Narrowing disparities in HIV incidence rates between males and females in rural KwaZulu-Natal, South Africa

  

Introduction

The disproportionate HIV burden among women in Sub-Saharan Africa has been a concerning and complex public health issue. Several factors have contributed to this including biological vulnerability, gender inequality, transactional sex, and economic dependence. The past few years have seen concerted efforts to address this public health challenge including geared up universal testing and treatment.

Methods

This study utilizes data from one of the world’s largest HIV cohorts (Africa Health Research Institute (AHRI) population cohort) from rural South Africa that prospectively followed participants between 2005 and 2021. Poisson regression models were used to estimate the HIV incidence, incidence rates and confidence intervals. The outcome variable was seroconversion representing whether an individual tested positive or not over the observation period.

Results

A total of 152,663 person-years with 3565 seroconversions were observed between 2005 and 2021. Our most recent data indicates a narrowing disparity in HIV incidence rates between males and females. The relative decrease in HIV incidence rates from 2014 to 2017 was 30.02% (from 3.92 to 2.74 per 100 person-years) among females and 38.91% (from 1.53 to 0.93 per 100 person-years) among males. In contrast, during the period from 2018 to 2021, there was a substantial decline of 43.08% (from 2.30 to 1.31 per 100 person-years) among females and 24.92% (from 0.78 to 0.58 per 100 person-years) among males. In 2014, the female/male incidence ratio was 2.57 and this declined to 2.23 in 2021. HIV incidence for females increased with age from age 15 before reaching its peak at age 30 while in males it peaked at age 27. HIV incidence in females was higher across all ages (15-54) fig 1.

Conclusion

Although massive strides have been made in lowering HIV incidence among both men and women, it is crucial to examine the plateauing reduction in HIV incidence among men to safeguard against any erosion of the advancements made thus far. The pace of HIV incidence reduction among women on the other hand underscores the effectiveness of intervention strategies and HIV programs. It is imperative to expand these strategies to further decrease HIV incidence among women.