title: Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland.
abstract: BACKGROUND
  HIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions.
  
  
  RESULTS
  This cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14-3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09-3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00-5.00; P<0.001), and ever cohabited (AOR, 2.39; CI, 1.66-3.43; P = 0.00). The most cited reason for having multiple sexual partners was financial gain. HIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319).
  
  
  CONCLUSIONS
  Structural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially research for family function.
authors.affiliation: Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Bhekumusa Wellington
authors.identifier: http://orcid.org/0000-0001-6429-638X
authors.initials: BW
authors.lastname: Lukhele
authors.affiliation: Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Teeranee
authors.initials: T
authors.lastname: Techasrivichien
authors.affiliation: Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.|Center for Medical Education, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: S Pilar
authors.initials: SP
authors.lastname: Suguimoto
authors.affiliation: Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Patou Masika
authors.initials: PM
authors.lastname: Musumari
authors.affiliation: Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Christina
authors.initials: C
authors.lastname: El-Saaidi
authors.affiliation: Center for Human Services, University Research Co., LLC, Mbabane, Swaziland.
authors.forename: Samson
authors.initials: S
authors.lastname: Haumba
authors.affiliation: Department of Midwifery Science, Faculty of Health Sciences, University of Swaziland, Mbabane, Swaziland.
authors.forename: Oslinah Buru
authors.initials: OB
authors.lastname: Tagutanazvo
authors.affiliation: Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Ono-Kihara
authors.affiliation: Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kihara
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D058872:Epidemics; D013541:Eswatini; D005190:Family / Q000208:ethnology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology* / Q000517:prevention & control; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000208:ethnology* / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior / Q000208:ethnology; D012747:Sexual Partners; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult