The socioeconomic determinants of HIV incidence: evidence from a longitudinal, population-based study in rural South Africa

Bärnighausen, Till; Hosegood, Victoria; Timæus, IM; Newell, Marie‐Louise

doi:10.1097/01.aids.0000300533.59483.95

Cited by 206 publications

(214 citation statements)

References 43 publications

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“…Infection rates remain high, especially amongst younger people with females more likely to be infected than males. 5,[7][8][9][10][11][12][13] Likewise, suicidal behaviour in South Africa is a major public health concern accounting respectively for an average non-natural death rate of 9.5% in young people and 11% in adults, giving overall suicide rates that range between 17.2 and 25 per 100 000 of the population. 2,[14][15][16] It is estimated that for every suicide in the country there are at least 20 attempts 2 , and studies show that suicidal ideation is present in 12% amongst adolescents 17 and 9.1% amongst adults 18 in the general population.…”

Section: Introductionmentioning

confidence: 99%

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Govender¹,

Schlebusch²

2012

Afr. J. Psych

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Objective: Suicidal behaviour and HIV/AIDS are significant public health concerns. The aim of this study was to investigate suicidal ideation in patients who were referred to a voluntary HIV counselling and testing (VCT) clinic and who were found to be seropositive. This in order to improve suicide prevention and intervention strategies amongst such patients. Method: The sample studied consisted of volunteer adult patients referred over a three-month period to a HIV VCT clinic based at a university-affiliated general state hospital. Patients completed a questionnaire on sociodemographic data. Suicidal ideation was measured using the Beck Hopelessness Scale and the Beck Depression Inventory (BDI), at two time points (within 72 hours after notification and again at a 6 week follow-up). All patients received extensive pre-and post-test counselling. Results: HIV-test results were available for 189 (99.5%) of the original sample of 190 patients studied, with 157 (83.1%) testing positive. More females tested positive as did unemployed and single/divorced patients. The mean age for HIV-positive patients was 33.49 (SD = 9.449), and for HIV-negative patients it was 37.94 (SD = 15.238). Age was a significant factor in that for each year increase in age, the risk of testing HIV-positive decreased by 4.1%. Lower education and traditional beliefs were also significantly associated with testing HIV-positive. At 72 hours suicidal ideation was present in 17.1% (95% confidence interval 12.16% to 23.45%), and at 6 weeks in 24.1% (95% confidence interval 17.26% to 32.39%) of the seropositive patients. Their average BDI scores were 15.20 and 14.23 respectively at the two time points. Conclusion: Suicidal ideation was present in a significant number of the seropositive cohort studied and increased over a six week period among these patients. The average BDI scores at both time points imply a clinical depression. The findings also suggest an association between positive HIV-test results and certain socio-demographic variables that can act as indicators for suicidal ideation in HIV-infected persons, although this requires further research. Although the relationship between suicidal ideation and HIV-infection is complex, it is an important consideration when assessing patient suicide vulnerability at HIV VCT clinics and when implementing suicide prevention and management strategies.

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Section: Introductionmentioning

confidence: 99%

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Govender¹,

Schlebusch²

2012

Afr. J. Psych

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“…The study area, data collection, and laboratory methods of the surveillance have been described elsewhere. 22 All participants in the surveillance provided written informed consent for the analysis of their information, including HIV status. Residents in the surveillance area had to meet age eligibility criteria (women between 15 and 49 and men between 15 and 54 years of age) in order to participate in the HIV surveillance.…”

mentioning

confidence: 99%

Lack of a Decline in HIV Incidence in a Rural Community with High HIV Prevalence in South Africa, 2003–2007

Bärnighausen

Tanser²,

Newell³

2009

AIDS Research and Human Retroviruses

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To understand the dynamics of the HIV epidemic and to plan HIV treatment and prevention programs, it is critical to know how HIV incidence in a population evolves over time. We used data from a large population-based longitudinal HIV surveillance in a rural community in South Africa to test whether HIV incidence in this population has changed in the period from 2003 through 2007. We observed 563 seroconversions in 8095 individuals over 16,256 person-years at risk, yielding an overall HIV incidence of 3.4 per 100 person-years (95% confidence interval 3.1-3.7). We included time-dependent period dummy variables (in half-yearly increments) in agestratified Cox regressions in order to test for trends in HIV incidence. We first did regression analyses separately for women and men. In both regressions, the coefficients of all period dummy variables were individually insignificant (all p ! 0.338) and jointly insignificant ( p ¼ 0.764 and p ¼ 0.111, respectively). We then did regression analysis using the pooled data on women and men, controlling for sex and interactions between sex and age. Again, the coefficients of the eight period dummy variables were individually insignificant (all p ! 0.387) and jointly insignificant ( p ¼ 0.701). We show for the first time that high levels of HIV incidence have been maintained without any sign of decline over the past 5 years in both women and men in a rural South African community with high HIV prevalence. It is unlikely that the HIV epidemic in rural South Africa can be reversed without new or intensified efforts to prevent HIV infection.

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“…[9,10] High rates of unemployment in SA can be understood as a significant factor driving the HIV epidemic, [11] and empirical evidence has pointed to increased educational attainment as a method of lowering the incidence. [12] The subject of race and HIV, and who is susceptible to HIV and why, remains a sensitive and controversial issue. Researchers have focused on sociocultural and behavioural aspects in explaining the observed HIV disparities by race.…”

Section: Discussionmentioning

confidence: 99%

The case for expanding the definition of ‘key populations’ to include high-risk groups in the general population to improve targeted HIV prevention efforts

et al. 2015

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Background. Two additional key populations within the general population in South Africa (SA) that are at risk of HIV infection are black African women aged 20 -34 years and black African men aged 25 -49 years. Objective. To investigate the social determinants of HIV serostatus for these two high-risk populations. Methods. Data from the 2012 South African National HIV Prevalence, Incidence, and Behaviour Survey were analysed for black African women aged 20 -34 years and black African men aged 25 -49 years.Results. Of the 6.4 million people living with HIV in SA in 2012, 1.8 million (28%) were black women aged 20 -34 years and 1.9 million (30%) black men aged 25 -49 years. In 2012, they constituted 58% of the total HIV-positive population and 48% of the newly infected population. Low socioeconomic status (SES) was strongly associated (p<0.001) with being HIV-positive among black women aged 20 -34 years, and was marginally significant among black men aged 25 -49 years (p<0.1). Conclusion. Low SES is a critical social determinant for HIV infection among the high-risk groups of black African women aged 20 -34 years and black African men aged 25 -49 years. Targeted interventions for these key populations should prioritise socioeconomic empowerment, access to formal housing and services, access to higher education, and broad economic transformation.

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The socioeconomic determinants of HIV incidence: evidence from a longitudinal, population-based study in rural South Africa

Cited by 206 publications

References 43 publications

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Lack of a Decline in HIV Incidence in a Rural Community with High HIV Prevalence in South Africa, 2003–2007

The case for expanding the definition of ‘key populations’ to include high-risk groups in the general population to improve targeted HIV prevention efforts

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