HIV Infection in High School Students in Rural South Africa: Role of Transmissions Among Students

Abstract

In South Africa, adolescents constitute a key population at high risk of HIV acquisition. However, little is known about HIV transmission among students within schools. This study was undertaken to assess the risk factors for HIV infection and the extent of transmission among rural high school students. Between February and May 2012, consenting students from five randomly selected public sector high schools in rural KwaZulu-Natal participated in an anonymous cross-sectional survey. Dried blood spot samples were collected and tested for HIV. β-Human chorionic gonadotropin (βHCG) levels were measured in females for pregnancy. Family circumstances as well as sociodemographic and behavioral factors were assessed as potential risk factors. A subset (106/148, 72%) of HIV-positive samples underwent gag p17p24 sequencing for phylogenetic analysis. A total of 3,242 students (81.7% of enrolled students) participated. HIV prevalence was 6.8% [95% confidence interval (CI) 3.9-9.8%] in girls and 2.7% (CI 1.6-3.8%) in boys [adjusted odds ratio (aOR)=3.0, CI 2.4-3.8; p<0.001]. HIV prevalence increased from 4.6% (95% CI 1.9-7.3) in the 12- to 15-year-old girls to 23.1% (95% CI 7.7-38.5) in girls over 20 years, while in boys HIV prevalence increased from 2.7% (95% CI 0.6-4.9) in the 12- to15-year-old boys to 11.1% (95% CI 2.7-19.4) in those over 20 years. Sequencing of samples obtained from students revealed only two clusters, suggesting within-school transmission and three interschool clusters, while the remainder was most likely acquired from sources other than those currently found in students attending the school concerned. HIV prevalence in both girls (aOR=3.6, CI 2.9-4.5; p<0.001) and boys (aOR=2.8, CI 1.2-6.2; p=0.01) was higher in those without a living biological mother. The high burden of HIV infection among students was not associated with intraschool transmission in this rural setting. Lack of a living parent is an important factor defining high risk in this group of adolescents.

HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities

“…The transmission links are important to understand dyadic relationships, and to identify clusters or networks in communities. A combination of HIV phylogenetic analyses with the relevant socio demographic and behavioral data provide powerful knowledge on patterns and dynamics of HIV transmission networks across communities, which could guide HIV prevention and intervention strategies [ 56 - 58 ].…”

Qualitative evaluation of selected social factors that impact sexual risk-taking behaviour among African students in Kwazulu-Natal, South Africa

“…However, these enquiries have largely focused on young people in rural KwaZulu-Natal (KZN) (Harrison, Xaba, Kunene & Ntuli 2001 ; Kharsany, Buthelezi, Frohlich, Yende-Zuma, Samsunder, Mahlase, et al . 2014 ), secondary schools (Bhana & Pattman 2009 ; Campbell & MacPhail 2002 ; James, Reddy, Taylor & Jinabhai 2004 ; Karim, Kharsany, Leask, Ntombela, Humphries, Frohlich, et al . 2014 ) and specific youths in townships (MacPhail & Campbell 2001 ; Pettifor, Lippman, Selin, Peacock, Gottert, Maman, et al .…”

Women’s estimated HIV infections from sex in trials of pre-exposure prophylaxis in Africa: Implications for HIV prevention strategies

“…For example, a 2012 survey of 1,698 young women aged ≥ 12 years (only 7% were ≥ 20 years old) in grades 8-12 in a high-prevalence sub-district in KwaZulu Natal, South Africa, found 54% (=56/104) of infections in self-reported virgins. [44] Using data from Demographic and Health Surveys in Lesotho, Malawi, and Swaziland, Eva Deuchert estimated 30% of HIV in unmarried women aged 15-19 years came from sex if all self-reported virgins were telling the truth; and that more than 55% of sexually active women would have had to misrepresent themselves as virgins for sex to account for more than half of observed HIV infections. [45] Persistent evidence that heterosexual risks fall short of explaining most HIV in African adults challenges those who choose to focus on sex.…”