title: HIV incidence remains high in KwaZulu-Natal, South Africa: evidence from three districts.
abstract: BACKGROUND
  HIV prevalence and incidence among sexually active women in peri-urban areas of Ladysmith, Edendale, and Pinetown, KwaZulu-Natal, South Africa, were assessed between October 2007 and February 2010 in preparation for vaginal microbicide trials.
  
  
  RESULTS
  Sexually active women 18-35 years, not known to be HIV-positive or pregnant were tested cross-sectionally to determine HIV and pregnancy prevalence (798 in Ladysmith, 1,084 in Edendale, and 891 in Pinetown). Out of these, approximately 300 confirmed non-pregnant, HIV-negative women were subsequently enrolled at each clinical research center (CRC) in a 12-month cohort study with quarterly study visits. Women in the cohort studies were required to use a condom plus a hormonal contraceptive method. HIV prevalence rates in the baseline cross-sectional surveys were high: 42% in Ladysmith, 46% in Edendale and 41% in Pinetown. Around 90% of study participants at each CRC reported one sex partner in the last 3 months, but only 14-30% stated that they were sure that none of their sex partners were HIV-positive. HIV incidence rates based on seroconversions over 12 months were 14.8/100 person-years (PY) (95% CI 9.7, 19.8) in Ladysmith, 6.3/100 PY (95% CI 3.2, 9.4) in Edendale, and 7.2/100 PY (95% CI 3.7, 10.7) in Pinetown. The 12-month pregnancy incidence rates (in the context of high reported contraceptive use) were: 5.7/100 PY (95% CI 2.6, 8.7) in Ladysmith, 3.1/100 PY (95% CI 0.9, 5.2) in Edendale and 6.3/100 PY (95% CI 3.0, 9.6) in Pinetown.
  
  
  CONCLUSIONS
  HIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal.
authors.affiliation: International Partnership for Microbicides, Silver Spring, Maryland United States of America.
authors.forename: Annaléne
authors.initials: A
authors.lastname: Nel
authors.forename: Zonke
authors.initials: Z
authors.lastname: Mabude
authors.forename: Jenni
authors.initials: J
authors.lastname: Smit
authors.forename: Philip
authors.initials: P
authors.lastname: Kotze
authors.forename: Derek
authors.initials: D
authors.lastname: Arbuckle
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.forename: Neliëtte
authors.initials: N
authors.lastname: van Niekerk
authors.forename: Janneke
authors.initials: J
authors.lastname: van de Wijgert
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D011247:Pregnancy / Q000706:statistics & numerical data; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D011446:Prospective Studies; D021841:Safe Sex; D013019:South Africa / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult