High HIV incidence in a community with high HIV prevalence in rural South Africa: findings from a prospective population-based study.
OBJECTIVE
To measure HIV incidence in a rural area of South Africa with high HIV prevalence and to analyze risk factors for acquisition of HIV using a prospective population-based cohort study.


METHODS
Data from two rounds (2003-2005) of a large prospective population-based HIV survey in rural KwaZulu-Natal were used to calculate HIV incidence by sex and 5-year age group. Multiple imputations (MI) were used to adjust for selection effects and risk factors for acquiring HIV were examined in Weibull multiple regression.


RESULTS
During 5253 person-years at risk, 170 individuals became seropositive. The crude HIV incidence rate per 100 person-years was 3.8 [95% confidence interval (CI), 3.2-4.6] in women aged 15-49 years and 2.3 (95% CI, 1.8-3.1) in men aged 15-54 years. MI significantly increased the HIV incidence rates both in women and men [7.9/100 person-years (95% CI, 7.4-8.4) and 5.1/100 person-years (95% CI 4.1-6.2), respectively]. When holding other factors constant in Weibull multiple regression, the hazard of HIV seroconversion was approximately twice as high in people who were currently unmarried but had a partner than among people who were currently married (P < 0.001) and increased with increasing distance from a government health clinic (P = 0.051) and decreasing distance from a primary road (P = 0.002).


CONCLUSIONS
In this high HIV prevalence community in rural South Africa HIV incidence is very high. The present focus on antiretroviral treatment needs to be balanced with a renewed emphasis on HIV prevention for both sexes.
Bärnighausen
Till
T
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa. tbarnighausen@africacentre.ac.za
Tanser
Frank
F
Gqwede
Zanomsa
Z
Mbizana
Clifford
C
Herbst
Kobus
K
Newell
Marie-Louise
ML
D000293:Adolescent; D000328:Adult; D005260:Female; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology*; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012111:Residence Characteristics; D012424:Rural Population; D018571:Sentinel Surveillance; D013019:South Africa / Q000453:epidemiology
D015483:HIV Antibodies