Prevalence of Untreated HIV and Associated Risk Behaviors Among the Sexual Partners of Recent Migrants and Long-term Residents in Rakai, Uganda

Abstract

Background: Migrants in sub-Saharan Africa are at increased risk of HIV acquisition after migration, but little is known about their sexual partners at place of destination.Setting: Rakai Community Cohort Study (RCCS) in Uganda. Methods:From 1999 to 2016, persons aged 15-49 years were surveyed in the RCCS and reported on their 4 most recent sexual partners in the last year. We compared the characteristics of sexual partners reported by migrants moving into RCCS communities in the last 2 years (ie, in-migrants) with those of long-term residents with no recent migration history. Among a subset of participants in cohabitating epidemiologically linked couples of known HIV serostatus, we also assessed prevalence of having $1 untreated HIV-positive partner among in-migrants and long-term residents.Results: One hundred sixteen thousand seven hundred forty-four sexual partners were reported by 29,423 participants. The sexual partnerships of in-migrants were significantly less likely to be marital, more likely to span community boundaries, and shorter in duration than those of long-term residents. In-migrants also reported more sexual partners and were less likely to know their partner's HIV status or to have told their partner their HIV status. Among 7558 epidemiologically linked couples, HIV-negative in-migrants were more likely to partner with untreated HIV-positive persons compared with HIV-negative longterm residents (women: 6.3% vs. 4.1%; prevalence risk ratio = 1.77, 95% confidence interval: 1.49 to 2.11; men: 6.9% vs. 3.9%; prevalence risk ratio = 1.72, 95% confidence interval: 1.38-2.14). Conclusion:There is a higher frequency of risky sexual behaviors among the partnerships of in-migrants compared with those of longterm residents. Among cohabitating couples, in-migrants are more likely to partner with untreated HIV-positive individuals.

HIV incidence among non-migrating persons following a household migration event: a population-based, longitudinal study in Uganda

“…This could be due to an increased likelihood for non-migrants, especially men, to partner with migrants with untreated HIV. (24) Our results corroborate with other studies from SSA, demonstrating that changes in sexual behavior following spousal migration are common for men and women with non-migrants reporting riskier sexual behaviors such as reduced condom use and an increased number of sexual partners. (10,11,13)…”

Increasing intra- and inter-subtype HIV diversity despite declining HIV incidence in Uganda

“…Increasing HIV subtype diversity might be partly driven by individuals acquiring multiple infections of different HIV subtypes. Previous analyses from this same population revealed that individuals who remain viremic tended to have substantially higher levels of HIV-related risk behaviors compared to those who were virally suppressed (Brophy et al, 2021; Kennedy et al, 2023), potentially increasing the risk of coinfections and superinfections. Interestingly, however, our analyses of inter-subtype genetic diversity revealed no significant differences in levels of recombinant infection across various population sub-groups, including those with and without recent history of migration or those having extra-community sexual partners.…”

“…Increasing HIV subtype diversity might be partly driven by individuals acquiring multiple infections of different HIV subtypes. Previous analyses from this same population revealed that individuals who remain viremic tended to have substantially higher levels of HIVrelated risk behaviors compared to those who were virally suppressed (Brophy et al, 2021;Kennedy et al, 2023), potentially increasing the risk of coinfections and superinfections.…”