Herpes simplex virus type 2 among mobile pastoralists in northwestern Namibia

Abstract

Background: Although herpes simplex virus type 2 (HSV-2) epidemiology has been described for many western and/or urban populations, disease burden has not been characterized for remote, non-western, under treated populations, where patterns of risk and vulnerability may be very different.

Aims: To understand demographic, behavioural and geographic influences on risk for HSV-2 in a population of mobile, rural pastoralists in northwestern Namibia.

Subjects and methods: The authors conducted a cross-sectional survey of reproductively aged adults (n = 445) across 28 villages in Kaokoveld, Namibia. All participants completed a questionnaire of demographic data, ecological interactions and sexual behaviour, and a rapid test specific for HSV-2.

Results: HSV-2 status was significantly associated with being female (OR = 3.1, 95% CI = 2.00, 4.71), increasing age (men: OR = 7.5, 95% CI = 2.67, 20.85; women: OR = 6.2, 95% CI = 2.48, 15.50) and with higher wealth among men (OR = 5.1, 95% CI = 1.98, 13.09).

Conclusions: Higher risk among women can be explained, in part, by local hygiene practices and a preference for “dry” sex. There was considerable variation in prevalence by region, which appears to be linked to geographic remoteness. Culturally contextualized epidemiologic studies of remote, vulnerable populations can provide essential information for limiting the introduction and spread of new infections.

• HSV-2
• nomads
• rural health
• sexually transmitted disease
• Southern Africa

Acknowledgements

We thank Brady West for statistical consultation and Nita Bharti for creating our fieldsite map (Figure 1). Finally, we would like to thank our field colleague, Kemuu Jakurama, the Namibian Ministry of Health and Social Services and, especially, our participants in Kaokoveld.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

We thank our funding sources: Interdisciplinary Program in Infectious Diseases (NIH T32 A1049816), the Robert Wood Johnson Health and Society Small Grant Program, the Wenner-Gren Dissertation Fieldwork Grant, American Philosophical Society’s Lewis & Clark Fund and the University of Michigan’s Rackham Graduate School and the School of Natural Resources and Environment.