Association between severe drought and HIV prevention and care behaviors in Lesotho: A population-based survey 2016–2017

Abstract

BackgroundA previous analysis of the impact of drought in Africa on HIV demonstrated an 11% greater prevalence in HIV-endemic rural areas attributable to local rainfall shocks. The Lesotho Population-Based HIV Impact Assessment (LePHIA) was conducted after the severe drought of 2014–2016, allowing for reevaluation of this relationship in a setting of expanded antiretroviral coverage.Methods and findingsLePHIA selected a nationally representative sample between November 2016 and May 2017. All adults aged 15–59 years in randomly selected households were invited to complete an interview and HIV testing, with one woman per household eligible to answer questions on their experience of sexual violence. Deviations in rainfall for May 2014–June 2016 were estimated using precipitation data from Climate Hazards Group InfraRed Precipitation with Station Data (CHIRPS), with drought defined as <15% of the average rainfall from 1981 to 2016. The association between drought and risk behaviors as well as HIV-related outcomes was assessed using logistic regression, incorporating complex survey weights. Analyses were stratified by age, sex, and geography (urban versus rural). All of Lesotho suffered from reduced rainfall, with regions receiving 1%–36% of their historical rainfall. Of the 12,887 interviewed participants, 93.5% (12,052) lived in areas that experienced drought, with the majority in rural areas (7,281 versus 4,771 in urban areas). Of the 835 adults living in areas without drought, 520 were in rural areas and 315 in urban. Among females 15–19 years old, living in a rural drought area was associated with early sexual debut (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.43–6.74, p = 0.004), and higher HIV prevalence (OR 2.77, 95% CI 1.19–6.47, p = 0.02). It was also associated with lower educational attainment in rural females ages 15–24 years (OR 0.44, 95% CI 0.25–0.78, p = 0.005). Multivariable analysis adjusting for household wealth and sexual behavior showed that experiencing drought increased the odds of HIV infection among females 15–24 years old (adjusted OR [aOR] 1.80, 95% CI 0.96–3.39, p = 0.07), although this was not statistically significant. Migration was associated with 2-fold higher odds of HIV infection in young people (aOR 2.06, 95% CI 1.25–3.40, p = 0.006). The study was limited by the extensiveness of the drought and the small number of participants in the comparison group.ConclusionsDrought in Lesotho was associated with higher HIV prevalence in girls 15–19 years old in rural areas and with lower educational attainment and riskier sexual behavior in rural females 15–24 years old. Policy-makers may consider adopting potential mechanisms to mitigate the impact of income shock from natural disasters on populations vulnerable to HIV transmission.

Disabled Families: The Impacts of Disability and Care on Family Labour and Poverty in Rural Guatemala

“…While some family members were forced to pull out of work or cut down on labour input, those who continued to work following the onset of impairment within the family were too often forced to work harder. Similar patterns have been observed during or after other crises, including drought, floods, crop failure, and HIV among others (see for example [49]). These responses were not necessarily either/or, and at times complemented each other over time, and as needs and demands unfolded and changed.…”

Drought and intimate partner violence towards women in 19 countries in sub-Saharan Africa during 2011-2018: A population-based study

“…We then ranked this quantity of precipitation with the prior 29 years and converted this ranking to a percentile; for example, the 50th percentile signifies the median level of precipitation in the 30-year period. This use of deviations from long-term precipitation trends is standard in the literature, as it captures weather shocks representing deviations from the norm and therefore does not reflect inherent differences in populations that live in drier or wetter areas [11,12]. We generated an ordinal categorical variable of drought, classifying severe drought as annual precipitation equal to or lower than the 10th percentile of the historical record, mild/moderate drought as above the 10th percentile and equal to or below the 30th percentile, and no drought as above the 30th percentile.…”

“…We generated an ordinal categorical variable of drought, classifying severe drought as annual precipitation equal to or lower than the 10th percentile of the historical record, mild/moderate drought as above the 10th percentile and equal to or below the 30th percentile, and no drought as above the 30th percentile. We also considered a binary categorization of drought, where drought was defined as annual precipitation in the 12 months prior to the survey that was lower than the 15th percentile of the historical record, reflecting the level of precipitation that impacts GDP and agricultural productivity, as defined previously in the literature [11,12,35]. The calculation and classifications of drought were specified a priori; however, we did not have a written prespecified protocol.…”

“…Droughts lead to reduced agricultural production, impacting households' food security and income [3,9]. These impacts may affect downstream health and behavioral outcomes such as nutrition [2,10], HIV prevalence and risk [11,12], and the incidence of infectious diseases such as diarrhea and respiratory infection [13,14]. One potential downstream effect of drought that has received little attention is intimate partner violence (IPV) towards women.…”

‘I go to school to survive’: Facing physical, moral and economic uncertainties in rural Lesotho

“…Compounding the dramatic labour market changes, Lesotho also has the world's second-highest HIV prevalence (Tchuenche et al 2018). Prevalence is around 25% of the adult population (Low et al 2019) and is rising, especially among women (Tchuenche et al 2018). Recurrent food crises have afflicted the country over the past two decades.…”