The case for expanding the definition of ‘key populations’ to include high-risk groups in the general population to improve targeted HIV prevention efforts

Abstract

Background. Two additional key populations within the general population in South Africa (SA) that are at risk of HIV infection are black African women aged 20 -34 years and black African men aged 25 -49 years. Objective. To investigate the social determinants of HIV serostatus for these two high-risk populations. Methods. Data from the 2012 South African National HIV Prevalence, Incidence, and Behaviour Survey were analysed for black African women aged 20 -34 years and black African men aged 25 -49 years.Results. Of the 6.4 million people living with HIV in SA in 2012, 1.8 million (28%) were black women aged 20 -34 years and 1.9 million (30%) black men aged 25 -49 years. In 2012, they constituted 58% of the total HIV-positive population and 48% of the newly infected population. Low socioeconomic status (SES) was strongly associated (p<0.001) with being HIV-positive among black women aged 20 -34 years, and was marginally significant among black men aged 25 -49 years (p<0.1). Conclusion. Low SES is a critical social determinant for HIV infection among the high-risk groups of black African women aged 20 -34 years and black African men aged 25 -49 years. Targeted interventions for these key populations should prioritise socioeconomic empowerment, access to formal housing and services, access to higher education, and broad economic transformation.

Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study

“…The retrospective nature of our study did result in missing data, but we corrected for this with multiple imputation and confirmed the findings from the complete case analyses (Table 3). The KS patients in our study were mostly black Africans between 20–50 years old, which reflects national HIV prevalence distribution where this key population has the highest HIV seroprevalence [5,13] . There was potential for selection bias in our study.…”

Age‐disparate sex and HIV risk for young women from 2002 to 2012 in South Africa

“…For our regression analyses we create several variables to control for potential confounding factors. In addition to basic demographic characteristics (age, race, marital status, and locality type) we included a measure of employment status given the association between wealth and both HIV status [28][29][30][31] and the formation of agedisparate partnerships [6,7,[32][33][34][35]. We also created a set of sexual behaviour measures for each survey year.…”

Trajetórias de mulheres vivendo com HIV/aids no Brasil. Avanços e permanências da resposta à epidemia

“…O não uso do preservativo é atribuído à presença da relação estável, à não percepção do risco ou mesmo à dificuldade de uso de proteção junto a um parceiro eventual. Ou seja, apesar do esforço de organizações governamentais e não governamentais, em especial na década de 90, visando desconstruir a ideia dos "grupos de risco" e incentivar a negociação para o uso do preservativo, esta ideia parece que se manteve no imaginário social e a prática de prevenção continua um desafio, especialmente quando a mulher estabelece vínculos afetivos e de confiança com o parceiro 21 . De fato, a persistência do estigma relacionado ao HIV/aids e seus portadores continua a fomentar atribuições negativas ao uso do preservativo, restringindo a prevenção entre as mulheres, mesmo nos dias atuais 22 .…”