Community effects on the risk of HIV infection in rural Tanzania

Abstract

Objectives: To investigate the effect of community characteristics on HIV prevalence and incidence. Methods: Data from an open cohort study with demographic surveillance, epidemiological surveys, and qualitative research were used to examine the association between individual and community risk factors with HIV prevalence in 1994-5 and incidence between 1994-5 and 1996-7 among men (n=2271) and women (n=2752) living in a rural area in northwest Tanzania. Using subvillages as the unit of analysis, community factors investigated were level of social and economic activity, ratio of bar workers per male population aged 18-59, level of community mobility, and distance to the nearest town. Logistic and Cox regression models were estimated to assess community effects, controlling for multiple individual factors. Results: All four community factors had strong effects on HIV transmission. Men who lived in subvillages with the highest level of social and economic activity had an odds of being HIV positive that was about five times higher (OR=4.71, 95% CI=2.89 to 6.71) than those in places with low levels of activity; women in these subvillages had an odds that was twice as high (OR=1.92, 95% CI=1.27 to 2.92). After controlling for community effects, the effects of some individual factors on the risk of HIVeducation, male circumcision, type of work, and number of household assets-changed notably. The association between HIV incidence and community factors was in the expected direction, but did not reach statistical significance (RR=2.07, p=0.10). Conclusions: Results suggest that community characteristics play an important part in the spread of HIV in rural Tanzania. Community effects need both to be considered in individual risk factor analyses and be given more attention in intervention programmes.

Is social capital associated with HIV risk in rural South Africa?

“…This is echoed in research from elsewhere in sub-Saharan Africa examining geographic differences in HIV infection rates. For example, numerous surveillance sites have reported four to six fold variations in HIV prevalence within the same local area (Barongo et al, 1992;Bloom et al, 2002;Boerma et al, 1999;Killewo et al, 1994;Kipp et al, 1995;Soderberg et al, 1994). This pattern captures disparities between low prevalence isolated rural areas and higher prevalence more accessible trading centres.…”

Willingness to Participate in HIV/STD Prevention Activities among Chinese Rural-To-Urban Migrants

“…Their awareness of HIV/AIDS should be increased and HIV-related stigma should be reduced to increase the level of WTP. Recruitment and retention of individuals with high-risk behavior in prevention activities will be critical and challenging.Population mobility has been identified as a major risk factor for HIV/STD infection and transmission in many developing countries, including China (Bloom, Urassa, Isingo, Ng'weshemi & Boerma, 2002;Hope, 2000;Zhang & Ma, 2002 For any successful intervention, a prerequisite is that adequate numbers of individuals are willing to participate in it. Estimates of willingness to participate (WTP) will help researchers to determine the feasibility of prevention intervention program.…”

HIV/AIDS epidemiology, pathogenesis, prevention, and treatment

“…1 HIV-1 infection rates are three to six times higher in female adolescents than in their male counterparts, 1,[5][6][7] and this difference is attributed to sexual coupling patterns of young women with older men. Population prevalence of HIV-1 infection, concurrent sexual relationships, partner change, sexual practices, the presence of other sexually transmitted diseases, [8][9][10][11] and population mobility patterns [12][13][14] for economic and other reasons (eg, natural disasters and wars) further increase the probability of HIV-1 acquisition. 3,15 Emerging data accord with strong links between risk of sexual HIV-1 acquisition and episodic recreational drug or alcohol use.…”