Stabilizing HIV prevalence masks high HIV incidence rates amongst rural and urban women in KwaZulu-Natal, South Africa

Abdool Karim, Quarraisha; Kharsany, Ayesha B. M.; Frohlich, Janet A.; Werner, Lise; Mashego, May; Mlotshwa, Mukelisiwe; Madlala, Bernadette T.; Ntombela, Fanelesibonge; Abdool Karim, Salim

Background: In mature generalized human immunodeficiency virus (HIV) epidemics, as survival from accessing antiretroviral treatment (ART) increases, HIV prevalence data may be suboptimal and difficult to interpret without HIV incidence rates. Objective: To determine the HIV incidence rate among rural and urban women in KwaZulu-Natal, South Africa. Methods: We conducted a prospective cohort study from March 2004 to May 2007. Volunteers were recruited from a rural family-planning clinic and an urban clinic for sexually transmitted infections. Consenting, HIV-uninfected women aged 14-30 years were enrolled. Demographic, clinical, sexual and behavioural data were collected using standardized questionnaires with HIV risk reduction counselling and HIV testing. Pelvic examinations were completed at quarterly visits. Results: The HIV prevalence at screening was 35.7% [95% confidence interval (CI) 32.7-38.8] amongst rural women and 59.3% (95% CI 56.5-62.0) amongst urban women. A total of 594/2240 (26.5%) enrolled women contributed to 602 person-years (PYs) of follow-up. The median age was 22 years [inter-quartile range 18-23 years]. HIV incidence rate was 6.5/100 PY (95% CI 4.4-9.2) amongst rural women and 6.4/100 PY (95% CI 2.6-13.2) amongst urban women. HIV incidence rate of 17.2/100 PY (95% CI 2.1-62.2) was highest amongst urban women <20 years of age and 10.2/100 PY (95% CI 4.1-20.9) amongst rural women ≥25 years of age. Conclusion: HIV incidence rates are devastatingly high in young women in rural and urban KwaZulu-Natal, despite reports of stabilized HIV prevalence observed in current surveillance data. The diffuse nature of the HIV epidemic underscores the urgent need to enhance HIV prevention and treatment modalities.

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International Journal of Epidemiology

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February 8, 2012