title: Sexual Behaviors and HIV Status: A Population-Based Study Among Older Adults in Rural South Africa.
abstract: OBJECTIVE
  To identify the unmet needs for HIV prevention among older adults in rural South Africa.
  
  
  METHODS
  We analyzed data from a population-based sample of 5059 men and women aged 40 years and older from the study Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI), which was carried out in the Agincourt health and sociodemographic surveillance system in the Mpumalanga province of South Africa. We estimated the prevalence of HIV (laboratory-confirmed and self-reported) and key sexual behaviors by age and sex. We compared sexual behavior profiles across HIV status categories with and without age-sex standardization.
  
  
  RESULTS
  HIV prevalence was very high among HAALSI participants (23%, 95% confidence interval [CI]: 21 to 24), with no sex differences. Recent sexual activity was common (56%, 95% CI: 55 to 58) across all HIV status categories. Condom use was low among HIV-negative adults (15%, 95% CI: 14 to 17), higher among HIV-positive adults who were unaware of their HIV status (27%, 95% CI: 22 to 33), and dramatically higher among HIV-positive adults who were aware of their status (75%, 95% CI: 70 to 80). Casual sex and multiple partnerships were reported at moderate levels, with slightly higher estimates among HIV-positive compared to HIV-negative adults. Differences by HIV status remained after age-sex standardization.
  
  
  CONCLUSIONS
  Older HIV-positive adults in an HIV hyperendemic community of rural South Africa report sexual behaviors consistent with high HIV transmission risk. Older HIV-negative adults report sexual behaviors consistent with high HIV acquisition risk. Prevention initiatives tailored to the particular prevention needs of older adults are urgently needed to reduce HIV risk in this and similar communities in sub-Saharan Africa.
authors.affiliation: *Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN;†Center for Population and Development Studies, Harvard University, Cambridge, MA;‡MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;§INDEPTH Network, Accra, Ghana;‖School of Demography, Australian National University, Canberra, Australia;¶Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom;#Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA;**Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden;Departments of ††Epidemiology;‡‡Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA;§§Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa; and‖‖Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Molly S
authors.initials: MS
authors.lastname: Rosenberg
authors.forename: Francesc X
authors.initials: FX
authors.lastname: Gómez-Olivé
authors.forename: Julia K
authors.initials: JK
authors.lastname: Rohr
authors.forename: Brian C
authors.initials: BC
authors.lastname: Houle
authors.forename: Chodziwadziwa W
authors.initials: CW
authors.lastname: Kabudula
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Wagner
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Berkman
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Tollman
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology