title: Prevalence of HIV, HSV-2 and pregnancy among high school students in rural KwaZulu-Natal, South Africa: a bio-behavioural cross-sectional survey.
abstract: OBJECTIVE
  Adolescents in southern African high schools are a key population for HIV prevention interventions. We report on the prevalence of HIV, HSV-2 and pregnancy as indicators of high-risk sexual behaviour among high school students in rural KwaZulu-Natal.
  
  
  METHODS
  Bio-behavioural cross-sectional survey.
  
  
  METHODS
  Students completed a self-administered structured, standardised demographic and sexual behavioural questionnaire. Dried blood spot specimens were collected for HIV and HSV-2 testing. Urine specimens were used for pregnancy testing in female students.
  
  
  RESULTS
  A total of 2675 (1423 females, 1252 males) consenting students were enrolled from 14 high schools between September and November 2010. The median age of students was 16 years (IQR 15-18). HIV prevalence was 1.4% (95% CI 0.9 to 1.9) in males and 6.4% (95% CI 4.6 to 8.3) in females (p<0.001). HSV-2 prevalence was 2.6% (95% CI 1.6 to 3.7) in males and 10.7% (95% CI 8.8 to 12.6) in females (p<0.001). Pregnancy prevalence was 3.6% (95% CI 2.6 to 4.5). Risk factors for prevalent HIV infection in female students included being over 18 years of age (adjusted OR (aOR)=2.67, 95% CI 1.67 to 4.27; p<0.001), prevalent HSV-2 infection (aOR=4.35, 95% CI 2.61 to 7.24; p<0.001), previous pregnancy (aOR=1.66, 95% CI 1.10 to 2.51; p=0.016) and experience of two or more deaths in the household in the previous year (aOR=1.97, 95% CI 1.13 to 3.44; p=0.016).
  
  
  CONCLUSIONS
  The high prevalence of HIV, HSV-2 and pregnancy underscore the need for school-based sexual and reproductive health services, and provide further impetus for the inclusion of adolescents in behavioural and biomedical trials with HIV incidence endpoints.
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa Department of Epidemiology, Mailman School of Public Health, Columbia University.
authors.forename: Quarraisha
authors.initials: Q
authors.lastname: Abdool Karim
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Ayesha B M
authors.initials: AB
authors.lastname: Kharsany
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Kerry
authors.initials: K
authors.lastname: Leask
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Fanelisibonge
authors.initials: F
authors.lastname: Ntombela
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Hilton
authors.initials: H
authors.lastname: Humphries
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Frohlich
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Natasha
authors.initials: N
authors.lastname: Samsunder
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Anneke
authors.initials: A
authors.lastname: Grobler
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Rachael
authors.initials: R
authors.lastname: Dellar
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa Department of Epidemiology, Mailman School of Public Health, Columbia University.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Abdool Karim
mesh_terms: D000293:Adolescent; D001769:Blood / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006558:Herpes Genitalis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011247:Pregnancy / Q000706:statistics & numerical data; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D012309:Risk-Taking; D012424:Rural Population; D012574:Schools; D012725:Sexual Behavior / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D013334:Students; D011795:Surveys and Questionnaires; D014556:Urine / Q000737:chemistry
keywords: Adolescent; Africa; HIV; HSV; Pregnancy