Promoting male partner HIV testing & safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: A cohort study

BACKGROUND:

Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple self-tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making.

METHODS:

In this cohort study, HIV-negative women aged 18-39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV tests. Participants enrolled at the health facility received three self-tests and those at the drop-in centre received five self-tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how self-tests were used. Outcomes included the number of self-tests distributed by participants, the proportion of participants whose sexual partners used a self-test, couples testing, and sexual behaviour after self-testing.

FINDINGS:

Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed self-tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one self-test to commercial sex clients. Among self-tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among tests received by primary and non-primary sexual partners, two (4%) of 53 tests from participants in antenatal care, two (2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had positive results. Participants reported sexual intercourse with 235 (62%) of 380 sexual partners who tested HIV-negative, compared with eight (18%) of 45 who tested HIV-positive (p<0·0001); condoms were used in all eight intercourse events after positive results compared with 104 (44%) after of negative results (p<0·0018). Four participants reported intimate partner violence as a result of self-test distribution: two in the post-partum care group and two female sex workers. No other adverse events were reported.

INTERPRETATION:

Provision of multiple HIV self-tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop self-testing policies and programmes.

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By: Thirumurthy H¹, Masters SH², Mavedzenge SN³, Maman S⁴, Omanga E⁵, Agot K⁵.

Author information

¹Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: harsha@unc.edu.

²Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

³RTI International, San Francisco, CA, USA.

⁴Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

⁵Impact Research and Development Organization, Kisumu, Kenya.

Lancet HIV. 2016 Jun;3(6):e266-74. doi: 10.1016/S2352-3018(16)00041-2. Epub 2016 Apr 8.

  

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Anti-Retroviral Therapy Increases the Prevalence of Dyslipidemia in South African HIV-Infected Patients

Purpose

Data on the prevalence of dyslipidaemia and associated risk factors in HIV-infected patients from sub-Saharan Africa is sparse. We performed a cross-sectional analysis in a cohort of HIV-infected South African adults.

Methods

We studied HIV-infected patients who were either antiretroviral therapy (ART)-naive or receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based or protease inhibitor (PI)-based ART. Evaluation included fasting lipograms, oral glucose tolerance tests and clinical anthropometry. Dyslipidemia was defined using the NCEP ATPIII guidelines.

Results

The median age of the participants was 34 years (range 19–68 years) and 78% were women. The prevalence of dyslipidemia in 406 ART-naive and 551 participants on ART was 90.0% and 85%, respectively. Low HDL-cholesterol (HDLC) was the most common abnormality [290/406 (71%) ART-naïve and 237/551 (43%) ART- participants]. Participants on ART had higher triglycerides (TG), total cholesterol (TC), LDL-cholesterol (LDLC) and HDLC than the ART-naïve group. Severe dyslipidaemia, (LDLC> 4.9 mmol/L or TG >5.0 mmol/L) was present in <5% of participants. In multivariate analyses there were complex associations between age, gender, type and duration of ART and body composition and LDLC, HDLC and TG, which differed between ART-naïve and ART-participants.

Conclusion

Participants on ART had higher TG, TC, LDLC and HDLC than those who were ART-naïve but severe lipid abnormalities requiring evaluation and treatment were uncommon.

Below:  Distribution of lipid abnormalities in treatment naïve (A) and participants receiving ART (B).

The left-sided Venn diagrams indicate % with dyslipidaemia. The right-sided diagrams indicate the individual lipid abnormalities in dyslipidaemic participants. Percentages in the right diagrams refer to % dyslipidaemic participants. Rounding accounts for percentages not equal to 100. 

Full article at:   http://goo.gl/HqvLhU

By:  

Joel A. Dave, Naomi S. Levitt, Ian L. Ross 
Divisions of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa

Miguel Lacerda 

Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa

Gary Maartens 

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa

Dirk Blom 

Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa 

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A Risk Score to Identify HIV-Infected Women Most Likely to Become Lost to Follow-Up in the Postpartum Period

Access to lifelong combination antiretroviral therapy (cART) is expanding among HIV-infected pregnant and breastfeeding women throughout sub-Saharan Africa (SSA). For this strategy to meaningfully improve maternal HIV outcomes, retention in HIV care is essential. 

We developed a risk score to identify women with high likelihood of loss to follow-up (LTFU) at 6 months postpartum from HIV care, using data from public health facilities in Lusaka, Zambia. LTFU was defined as not presenting for HIV care within 60 days of the last scheduled appointment. We used logistic regression to assess demographic, obstetric and HIV predictors of LTFU and to develop a simple risk score. Sensitivity and specificity were assessed at each risk score cut-point. 

