Correlates of Sexually Transmitted Infections Among South African Women Using Individual- and Community-Level Factors: Results from Generalized Additive Mixed Models

Abstract

South Africa has the highest burden of Human Immunodeficiency Virus (HIV) infections in the world. There is also growing evidence that an individual’s risk of contracting HIV is increased by the presence of other sexually transmitted infections (STIs). Primary objective of this study was to examine the association between the prevalence of STIs in a cohort of South African women who enrolled in HIV prevention trials (2002–2012). The current study linked the individual-factors with the community-level characteristics using geo-referencing. This multi-level data was analysed in generalized additive mixed models (GAMMS) settings. In the multivariate logistic regression model, younger age [Odds Ratio (OR):4.30, 95%CI: 3.20, 5.77 and OR:2.72, 95% CI: 2.02, 3.66 for age<25 and 25–29, respectively]; being single/not cohabiting (OR:4.57, 95% CI: 3.18, 6.53), two+ sex partners (OR:1.46, 95% CI: 1.18,1.80); parity<2 (OR:2.04, 95% CI: 1.53, 2.72 ), parity=2 (OR:1.85, 95% CI: 1.37, 2.48), and using injectables (contraceptive) (OR:1.53, 95%CI: 1.13, 2.06) were all significantly associated with increased prevalence of STIs. Besides these individual-level characteristics, women who resided in the communities where high proportions of: female headed-households (OR: 1.17, 95%CI: 1.02, 1.38), and no schooling (OR: 1.26, 95%CI: 1.08, 1.45). Because, these factors may reflect characteristics of the larger groups who share similar cultural norms and social environments, they can provide considerable insight into the spread of STIs. Prevention strategies based on individual and community-level drivers of STIs are likely to be the most effective means of targeting and reaching those at greatest risk of infection. This strategy has the potential to play a significant role in the epidemic’s trajectory.