Objectives: To determine the seroprevalence of HIV and herpes simplex virus-2 (HSV-2) by age and gender among young people aged 14-24 years in a South African town and to identify risk factors for HIV infection.
Design: A community-based, cross-sectional study was conducted on a random sample of men (n = 723) and women (n = 784) living in a township in the Carletonville district of South Africa.
Methods: Potential demographic and behavioural risk factors associated with HIV were recorded by questionnaire and biological tests were performed on serum and urine. Data analysis was performed using multivariate logistic regression.
Results: Among men and women the prevalence of HIV infection was 9.4 and 34.4%, respectively, and of positive HSV-2 serology was 17.0 and 53.3%, respectively. Among 24-year-old women the prevalence of HIV was 66.7% [95% confidence interval (CI), 54.6–77.3%]. HSV-2 seropositivity was a strong independent risk factor for HIV infection with odds ratios of 5.3 (95% CI, 2.7–10.3) for men and 8.4 (95% CI, 4.9–14.2) for women. There was no independent effect of age at first sex or serological markers of other sexually transmitted infections on HIV infection.
Conclusions: HIV infection among young women increases rapidly after the onset of sexual activity and reaches extremely high levels by 24 years of age. These findings suggest that rates of HIV transmission from men to women are high and that HSV-2 plays a major role in the spread of HIV in this population.
From aINSERM U88, Saint-Maurice, the bHôpital Ambroise Paré, Boulogne-Billancourt, France, the cReference Centre for Sexually Transmitted Diseases, School of Pathology, University of the Witwatersrand and South African Institute for Medical Research, Johannesburg, South Africa, the dLondon Schools of Economics and Political Science, London, UK, the eUNAIDS, Geneva, Switzerland, the fMedical Research Council, Durban, the gCouncil for Scientific and Industrial Research, Johannesburg, South Africa and the hPopulation Council, Washington DC, USA.
Correspondence to Bertran Auvert, INSERM U88, 14, rue du Val d'Osne, 94415 Saint-Maurice Cedex, France. E-mail: firstname.lastname@example.org
Received: 30 June 2000;
revised: 10 November 2000; accepted: 20 December 2000.
Sponsorship: The original project was funded by the Department for International Development from the beginning of 1998 and by the US Agency for International Development through the Population Council's Horizons Project since the beginning of 1999 under Cooperative agreement HRN-A-00-97-00012-00. Funding was received from Agence Nationale de Recherche contre le SIDA (2000-129), Ensemble Contre le SIDA, Institut National de la Santé et de la Recherche Médicale, Glaxo Wellcome Research and Development UK and UNAIDS. The Gauteng Department of Health contributed to the costs of the survey. Support was provided by the Council for Scientific and Industrial Research, the South African Institute for Medical Research, the London School of Economics and Progressus.
Note: The authors of this paper are listed alphabetically. Their respective contributions were as follows: Bertran Auvert conceptualized the HSV-2 part of the study, arranged for the laboratory testing to be done, supervized the analysis of the data, and wrote the first draft of the paper. Brian Williams, who is the principal investigator for the Carletonville–Mothusimpilo Project, and Catherine Campbell conceptualized the original project and they have been responsible for running the project since its inception in January 1998. Catherine Campbell was responsible for co-ordinating all the social science aspects of the project. Catherine MacPhail worked extensively with Catherine Campbell and Michel Caraël on the social and behavioural aspects of the work and carried out the validation study. Dirk Taljaard was responsible for carrying out the biomedical and social surveys and gave inputs for the data analysis. Ron Ballard and Glenda Fehler co-ordinated and supervised all of the laboratory testing and provided valuable input concerning HSV-2 in particular. Eleanor Gouws contributed to the statistical analysis of the data. Johannes Van Dam was involved in the conceptualization and design of the project and has worked closely with Brian Williams on the epidemiological aspects and with Catherine Campbell on the social aspects of the study. Matthieu Carton carried out statistical analysis and contributed to writing the first draft of the paper. Michel Caraël was responsible for the design of the social and behavioural questionnaire and has provided important technical advice regarding the social aspects of the project.