Among 2029 pregnant women initiating cART between 2009 and 2011, 507 (25%) were LTFU by 6 months postpartum. Parity, education, employment status, WHO clinical stage, duration of cART during pregnancy and number of antenatal care visits were associated with LTFU (p-value < .10). A risk score cut-point of 11 (42nd percentile) had 85% sensitivity (95% CI 82%, 88%) and 22% specificity (95% CI 20%, 24%) to detect women LTFU and would exclude 20% of women from a retention intervention. A risk score cut-point of 18 (69th percentile) identified the 23% of women with the highest probability of LTFU and had sensitivity 32% (95% CI 28%, 36%) and specificity 80% (95% CI 78%, 82%). 

A risk score approach may be useful to triage a subset of women most likely to be LTFU for targeted retention interventions.

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By:  Bengtson AM1, Chibwesha CJ2, Westreich D1, Mubiana-Mbewe M3, Chi BH2,3, Miller WC1,4, Mapani M2, Pence BW1, Musonda P5, Stringer JS2, Pettifor A1.

• 1 Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA.
• 2 Department of Obstetrics and Gynecology , University of North Carolina , Chapel Hill , NC , USA.
• 3 Centre for Infectious Disease Research , Zambia , Africa.
• 4 Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.
• 5 Department of Public Health, University of Zambia School of Medicine , Lusaka , Zambia , Africa. 
• AIDS Care. 2016 Feb 17:1-11

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Reductions in Access to HIV Prevention & Care Services Are Associated with Arrest & Convictions in a Global Survey of Men Who Have Sex with Men

OBJECTIVES:

Men who have sex with men (MSM) are disproportionately impacted by HIV. Criminalisation of homosexuality may impede access to HIV services. We evaluated the effect of the enforcement of laws criminalising homosexuality on access to services.

METHODS:

Using data from a 2012 global online survey that was published in a prior paper, we conducted a secondary analysis evaluating differences in perceived accessibility to health services (ie, 'how accessible are ____' services) between MSM who responded 'yes'/'no' to: 'have you ever been arrested or convicted for being gay/MSM?'

RESULTS:

Of the 4020 participants who completed the study and were included in the analysis, 8% reported ever being arrested or convicted under laws relevant to being MSM. Arrests and convictions were most common in sub-Saharan Africa (23.6%), Eastern Europe/Central Asia (18.1%), the Caribbean (15%), Middle East/North Africa (13.2%) and Latin America (9.7%). Those arrested or convicted had significantly lower access to sexually transmitted infection treatment, condoms and medical care, compared with other MSM, while accounting for clustering by country and adjusting for age, HIV status, education and country-level income.

CONCLUSIONS:

Arrests and convictions under laws relevant to being MSM have a strong negative association with access to HIV prevention and care services. Creating an enabling legal and policy environment, and increasing efforts to mitigate anti-homosexuality stigma to ensure equitable access to HIV services are needed, along with decriminalisation of homosexuality, to effectively address the public health needs of this population.

Purchase full article at:   http://goo.gl/A5bhln

By:  Santos GM1, Makofane K2, Arreola S2, Do T3, Ayala G2.

• 1San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA.
• 2The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA.
• 3Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA. 

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Prevalence Of & Factors Associated with Prediabetes & Diabetes among HIV-Infected Adults in Cameroon

BACKGROUND:

HIV and certain antiretrovirals (ARVs) are associated with diabetes. Few studies have examined the prevalence of and factors associated with diabetes amongst HIV-infected individuals on combination antiretroviral therapy (cART) in sub-Saharan Africa; some report prevalence estimates between 3.5-26.5% for diabetes in Cameroon and 20.2-43.5% for prediabetes in sub-Saharan Africa.

METHODS:

In a cross-sectional study, HIV-infected individuals (16-65 years old) were screened for diabetes using haemoglobin A_1C (HbA_1C ). We further categorized HbA_1C as normoglycemia (HbA_1C <5.7%), prediabetes (HbA_1C 5.7-6.4%), or diabetes (HbA_1C  ≥6.5%). Dysglycemia was defined as HbA_1C ≥5.7%. Logistic regression modeling was used to assess factors associated with having dysglycemia. .

