To identify the unmet needs for HIV prevention among older adults in rural South Africa.
We analyzed data from a population-based sample of 5059 men and women aged 40 years and older from the study Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI), which was carried out in the Agincourt health and sociodemographic surveillance system in the Mpumalanga province of South Africa. We estimated the prevalence of HIV (laboratory-confirmed and self-reported) and key sexual behaviors by age and sex. We compared sexual behavior profiles across HIV status categories with and without age–sex standardization.
HIV prevalence was very high among HAALSI participants (23%, 95% confidence interval [CI]: 21 to 24), with no sex differences. Recent sexual activity was common (56%, 95% CI: 55 to 58) across all HIV status categories. Condom use was low among HIV-negative adults (15%, 95% CI: 14 to 17), higher among HIV-positive adults who were unaware of their HIV status (27%, 95% CI: 22 to 33), and dramatically higher among HIV-positive adults who were aware of their status (75%, 95% CI: 70 to 80). Casual sex and multiple partnerships were reported at moderate levels, with slightly higher estimates among HIV-positive compared to HIV-negative adults. Differences by HIV status remained after age–sex standardization.
Older HIV-positive adults in an HIV hyperendemic community of rural South Africa report sexual behaviors consistent with high HIV transmission risk. Older HIV-negative adults report sexual behaviors consistent with high HIV acquisition risk. Prevention initiatives tailored to the particular prevention needs of older adults are urgently needed to reduce HIV risk in this and similar communities in sub-Saharan Africa.
*Department of Epidemiology and Biostatistics, School of Public Health—Bloomington, Indiana University, Bloomington, IN;
†Center for Population and Development Studies, Harvard University, Cambridge, MA;
‡MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
§INDEPTH Network, Accra, Ghana;
‖School of Demography, Australian National University, Canberra, Australia;
¶Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom;
#Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA;
**Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden;
Departments of ††Epidemiology;
‡‡Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA;
§§Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa; and
‖‖Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
Correspondence to: Molly S. Rosenberg, MPH, PhD, Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, 1025 East 7th Street, Office C032, Bloomington, IN 47405 (e-mail: firstname.lastname@example.org).
The HAALSI study was funded by the NIA of the NIH (P01 AG041710). HAALSI is nested within the Agincourt Health and Socio-Demographic Surveillance System, with funding from Wellcome Trust (058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z), University of the Witwatersrand, and Medical Research Council, South Africa.
T.W.B. received funding from the Wellcome Trust and NICHD of NIH (R01-HD084233) and NIAID of NIH (R01-AI124389 and R01-AI112339). The other authors have no funding or conflicts of interest to disclose.
Presented at CROI 2016, February 23, 2016, Boston, MA.
Conceived and designed the analysis: M.S.R. and T.W.B.; Analyzed the data: M.S.R.; Wrote the paper: M.S.R., F.X.G.-O., J.K.R., B.C.H., C.W.K., R.G.W., J.A.S., K.K., L.F.B., S.M.T., and T.W.B.; Design of the parent study: J.A.S., K.K., L.F.B., S.M.T., and T.W.B.; Collection, storage, laboratory testing and analysis of data from the parent study: F.X.G.-O., J.K.R., C.W.K., and R.G.W.; Contributed to the interpretation of findings, critical review of manuscript and approval of final manuscript as submitted: M.S.R., F.X.G.-O., J.K.R., B.C.H., C.W.K., R.G.W., J.A.S., K.K., L.F.B., S.M.T., and T.W.B.
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Received April 28, 2016
Accepted August 16, 2016