BACKGROUND:
Population
HIV prevalence across West Africa varies substantially. We assess the national
epidemiological and behavioural factors associated with this.
METHODS:
National,
urban and rural data on HIV prevalence, the percentage of younger (15-24) and
older (25-49) women and men reporting multiple (2+) partners in the past year,
HIV prevalence among female sex workers (FSWs), men who have bought sex in the
past year (clients), and ART coverage, were compiled for 13 countries. An
Ecological analysis using linear regression assessed which factors are
associated with national variations in population female and male HIV
prevalence, and with each other.
FINDINGS:
National
population HIV prevalence varies between 0 4-2 9% for men and 0 4-5.6% for
women. ART coverage ranges from 6-23%. National variations in HIV prevalence
are not shown to be associated with variations in HIV prevalence among FSWs or
clients. Instead they are associated with variations in the percentage of
younger and older males and females reporting multiple partners. HIV prevalence
is weakly negatively associated with ART coverage, implying it is not increased
survival that is the cause of variations in HIV prevalence. FSWs and younger
female HIV prevalence are associated with client population sizes, especially
older men. Younger female HIV prevalence is strongly associated with older male
and female HIV prevalence.
INTERPRETATION:
In
West Africa, population HIV prevalence is not significantly higher in countries
with high FSW HIV prevalence. Our analysis suggests, higher prevalence occurs
where more men buy sex, and where a higher percentage of younger women, and
older men and women have multiple partnerships. If a sexual network between
clients and young females exists, clients may potentially bridge infection to
younger females. HIV prevention should focus both on commercial sex and
transmission between clients and younger females with multiple partners.
Below: HIV prevalence data taken from DHS and UNGASS reports in West African settings from 2010–2014
Below: Fig 2. Fig 2(a): DHS Data from 10 West African
countries, stratified by 15–24 and 25–49 year old males. Presented in ascending
order of 25–49 year old males reporting payment for sex in the past 12 months,
by country (2010–2014), data not available for Nigeria, Gambia and Togo. Fig
2(b): DHS data from 13 West African countries, stratified by age. Presented in
ascending order of 25–49 year old males reporting 2 or more partners, by
country. Fig 2(c): DHS data from 13 West African countries, stratified by age. Listed
in ascending order of 15–24 year old females reporting 2+ partners in the past
year, by country.
- 1Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
- 2The World Bank, Washington, District of Columbia, United States of America.
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