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High HIV incidence in a community with high HIV prevalence in rural South Africa: findings from a prospective population-based study

Bärnighausen, Tilla,b; Tanser, Franka; Gqwede, Zanomsaa; Mbizana, Clifforda; Herbst, Kobusa; Newell, Marie-Louisea,c

doi: 10.1097/QAD.0b013e3282f2ef43
Epidemiology and Social: Concise Communication

Objectives: To measure HIV incidence in a rural area of South Africa with high HIV prevalence and to analyze risk factors for acquisition of HIV using a prospective population-based cohort study.

Methods: Data from two rounds (2003–2005) of a large prospective population-based HIV survey in rural KwaZulu-Natal were used to calculate HIV incidence by sex and 5-year age group. Multiple imputations (MI) were used to adjust for selection effects and risk factors for acquiring HIV were examined in Weibull multiple regression.

Results: During 5253 person-years at risk, 170 individuals became seropositive. The crude HIV incidence rate per 100 person-years was 3.8 [95% confidence interval (CI), 3.2–4.6] in women aged 15–49 years and 2.3 (95% CI, 1.8–3.1) in men aged 15–54 years. MI significantly increased the HIV incidence rates both in women and men [7.9/100 person-years (95% CI, 7.4–8.4) and 5.1/100 person-years (95% CI 4.1–6.2), respectively]. When holding other factors constant in Weibull multiple regression, the hazard of HIV seroconversion was approximately twice as high in people who were currently unmarried but had a partner than among people who were currently married (P < 0.001) and increased with increasing distance from a government health clinic (P = 0.051) and decreasing distance from a primary road (P = 0.002).

Conclusion: In this high HIV prevalence community in rural South Africa HIV incidence is very high. The present focus on antiretroviral treatment needs to be balanced with a renewed emphasis on HIV prevention for both sexes.

From the aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa

bDepartment of Population and International Health, Harvard School of Public Health, Boston, Massachusetts, USA

cCentre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK.

Received 12 March, 2007

Revised 28 September, 2007

Accepted 3 October, 2007

Correspondence to Dr T. Bärnighausen, Africa Centre for Health and Population Studies, University of KwaZulu-Natal, PO Box 198, Mtubatuba 3935, South Africa. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.