The relationship between age of coital debut and HIV seroprevalence among women in Durban, South Africa: a cohort study

objectives: To investigate the impact of early sexual debut on HIV seroprevalence and incidence rates among a cohort of women. Design: Prospective study. Setting: KwaZulu-Natal, South Africa. Participants: A total of 3492 sexually active women who consented to screen a HIV prevention trial during September 2002 to September 2005; a total of 1485 of them were followed for approximately 24 months. Primary and secondary outcome measures: HIV seroprevalence among those who were screened for the trial and HIV seroconversion among those who seroconverted during the study. Results: Lowest quintiles of age at sexual debut, less than high school education, a higher number of lifetime sexual partners and lack of cohabitation, being diagnosed as having herpes simplex virus 2 and other sexually transmitted infections were all significantly associated with prevalent HIV infection in multivariate analysis. During follow-up, 148 (6.8 per 100 person years, 95% CI 5.8 to 8.0) women seroconverted. Highest seroconversion rate was observed among women who had reported having had sex 15 years or younger (12.0 per 100 person-years, 95% CI 8.0 to 18.0). Overall, impact of risk factors considered in this study was associated with considerable potential reductions in HIV prevalence and incidence rates (population attributable risk: 85%, 95% CI 84% to 87% and population attributable risk: 77%, 95% CI 72% to 82%, respectively). Conclusions: The association of HIV status with younger age at sexual debut may likely due to an increased number of lifetime partners. This increase could result from a longer duration of sexual life. Prevention of HIV infection should include efforts to delay age at first sex in young women

Geoadditive models to assess spatial variation of HIV infections among women in Local communities of Durban, South Africa

<p>Abstract</p> <p>Background</p> <p>The severity of the HIV/AIDS epidemic in South Africa varies between and within provinces, with differences noted even at the suburban scale. We investigated the geographical variability of HIV infection in rural areas of the eThekwini Metropolitan Municipality in KwaZulu-Natal province, South Africa.</p> <p>Method</p> <p>We used geoadditive models to assess nonlinear geographical variation in HIV prevalence while simultaneously controlling for important demographic and sexual risk factors. A total of 3,469 women who were screened for a Phase-III randomized trial were included in the current analysis.</p> <p>Results</p> <p>We found significant spatial patterns that could not be explained by demographic and sexual risk behaviors. In particular, the epidemic was determined to be much worse 44 km south of Durban after controlling for all demographic and sexual risk behaviors.</p> <p>Conclusion</p> <p>The study revealed significant geographic variability in HIV infection in the eThekwini Metropolitan Municipality in KwaZulu-Natal, South Africa.</p

Population attributable risk for chlamydia infection in a cohort of young international travellers (backpackers) and residents in Australia

Aim To estimate the population attributable risk (PAR) for Chlamydia trachomatis infection in young men and women in Sydney, Australia.Method Multivariate logistic regression was used to examine the association between demographic, sexual behaviour and other potential risk factors and chlamydia positivity in young (¡Ü30 years) heterosexual international travellers (backpackers) and Australian residents attending a sexual health clinic. Point and interval estimates of PAR were calculated to quantify the proportion of chlamydia infections that can theoretically be prevented if a combination of risk factors is eliminated from a target population.Results In males, the PAR associated with inconsistent condom use in the past 3 months was 65% (95% CI 56% to 71%) in backpackers compared to 50% (95% CI 41% to 56%) in non-backpackers and the PAR associated with reporting three or more female sexual partners in the past 3 months was similar between male backpackers and non-backpackers (33% (95% CI 28% to 40%) and 36% (95% CI 32% to 41%), respectively). In females, the PAR associated with inconsistent condom use in the past 3 months was 51% (95% CI 42% to 59%) in backpackers compared to 41% (95% CI 31% to 51%) in non-backpackers, and the PAR associated with reporting three or more male sexual partners in the past 3 months was 14% (95% CI 11% to 18%) in backpackers compared to 30% (95% CI 25% to 37%) in non-backpackers.Conclusion These findings suggest that the largest number of chlamydia infections could be avoided by increasing condom use, particularly in backpackers. Reporting multiple partners was also associated with a large proportion of infections and the risk associated with this behaviour should be considered in health promotion strategies

High risk sexual behaviors are associated with sexual violence among a cohort of women in Durban, South Africa

