High HIV incidence and low uptake of HIV prevention services: The context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal, South Africa

Abstract

BackgroundYoung men are less likely than young women to engage with HIV prevention and care, and their HIV-related mortality is higher. We describe HIV incidence and uptake of HIV services in men 20–29 years(y) in rural KwaZulu-Natal, South Africa, before the roll-out of DREAMS.MethodsWe used data from a population-based demographic and HIV surveillance cohort. HIV incidence was estimated from anonymised testing in an annual serosurvey. Service uptake was assessed in 2011 and 2015, through two self-reported outcomes: 1) HIV testing in the past 12 months(m); 2) voluntary medical male circumcision(VMMC). Logistic regression was used to estimate odds ratios(OR) and 95% confidence intervals(CI) for factors associated with each outcome.ResultsHIV incidence in 2011–2015 was 2.6/100 person-years (95%CI = 2.0–3.4) and 4.2 (95%CI = 3.1–5.6) among men 20-24y and 25-29y, respectively, with no significant change from 2006–2010. N = 1311 and N = 1221 young men participated in the 2011 and 2015 surveys, respectively. In both years, <50% reported testing for HIV in the past 12m. In 2011, only 5% reported VMMC, but coverage in 2015 increased to 40% and 20% in men 20-24y and 25-29y, respectively. HIV testing was positively associated with higher education and mobility. Testing uptake was higher in men reporting >1 partner in the past 12m, or condom use at last sex, but lower in those reporting a casual partner (adjusted (a)OR = 0.53, 95%CI = 0.37–0.75). VMMC uptake was associated with survey year and higher education. Men aged 25-29y and those who were employed (aOR = 0.66; 95%CI = 0.49–0.89) were less likely to report VMMC.ConclusionsHIV incidence in men 20-29y was very high, and pre-exposure prophylaxis (PrEP) should be considered in this population. Uptake of services was low. VMMC coverage increased dramatically from 2011 to 2015, especially among younger men, suggesting a demand for this service. Interventions designed with and for young men are urgently needed.

Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria

“…Although, our data suggest gender of sexual partners may be related to the frequency of behavior. Prior studies found HIV testing behavior was significantly associated with sexual practices, but anal sexual practices were pooled with oral under an all-inclusive category [38][39][40] or the studies only evaluated anal sex [41,42]. In Cameroon, prior HIV testing was associated with having 4 or more oral or anal sexual partners in the past year as compared to 1 to 3 sexual partners, but this association was not stratified by sexual practice [40].…”

Thetha Nami: Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa

“…The study area of ~ 500 km 2 with a population of ~ 17000 16-29 year-olds was the site of the scale-up of structural and behavioural interventions through the DREAMS partnership between 2016 and 2018 [7]. The study area is mostly rural and poorer than most other parts of South Africa, with high levels of unemployment and a high burden of HIV [1,9,23].…”

“…The evaluation data arose from: (i) surveys with a representative sample of 13-35-year-old-males and females (n = 4918); (ii) rapid ethnographic community mapping (n = 4); (iii) provider and user interviews (n = 22 and n = 58 respectively); and (iv) group discussions (n = 29). Detailed methods and ndings of the contextual factors that drive risk and create barriers to effective HIV testing, care and prevention have been previously reported [1,6,9,15,[25][26][27][28]. For the purposes of the intervention development the ndings were summarised and converted into vignettes, case-studies and simple infographics by a team of social scientists, statisticians and clinicians who had been engaged in the data collection and peernavigator training.…”

“…Concern about young people's vulnerability to HIV-infection has led to the launch of initiatives, such as the DREAMS (determined, resilient, empowered, mentored and safe) partnership that combine social and behavioural interventions to reduce adolescent and youth vulnerability [7]. This combination of HIV interventions struggled to adequately integrate the biomedical and sociobehavioural components, partly because the public-sector health system has not been effective in linking young men and non-pregnant young women to HIV care [8,9]. The challenge of linkage was also found across the HIV treatment as prevention trials with young people, in particular men aged 25-35, missing from the treatment cascade [10][11][12].…”

MAVSCOT: A fuzzy logic-based HIV diagnostic system with indigenous multi-lingual interfaces for rural Africa

“…Access to HIV diagnostic and testing services is not readily available to many rural and sub-urban dwellers. For instance, KwaZulu-Natal province in South Africa, has been known for its high incidence and prevalence of HIV [3][4][5][6] and the region is also known for low uptake of HIV prevention services [7]. Precise and efficient diagnosis of any disease, coupled with the appropriate treatments, will result in proper control [8].…”