizing areas to change the
trajectory of the epidemic. Geoadditive models were used to investigate spatial
characteristics of the risk factors from two clinical trial units (Umkomaas and
Botha's Hill) in the province of KwaZulu-Natal, South Africa.
Study population
was a cohort of women who screened and enrolled in an HIV prevention biomedical
intervention trial. The results suggest high HIV incidence rates (5.8 and 8 per
100 person-year). Considerable spatial variations in behavioural factors within
a relatively small geographical region, low level of education, early age at
sexual debut, higher number of sexual partners, not being married/cohabitating
with a sexual partner and sexual activity in exchange for money, gift and drugs
were all determined to be clustered in certain regions; they were accounted for
25% (Umkomaas) and 65% (Botha's Hill) of the excess new HIV infections in two
clinical trial units.
Results from our study highlighted existence of
significant spatial heterogeneity in "measured" and
"unmeasured" risk factors in a relatively small region. As the HIV
funding has been declining, identifying, targeting and reaching the
most-at-risk individuals will likely play a significant role in developing the
most efficient and cost-effective prevention programmes and subsequently will
change the trajectory of the epidemic.
Purchase full article at: http://goo.gl/dcY7hi
- 1 The Kirby Institute , Sydney , Australia.
- 2 HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa.
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