The impact of migration on HIV-1 transmission in South Africa: a study of migrant and nonmigrant men and their partners.
BACKGROUND
To investigate the association between migration and HIV infection among migrant and nonmigrant men and their rural partners.


OBJECTIVE
The goal was to determine risk factors for HIV-1 infection in South Africa.


METHODS
This was a cross-sectional study of 196 migrant men and 130 of their rural partners, as well as 64 nonmigrant men and 98 rural women whose partners are nonmigrant. Male migrants were recruited at work in two urban centers, 100 km and 700 km from their rural homes. Rural partners were traced and invited to participate. Nonmigrant couples were recruited for comparison. The study involved administration of a detailed questionnaire and blood collection for HIV testing.


RESULTS
Testing showed that 25.9% of migrant men and 12.7% of nonmigrant men were infected with HIV ( P= 0.029; odds ratio = 2.4; 95% CI = 1.1-5.3). In multivariate analysis, main risk factors for male HIV infection were being a migrant, ever having used a condom, and having lived in four or more places during a lifetime. Being the partner of a migrant was not a significant risk factor for HIV infection among women; significant risk factors were reporting more than one current regular partner, being younger than 35 years, and having STD symptoms during the previous 4 months.


CONCLUSIONS
Migration is an independent risk factor for HIV infection among men. Workplace interventions are urgently needed to prevent further infections. High rates of HIV were found among rural women, and the migration status of the regular partner was not a major risk factor for HIV. Rural women lack access to appropriate prevention interventions, regardless of their partners' migration status.
Lurie
Mark N
MN
South African Medical Research Council, HIV Prevention and Vaccine Research Unit, Durban, South Africa. Mark_Lurie@brown.edu
Williams
Brian G
BG
Zuma
Khangelani
K
Mkaya-Mwamburi
David
D
Garnett
Geoff
G
Sturm
Adriaan W
AW
Sweat
Michael D
MD
Gittelsohn
Joel
J
Abdool Karim
Salim S
SS
D000328:Adult; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012747:Sexual Partners; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires
D015483:HIV Antibodies