RESULTS:

Of 500 participants, 363 (72.6%) were female. Median age was 42.5 years [Interquartile Range (IQR):36.5-49.5]. Nineteen (3.8%) were diabetic, and 170 (34%) were prediabetic. One hundred nine (22%) had a CD4+ count <200 cells/mm³ , and 464 (93%) had received >28 days of antiretroviral therapy (ART) at time of screening. Median abdominal circumference for women was 79.5 cm (IQR: 75.5-85.3) and for men, 86.5 cm (IQR: 81.7-90.5). Adjusting for age, sex, socio-economic status, CD4 cell count, being on cART >28 days, BMI, hypertension, history of hypertension, abdominal circumference, and duration of HIV infection, larger abdominal circumference was associated with higher prevalence of prediabetes or diabetes [adjusted Odds Ratio (aOR)=1.07, 95% Confidence Interval (CI):1.03-1.11], while being on cART (aOR=0.46, CI:0.22-0.99) was associated with lower prevalence.

CONCLUSIONS:

There was a high prevalence of Cameroonian HIV-infected adults with dysglycemia. Larger abdominal circumference was associated with higher prevalence, while cART was associated with lower prevalence.

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By:  Rhee JY1, Bahtila TD2, Palmer D2, Tih PM2, Aberg JA3, LeRoith D4, Jao J5.

• 1Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 2Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
• 3Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 4Department of Medicine, Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 5Department of Medicine, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 
• Diabetes Metab Res Rev. 2016 Feb 17. doi: 10.1002/dmrr.2792

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Predictors of Dropout from Care among HIV-Infected Patients Initiating Antiretroviral Therapy at a Public Sector HIV Treatment Clinic in Sub-Saharan Africa

METHODS:

In a cohort of HIV-infected patients initiating ART at a public sector clinic in Uganda, we assessed predictors of dropout from care (a composite outcome combining death and loss to follow-up). From a large set of socio-demographic, clinical, and laboratory variables routinely collected at ART initiation, we selected those predicting dropout at P <0.1 in unadjusted analyses for inclusion into a multivariable proportional hazards regression model. We then used a stepwise backward selection procedure to identify variables which independently predicted dropout at P <0.05.

RESULTS:

Data from 5,057 patients were analyzed. The median age was 33 years (IQR 28 to 40) and 27.4 % had CD4+ T-cell counts <100 cells/μL at ART initiation. The median duration of follow-up was 24 months (IQR = 14 to 42, maximum follow-up = 64 months). Overall dropout was 26.9 % (established cumulative mortality = 2.3 %, loss to follow-up = 24.6 %), 5.6 % were transferred to other service providers, and 67.5 % were retained in care. A diagnosis of Kaposi's sarcoma (hazard ratio (HR) = 3.3, 95 % CI 2.5 to 4.5); HIV-associated dementia (HR = 2.6, 95 % CI 1.5 to 4.6); history of cryptococcosis (HR = 2.2, 95 % CI 1.4 to 3.3); and reduced hemoglobin concentration (<11 g/dl versus ≥13.8 g/dl (HR = 1.9, 95 % CI 1.6 to 2.2) were strong predictors of dropout. Other independent predictors of dropout were: year of ART initiation; weight loss ≥10 %; reduced total lymphocyte count; chronic diarrhea; male sex; young age (≤28 years); and marital status.

CONCLUSIONS:

Among HIV-infected patients initiating ART at a public sector clinic in SSA, biological factors that usually predict death were especially predictive of dropout. As most of the dropouts were lost to follow-up, this observation suggests that many losses to follow-up may have died. Future studies are needed to identify appropriate interventions that may improve both individual-level patient outcomes and outcome ascertainment among HIV-infected ART initiators in this setting.

Full article at:   http://goo.gl/6c5fTV

By:  Asiimwe SB1,2, Kanyesigye M3, Bwana B4, Okello S5, Muyindike W6.

• 1Department of Medicine, Mbarara Regional Referral Hospital, P.O Box 40, Mbarara, Uganda. asiimwesteve@gmail.com.
• 2Department of Epidemiology and Biostatistics, University of California San Francisco, California, USA. asiimwesteve@gmail.com.
• 3Department of Medicine, Mbarara Regional Referral Hospital, P.O Box 40, Mbarara, Uganda. mkanyesigye2010@gmail.com.
• 4Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. mwebesa_bwana@yahoo.com.
• 5Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. okello.samson@must.ac.ug.
• 6Department of Medicine, Mbarara Regional Referral Hospital, P.O Box 40, Mbarara, Uganda. wmuyindike@gmail.com. 
• BMC Infect Dis. 2016 Feb 1;16(1):43. doi: 10.1186/s12879-016-1392-7.

