Temporal trends in sexual behaviours and their impacts on HIV incidence among South African women: 2002–2016

ABSTRACT

South Africa has the highest number of HIV infected individuals in the world. The primary objective of the current study was to describe temporal changes in HIV incidence rates using the data from 9,948 women who enrolled in one of the six HIV prevention trials conducted in KwaZulu-Natal, South Africa. Characteristics of the study population were presented and compared across the four study periods: 2002–2004, 2005–2008, 2009–2011 and 2012–2016. HIV infection rates increased from 6.2 to 9.3 per 100 person-year over the 15 years. These rates were as high as 14 per 100 person-year among women younger than 20 years age. Being single/not cohabiting, using injectable contraceptives, having less than two children, and diagnosed with STI(s) were associated with increased risk of HIV infection. These four factors were associated with 71%, 75%, 80% and 88% of the HIV seroconversions in four study periods. As the research continues to find ways of controlling the spread of the infections, quantifying the temporal trends in risk factors and their population-level impacts on HIV infection may have significant implications. This information may assist in developing effective counselling and education programs by targeting the sexually active single women and delivering more realistic messages.

KEYWORDS:

• HIV
• South Africa
• temporal trends
• population level impact

Acknowledgements

We gratefully acknowledge the women who participated in the studies. The current study used the site-specific secondary (subgroup) data and the authors did not receive any funding for the current study. However, we acknowledge that main studies associated with these trials have received funding and support from the various sources including: the UK Department for International Development and the Medical Research Council; the Bill & Melinda Gates Foundation; and the Division of AIDS, NIH.

Authors’ contributions

GR was the principal investigator of the studies. HW and TR participated in the design of the study and performed the statistical analysis. HW drafted the manuscript. HW, TR and GR interpreted the results. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Ethical approval for the trials, including all study protocols and informed consent forms, were received from the University of KwaZulu-Natal Biomedical Research Ethics Committee and the South African Medical Research Council Ethics Committee as well as the various study-specific Institutional Review Boards.