Peak HIV prevalence: a useful outcome variable for ecological studies

Abstract

Background Correctly identifying the determinants of generalized HIV epidemics is crucial to bringing down ongoing high HIV incidence in many of these countries. High rates of migration are believed by some to be an important determinant of HIV prevalence. This study evaluates the ecological association between levels of internal and international migration and peak HIV prevalence using thirteen variables from a variety of sources to capture various aspects of internal and international migration intensity. Methods Linear regression was used to analyze the association between these measures of migration intensity and peak national HIV prevalence for 141 countries. Results No evidence of a positive ecological association between migration intensity and HIV prevalence was found. This remained the case when the analyses were limited to the countries of sub-Saharan Africa. On the whole, countries with generalized HIV epidemics had lower rates of internal and external migration. Conclusion These results do not support the thesis that migration measured at the country level plays a significant role in determining peak HIV prevalence.

Conceptual Framework and Research Methods for Migration and HIV Transmission Dynamics

“…We focus on the measurement of migration, but of course there are methodological challenges to measuring both HIV/STI (56) and sexual risk behavior (60). An in-depth discussion of these measures is beyond the scope of this paper.…”

“…Modelers have to be careful in selecting outcomes that avoid this fallacy. In a recent paper, Kenyon et al demonstrate how spurious associations may be drawn, and existing associations missed, when outcome measures are incorrectly chosen; in particular, they argue that peak HIV prevalence as an outcome might be better in avoiding bias due to time of introduction of the virus, than HIV prevalence (56). …”

What underpins the decline in syphilis in Southern and Eastern Africa? An exploratory ecological analysis

“…The utility of peak HIV prevalence as a means of comparing different HIV epidemics has been detailed elsewhere. 18,19 (2) 'Pre-peak-HIV syphilis prevalence' defined as the syphilis prevalence in the country from the first year this was measured. (3) 'Post-peak-HIV syphilis prevalence' defined as the nadir of syphilis prevalence reached in the period after the year that HIV prevalence reached its peak prevalence.…”

HIV Prevalence by Race Co-Varies Closely with Concurrency and Number of Sex Partners in South Africa

“…“It must be borne in mind that HIV prevalence at a point in time represents the cumulative effect of behaviours over the preceding decade and longer [41]. Differences in current HIV prevalence therefore reflect the cumulative effect of behaviours over the preceding years.…”