Social Disequilibrium and the Risk of HIV Acquisition: A Multilevel Study in Rural KwaZulu-Natal Province, South Africa

被引:0
作者
Tomita, Andrew [1 ,2 ]
Vandormael, Alain M. [1 ,2 ]
Baernighausen, Till [2 ,3 ,4 ]
de Oliveira, Tulio [1 ,2 ,5 ]
Tanser, Frank [2 ,5 ,6 ]
机构
[1] Univ KwaZulu Natal, Nelson R Mandela Sch Med, Coll Hlth Sci, Congella, South Africa
[2] Univ KwaZulu Natal, Africa Hlth Res Inst, Congella, South Africa
[3] Harvard TH Chan Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA USA
[4] Heidelberg Univ, Inst Publ Hlth, Heidelberg, Germany
[5] CAPRISA, Congella, South Africa
[6] Univ KwaZulu Natal, Sch Nursing & Publ Hlth, Congella, South Africa
基金
英国惠康基金; 英国医学研究理事会;
关键词
HIV; geographical information systems; hotspot; rural South Africa; social disequilibrium; social disorganization; PREVENTION INTERVENTION; ANTIRETROVIRAL THERAPY; LABOR MIGRATION; COMMUNITY; NEIGHBORHOOD; DISORGANIZATION; INFECTION; HEALTH; IMPACT; INCOME;
D O I
10.1097/QAI.0000000000001349
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Few population-based multilevel studies have quantified the risks that social context poses in rural communities with high HIV incidence across South Africa. We investigated the individual, social, and community challenges to HIV acquisition risk in areas with high and low incidence of HIV infection (hotspots/coldspots). Methods: The cohort (N = 17,376) included all HIV-negative adults enrolled in a population-based HIV surveillance study from 2004 to 2015 in a rural South African community with large labor migrancy. Multilevel survival models were fitted to examine the social determinants (ie, neighborhood migration intensity), community traits (ie, HIV prevalence), and individual determinants of HIV acquisition risk in identified hotspots/coldspots. Results: The HIV acquisition risk (adjusted hazard ratio [aHR] = 1.05, 95% confidence interval [CI]: 1.01 to 1.09) was greater in hotspots with higher neighborhood migration intensity among men. In women, higher neighborhood migration intensity (aHR = 1.02, 95% CI: 1.01 to 1.02) was associated with a greater HIV acquisition risk, irrespective of whether they lived in hotspot/coldspot communities. HIV acquisition risk was greater in communities with a higher prevalence of HIV in both men (aHR = 1.07, 95% CI: 1.03 to 1.12) and women (aHR = 1.03, 95% CI: 1.01 to 1.05), irrespective of hotspot/coldspot locations. Conclusion: HIV acquisition risk was strongly influenced by gender (ie, young women), behavior (ie, sexual debut, contraception, circumcision), and social determinants. Certain challenges (ie, community disease prevalence) for HIV acquisition risk impacted both sexes, regardless of residence in hotspot/coldspot communities, whereas social determinants (ie, neighborhood migration intensity) were pronounced in hotspots among men. Future intervention scale-up requires addressing the social context that contributes to HIV acquisition risk in rural areas with high migration.
引用
收藏
页码:164 / 174
页数:11
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