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Conditional Cash Transfers & Uptake Of & Retention in Prevention of Mother-To-Child HIV Transmission Care

BACKGROUND:

Novel strategies are needed to increase retention in and uptake of prevention of mother-to-child HIV transmission (PMTCT) services in sub-Saharan Africa. We aimed to determine whether small, increasing cash payments, which were conditional on attendance at scheduled clinic visits and receipt of proposed services can increase the proportions of HIV-infected pregnant women who accept available PMTCT services and remain in care.

METHODS:

In this randomised controlled trial, we recruited newly diagnosed HIV-infected women, who were 32 or less weeks pregnant, from 89 antenatal care clinics in Kinshasa, Democratic Republic of Congo, and randomly assigned (1:1) them to either the intervention group or the control group using computer-based randomisation with varying block sizes of four, six, and eight. The intervention group received compensation on the condition that they attended scheduled clinic visits and accepted offered PMTCT services (US$5, plus US$1 increment at every subsequent visit), whereas the control group received usual care. Outcomes assessed included retention in care at 6 weeks' post partum and uptake of PMTCT services, measured by attendance of all scheduled clinic visits and acceptance of proposed services up to 6 weeks' post partum. Analyses were by intention to treat. This trial is registered with ClinicalTrials.org, number NCT01838005.

FINDINGS:

Between April 18, 2013, and Aug 30, 2014, 612 potential participants were identified, 545 were screened, and 433 were enrolled and randomly assigned; 217 to the control group and 216 to the intervention group. At 6 weeks' post partum, 174 participants in the intervention group (81%) and 157 in the control group (72%) were retained in care (risk ratio [RR] 1·11; 95% CI 1·00-1·24). 146 participants in the intervention group (68%) and 116 in the control group (54%) attended all clinic visits and accepted proposed services (RR 1·26; 95% CI 1·08-1·48). Results were similar after adjustment for marital status, age, and education.

INTERPRETATION:

Among women with newly diagnosed HIV, small, incremental cash incentives resulted in increased retention along the PMTCT cascade and uptake of available services. The cost-effectiveness of these incentives and their effect on HIV-free survival warrant further investigation.

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By:  Yotebieng M1, Thirumurthy H2, Moracco KE3, Kawende B4, Chalachala JL4, Wenzi LK4, Ravelomanana NL5, Edmonds A5, Thompson D5, Okitolonda EW4,Behets F6.

• 1The Ohio State University, College of Public Health, Division of Epidemiology, Columbus, OH, USA; The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA. Electronic address: yotebieng.2@osu.edu.
• 2The University of North Carolina at Chapel Hill, Department of Health Policy and Management, Chapel Hill, NC, USA.
• 3The University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC, USA.
• 4The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo.
• 5The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA.
• 6The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA; The University of North Carolina at Chapel Hill, Department of Social Medicine, Chapel Hill, NC, USA. 
• Lancet HIV. 2016 Feb;3(2):e85-93. doi: 10.1016/S2352-3018(15)00247-7.

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Correlates of Emotional and Behavioural Problems in Children with Perinatally Acquired HIV in Cape Town, South Africa

In the antiretroviral era, youth perinatally infected with HIV (PHIV+) are surviving into adulthood and are at risk for emotional and behavioural problems. Few studies of these problems have been conducted in low- and middle-income countries and even fewer in sub-Saharan Africa. 

The aims of this study were to provide a quantitative description of emotional and behavioural problems in a group of PHIV+ youth (n = 78) in South Africa compared with a group of demographically matched HIV-negative controls (n = 30) and to identify correlates of emotional and behavioural problems. A cross-sectional study was conducted employing participants from community and hospital-based clinics. Emotional and behavioural problems were assessed using the Child Behaviour Checklist (CBCL). Several measures were used to assess demographic, biological, cognitive and contextual correlates of problem behaviours. Youth were compared by HIV status on demographic, cognitive and contextual variables as well as the Total Problems and subscale scores of the CBCL. Multivariate comparisons of the influence of contextual and cognitive variables on CBCL Total Problems scores were performed using a stepwise linear regression analytic procedure. In this study, there were no significant differences in between-group comparisons for the prevalence of Internalizing, 

Externalizing and Total Problems in the PHIV+ youth and control group at the clinical and borderline cut-off ranges of the CBCL. Caregiver depression was the only significant predictor of greater Total Problems scores in the full model, after controlling for age and gender (F = 8.57, df = 5.102, P < .01). An interaction between HIV status and caregiver depression was observed (t = -2.20, P = .03), with follow-up within-group analyses confirming that caregiver depression predicted greater Total Problems scores both in HIV-negative youth (β = 0.61, P < .001), and to a lesser extent, in HIV-positive youth (β = 0.25, P < .001). 

