title: Behavioral, biological, and demographic risk and protective factors for new HIV infections among youth in Rakai, Uganda.
abstract: BACKGROUND
  Prevalence of HIV infection is considerable among youth, although data on risk factors for new (incident) infections are limited. We examined incidence of HIV infection and risk and protective factors among youth in rural Uganda, including the role of gender and social transitions.
  
  
  METHODS
  Participants were sexually experienced youth (15-24 years old) enrolled in the Rakai Community Cohort Study, 1999-2008 (n = 6741). Poisson regression with robust standard errors was used to estimate incident rate ratios (IRR) and 95% confidence intervals (CI) of incident HIV infection.
  
  
  RESULTS
  HIV incidence was greater among young women than young men (14.1 vs. 8.3 per 1000 person-years, respectively); this gender disparity was greater among teenagers (14.9 vs. 3.6). Beyond behavioral (multiple partners and concurrency) and biological factors (sexually transmitted infection symptoms), social transitions such as marriage and staying in school influenced HIV risk. In multivariate analyses among women, HIV incidence was associated with living in a trading village (adjusted IRR (aIRR) = 1.48; 95% CI: 1.04 to 2.11), being a student (aIRR = 0.22; 95% CI: 0.07 to 0.72), current marriage (aIRR = 0.55; 95% CI: 0.37 to 0.81), former marriage (aIRR = 1.73; 95% CI: 1.01 to 2.96), having multiple partners, and sexually transmitted infection symptoms. Among men, new infections were associated with former marriage (aIRR = 5.57; 95% CI: 2.51 to 12.36), genital ulceration (aIRR = 3.56; 95% CI: 1.97 to 6.41), and alcohol use (aIRR = 2.08; 95% CI: 1.15 to 3.77).
  
  
  CONCLUSIONS
  During the third decade of the HIV epidemic in Uganda, HIV incidence remains considerable among youth, with young women particularly at risk. The risk for new infections was strongly shaped by social transitions such as leaving school, entrance into marriage, and marital dissolution; the impact of marriage was different for young men than women.
authors.affiliation: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. js2637@columbia.edu
authors.forename: John S
authors.initials: JS
authors.lastname: Santelli
authors.forename: Zoe R
authors.initials: ZR
authors.lastname: Edelstein
authors.forename: Sanyukta
authors.initials: S
authors.lastname: Mathur
authors.forename: Ying
authors.initials: Y
authors.lastname: Wei
authors.forename: Wenfei
authors.initials: W
authors.lastname: Zhang
authors.forename: Mark G
authors.initials: MG
authors.lastname: Orr
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Higgins
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Ron H
authors.initials: RH
authors.lastname: Gray
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: David M
authors.initials: DM
authors.lastname: Serwadda
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D015994:Incidence; D008297:Male; D008393:Marriage; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D012423:Rural Health; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
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