Geographical Clustering of High Risk Sexual Behaviors in “Hot-Spots” for HIV and Sexually Transmitted Infections in Kwazulu-Natal, South Africa

Abstract

We investigated geographical variations of three sexually transmitted infections (STIs) namely chlamydia, gonorrhea and syphilis in the greater Durban area, so as to optimize intervention strategies. The study population was a cohort of sexually active women who consented to be screened in one of three biomedical studies conducted in Durban. A total of nine local regions collectively formed three clusters at screening, five of which were previously defined as HIV hot-spots. STI cases were geo-coded at the census level based on residence at the time of screening. Spatial SaTScan Statistics software was employed to identify the areas with a disproportionate prevalence and incidence of STI infection when compared to the neighboring areas under study. Both prevalence and incidence of STIs were collectively clustered in several localized areas, and the majority of these locations overlapped with high HIV clusters and shared the same characteristics: younger age, not married/cohabitating and multiple sex partners.

Evidence for localised HIV related micro–epidemics associated with the decentralised provision of antiretroviral treatment in rural South Africa: a spatio–temporal analysis of changing mortality patterns (2007–2010)

“…In others the pattern is less clear. This work confirms the conclusions made by other studies in the region that identified heterogeneous pattern of micro–epidemics within a more generalised epidemic [10–12,14,17]. Our results confirm trends shown by Tanser and colleagues [8] of considerable local geographic variation in HIV prevalence in a rural area of Kwa Zulu Natal South Africa.…”

The generational effect on age disparate partnerships and the risk for human immunodeficiency virus and sexually transmitted infections acquisition

“…A previous study revealed that being young and unmarried are strong contributing risk factors for STI acquisition in our local population. 3,17 Upon adjusting for these contributing factors, women in inter-GAD partnerships had a 32% decreased risk of STI acquisition compared to those in intra-GAD relationships (p ¼ 0.066).…”

“…1 The high HIV incidence rate among young women is disconcerting and summons scrutiny of associated social factors. [1][2][3] One such social factor is age disparate (AD) relationships, which refers to relationships in which the age gap between sexual partners is five years or more. 4 In a recent national survey, there was a significant gender difference relating to age disparity with 34% of all female adolescents aged 15-19 years old reporting ever having had a partner more than five years older than themselves, compared to only 4% of their corresponding male peer group.…”

Seek, Test and Disclose: knowledge of HIV testing and serostatus among high-risk couples in a South African township

“…Although HIV incidence has stabilised in South Africa over the past decade, the country sustains hyper-epidemics within specific regions and populations 2 3. The National Institutes of Health proposed the ‘Seek, Test, Treat and Retain’ (STTR) strategy to curtail HIV transmission by expanding HIV testing to seek undiagnosed cases (‘Seek’ and ‘Test’), bringing patients into HIV treatment (‘Treat’), and retaining them in clinical care (‘Retain’) 4.…”