The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa

Abstract

The human immunodeficiency virus (HIV) epidemic in South Africa rapidly developed into a major pandemic. Here we analyse the development of the epidemic in a rural area of the country. The data used were collected between 1992 and 2013 in a longitudinal population survey, the Agincourt Health and Demographic Surveillance Study, in the northeast of the country. Throughout the period of study mortality rates were similar in all villages, suggesting that there were multiple index cases evenly spread geographically. These were likely to have been returning migrant workers. For those aged below 39 years the HIV mortality rate was higher for women, above this age it was higher for men. This indicates the protective effect of greater access to HIV testing and treatment among older women. The recent convergence of mortality rates for Mozambicans and South Africans indicates that the former refugee population are being assimilated into the host community. More than 60% of the deaths occurring in this community between 1992 and 2013 could be attributed directly or indirectly to HIV. Recently there has been an increasing level of non-HIV mortality which has important implications for local healthcare provision. This study demonstrates how evidence from longitudinal analyses can support healthcare planning.

From “Secret” to “Sensitive Issue”: Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment

“…HIV prevalence among those aged 40 years and older was 23% in 2015-16 (Gómez-Olivé et al, 2020). While Voluntary Testing and Counseling have been available in Agincourt since 2002 and ART rollout began at area district hospitals (outside of the site) between 2004 and 2005, availability of ART in the site began in 2007 in a private clinic and then 2008 in public clinics, but wide availability in Agincourt began in 2011 (Mee et al, 2016); during the period, we study (2013–2018) there was a steady increase in both availability and uptake of ART. Two other important contextual factors occurred during this period.…”

Secular trends in HIV/AIDS mortality in China from 1990 to 2016: Gender disparities

“…In the northeast of South Africa, more than 60% of the deaths that occurred between 1992 and 2013 could be attributed to HIV. Although there was a 30% decrease in adult HIV-related mortality between 2007 and 2008, most South African villages still experienced a small increase in mortality from 2007 to 2013[4]. In some Eastern Mediterranean Regions (EMRs), the male mortality rate of HIV/AIDS increased from 0.38 per 100,000 to 2.15 per 100,000, with an increase of 6.7% annually since 1990, which was double that among females[5].…”

PROFILAXIA PRÉ-EXPOSIÇÃO AO HIV (PrEP)

“…Uma pesquisa se abarcou acerca da transmissão do vírus em casais homens gays sorodiscordantes com dois tipos de relações sexuais (insertivas e receptivas), resultou que 40% dos parceiros receptivos foram infectados, classificando o sexo receptivo como médio risco (15) . (15) . Dentre as estratégias de proteção e prevenção às IST's, a PrEP se destaca no controle da infecção pelo vírus HIV.…”