This study highlights the need for adequate screening of depression in the caregivers of HIV-infected youth.

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By:  Louw KA¹, Ipser J¹, Phillips N¹, Hoare J¹.

¹a Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.

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Characterizing HIV Epidemiology in Stable Couples in Cambodia, the Dominican Republic, Haiti, and India

Using a set of statistical methods and HIV mathematical models applied on nationally representative Demographic and Health Survey data, we characterized HIV serodiscordancy patterns and HIV transmission dynamics in stable couples (SCs) in four countries: Cambodia, the Dominican Republic, Haiti, and India. The majority of SCs affected by HIV were serodiscordant, and about a third of HIV-infected persons had uninfected partners. 

Overall, nearly two-thirds of HIV infections occurred in individuals in SCs, but only about half of these infections were due to transmissions within serodiscordant couples. The majority of HIV incidence in the population occurred through extra-partner encounters in SCs. 

There is similarity in HIV epidemiology in SCs between these countries and countries in sub-Saharan Africa, despite the difference in scale of epidemics. It appears that HIV epidemiology in SCs may share similar patterns globally, possibly because it is a natural 'spillover' effect of HIV dynamics in high-risk populations.

Below:  Patterns of HIV serodiscordancy in India, Cambodia, the Dominican Republic, and Haiti compared to those in low and high HIV prevalence countries in sub-Saharan Africa. Countries are shown in order of increasing HIV prevalence

Below:  HIV incidence and its sources in stable couples. (a) Fraction of new HIV infections in stable HIV serodiscordant couples that are due to sources external vs. internal to the couple. Estimates are shown for HIV incidence arising in stable HIV serodiscordant couples due to sources external to the couple. (b–h) The mean country-specific contributions to HIV incidence in the population stratified by couples' serostatus and source of HIV infection. Results are displayed for India, Cambodia, the Dominican Republic, and Haiti, compared to those in low and high HIV prevalence countries in sub-Saharan African. Countries are shown in order of increasing HIV prevalence.

Full article at:   http://goo.gl/YmTqBv

By:  Chemaitelly H1, Abu-Raddad LJ1.

• 1Infectious Disease Epidemiology Group,Weill Cornell Medical College - Qatar,Cornell University,Qatar Foundation - Education City,Doha,Qatar. 

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Sex Differences in HIV Prevalence Persist over Time: Evidence from 18 Countries in Sub-Saharan Africa

Objective

The aim of this study was to examine changes over time in the female: male HIV prevalence ratio in 18 countries in Sub-Saharan Africa, overall and when stratified by area of residence, educational attainment and marital status.

Methodology

We used data from the Demographic and Health Surveys, which are nationally representative household surveys. By using data from 18 countries with at least two survey rounds with HIV testing, and dividing the countries into three regions (Western/Central, Eastern and Southern) we were able to examine cross-country and regional changes in the female: male HIV prevalence ratio over time. Logistic regression was used to estimate female: male HIV prevalence ratios in urban versus rural areas and for different categories of education and marital status. To assess changes over time, we compared the confidence intervals of the prevalence ratios.

Results

The female: male HIV prevalence ratio was above one in all countries in at least one survey round for both ages 15–24 years and 25–49 years. In 13 out of 18 countries the prevalence ratio was higher for the younger age group compared to the age group 25–49 years (3 significant) and this difference in prevalence ratios between the age groups did not change over time. Overall, there was a higher frequency of increasing than decreasing prevalence ratios. The gender disparity was greater among those who were married/living together than among the never-married, and over time, the ratio was more stable among the married/living together. The study found no clear differential changes by education.

Conclusion

Women continue to carry the greater burden of HIV in Sub-Saharan Africa and there is no clear pattern of change in the gap between men and women as the direction and magnitude of change in the prevalence ratios varied greatly.

Below:  Western/Central Africa, age-adjusted female: male HIV prevalence ratios

Below:  Eastern Africa, age-adjusted female: male HIV prevalence ratios

Below:  Southern Africa, age-adjusted female: male HIV prevalence ratios

Full article at:   http://goo.gl/MHkxUp

By:  Hanne K. Hegdahl, Knut M. Fylkesnes, Ingvild F. Sandøy

Centre for International Health, University of Bergen, Bergen, Norway

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