Estimating HIV Prevalence and HIV-Related Risk Behaviors Among Heterosexual Women Who Have Multiple Sex Partners Using Respondent-Driven Sampling in a High-Risk Community in South Africa

Townsend, Loraine PhD*; Zembe, Yanga MA*; Mathews, Catherine PhD*,†; Mason-Jones, Amanda J. PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182816990
Epidemiology and Prevention

Background: Repeated surveillance surveys are important for monitoring trends in HIV and risk behaviors over time. In countries most adversely affected by HIV and AIDS, community-level HIV biological and behavioral surveillance surveys are needed among subpopulations who engage in high-risk sexual behaviors.

Purpose: To describe the effectiveness of respondent-driven sampling (RDS) to recruit heterosexual women who have multiple concurrent sexual partnerships, to report HIV prevalence and describe key characteristics among them, and to assess whether RDS-accessed women not usually recruited during routine sentinel surveillance surveys.

Methods: We conducted a HIV biological and behavioral surveillance surveys using RDS among women. Participants completed an audio-computer–assisted survey interview, voluntarily provided dried blood spots for HIV testing, and were offered rapid HIV testing.

Results: The analytical sample comprised 845 women whose mean age was 23.9 years. About 6.4% were married, 49.6% lived in informal dwellings, and 31.8% reported not to have enough money for food. HIV prevalence was 28.8% (95% confidence intervals: 24.3 to 33.4). Being between 20 and 29 years was significantly related to HIV infection. Women who had never attended a public health facility (10.1%) compared with those who had were more likely to be 16–19 years (P = 0.008), reported sexual debut at 10–14 years (P = 0.044), were more likely to have experienced a symptom of a sexually transmitted infection (P = 0.031), and to have taken illegal drugs (P = 0.007).

Conclusions: RDS effectively recruited women who reported 2 or more male sexual partners in the past 3 months. HIV prevalence and HIV-related risk behaviors were high among women who have multiple concurrent partners.

Author Information

*South African Medical Research Council, Tygerberg, South Africa

University of Cape Town.

Correspondence to: Loraine Townsend, PhD, South African Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa (e-mail: or

The authors have no conflicts of interest to disclose.

Supported by the President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention/Global AIDS Program under the terms of MRC-CDC Cooperative Agreement 5U2GPS001137.

Received August 04, 2012

Accepted December 04, 2012

© 2013 Lippincott Williams & Wilkins, Inc.