BACKGROUND: Studies show Gender Based Violence (GBV) to be significantly associated with risky sexual behaviour. In South Africa the incidence of GBV is reportedly high, and there is a strong argument for GBV to be a driver of HIV infection rates. This study describes the prevalence of Forced Sex (FS) experiences of women who enrolled into an HIV biomedical intervention study, and its association with risky sexual behaviour. FINDINGS: In this study, sociodemographic and behavioural data from women enrolled in the Carraguard™ trial, were assessed in relation to FS using logistic regression. The results indicated that 193/1485 (13%) of women reported ever experiencing FS at the screening visit. Women who were 30 years and older; reported having sex for cash; multiple partners; changing partners during the trial; inconsistent condom use during the trial; and 3 or more sex acts in the 2 weeks prior to screening, were significantly more likely to have experienced forced sex. CONCLUSIONS: The results of this study are broadly consistent with those found in other studies and are similar in profile to women at higher risk for HIV acquisition in our setting. This study indicates a need for GBV prevention to be integrated with HIV prevention programmes

Targeted Pregnancy and Human Immunodeficiency Virus Prevention Risk-Reduction Counseling for Young Women: Lessons Learned from Biomedical Prevention Trials.

Background: Women enrolled in human immunodeficiency virus (HIV) prevention efficacy trials receive counseling on prevention of HIV, sexually transmitted infections (STIs), and pregnancy during every visit. Incident pregnancy has an impact on efficacy outcomes. Incidence rates of pregnancy and HIV/STIs among women who became pregnant and associated risk factors were assessed. Methods: Data from 9165 women participating in HIV prevention trials in KwaZulu-Natal, South Africa from 2002-2012 were combined. Demographic and behavioral predictors of incidence pregnancy and incidence HIV and STIs were determined using Cox regression models. Results: Overall pregnancy incidence was 9.6 per 100 person-year (py) (95% confidence interval [Cl], 9.1-10.3). Human immunodeficiency virus incidence among pregnant women was 5.93 per 100 py (95% Cl, 4.73-7.44). Incidence of STIs among pregnant women for Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, and Treponema pallidum (syphilis) were 10.87, 7.42, 3.92, and 1.43 per 100 py, respectively. In the adjusted analyses, we observed overlapping risk factors for HIV acquisition during pregnancy, ie, young age, not married/not cohabitating, and low parity. The risk of pregnancy and HIV acquisition is more than 3 times higher among young women (<20 years of age). Conclusions: We identified overlapping risk factors for pregnancy and HIV incidence, suggesting an urgent need for appropriate, targeted, individual-centred counseling for women participating in HIV prevention trials

Characterizing trends in HIV infection among men who have sex with men in Australia by birth cohorts: results from a modified back-projection method

<p>Abstract</p> <p>Background</p> <p>We set out to estimate historical trends in HIV incidence in Australian men who have sex with men with respect to age at infection and birth cohort.</p> <p>Methods</p> <p>A modified back-projection technique is applied to data from the HIV/AIDS Surveillance System in Australia, including "<it>newly diagnosed HIV infections</it>", "<it>newly acquired HIV infections</it>" and "<it>AIDS diagnoses</it>", to estimate trends in HIV incidence over both calendar time and age at infection.</p> <p>Results</p> <p>Our results demonstrate that since 2000, there has been an increase in new HIV infections in Australian men who have sex with men across all age groups. The estimated mean age at infection increased from ~35 years in 2000 to ~37 years in 2007. When the epidemic peaked in the mid 1980s, the majority of the infections (56%) occurred among men aged 30 years and younger; 30% occurred in ages 31 to 40 years; and only ~14% of them were attributed to the group who were older than 40 years of age. In 2007, the proportion of infections occurring in persons 40 years or older doubled to 31% compared to the mid 1980s, while the proportion of infections attributed to the group younger than 30 years of age decreased to 36%.</p> <p>Conclusion</p> <p>The distribution of HIV incidence for birth cohorts by infection year suggests that the HIV epidemic continues to affect older homosexual men as much as, if not more than, younger men. The results are useful for evaluating the impact of the epidemic across successive birth cohorts and study trends among the age groups most at risk.</p

Integrating testing for sexually transmissible infections into annual health assessments for Aboriginal and Torres Strait Islander young people: a cross-sectional analysis

Background In the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16–29 years in Aboriginal Community Controlled Health Services between 2018 and 2020. Methods Using routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test. Results Of the13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20–24 years (OR 1.2, 95% CI 1.1–1.4) and 25–29 years (OR 1.1, 95% CI 1.0–1.2) compared to 16–19 years and patients residing in very remote (OR 4.2, 95% CI 3.7–4.8), remote (OR 2.4, 95% CI 2.1–2.8), and regional areas (OR 2.5, 95% CI 2.2–2.8) compared to metropolitan areas. There was no association with patient sex. Conclusions Integration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women