Abstract
BackgroundPopulation HIV prevalence across West Africa varies substantially. We assess the national epidemiological and behavioural factors associated with this.MethodsNational, urban and rural data on HIV prevalence, the percentage of younger (15–24) and older (25–49) women and men reporting multiple (2+) partners in the past year, HIV prevalence among female sex workers (FSWs), men who have bought sex in the past year (clients), and ART coverage, were compiled for 13 countries. An Ecological analysis using linear regression assessed which factors are associated with national variations in population female and male HIV prevalence, and with each other.FindingsNational population HIV prevalence varies between 0 4–2 9% for men and 0 4–5.6% for women. ART coverage ranges from 6–23%. National variations in HIV prevalence are not shown to be associated with variations in HIV prevalence among FSWs or clients. Instead they are associated with variations in the percentage of younger and older males and females reporting multiple partners. HIV prevalence is weakly negatively associated with ART coverage, implying it is not increased survival that is the cause of variations in HIV prevalence. FSWs and younger female HIV prevalence are associated with client population sizes, especially older men. Younger female HIV prevalence is strongly associated with older male and female HIV prevalence.InterpretationIn West Africa, population HIV prevalence is not significantly higher in countries with high FSW HIV prevalence. Our analysis suggests, higher prevalence occurs where more men buy sex, and where a higher percentage of younger women, and older men and women have multiple partnerships. If a sexual network between clients and young females exists, clients may potentially bridge infection to younger females. HIV prevention should focus both on commercial sex and transmission between clients and younger females with multiple partners.
Highlights
Population HIV prevalence across West Africa varies substantially
Population HIV prevalence remains relatively low [8], infection levels among brothel-based female sex workers (FSWs) are far higher, ranging from 16% to 37% [9,10]. In such ‘concentrated’ HIV epidemic settings, prevention programming is focused on FSWs and their male clients [10,11], with the latter conceived as the main ‘bridging group’ through which HIV spreads to the general population [12,13]
This paper presents the findings from an ecological analysis that explored whether the variations in population HIV prevalence observed across West Africa are associated with variations in the extent of formal commercial sex work, and/or the degree to which women and men of different ages report having multiple sexual partnerships in the past year
Summary
Population HIV prevalence across West Africa varies substantially. We assess the national epidemiological and behavioural factors associated with this. There are substantial differences in the levels of infection between West African countries, with Nigeria, Cote d’Ivoire and Cameroon having estimated female population HIV prevalence levels ranging from 4–7%, compared to 0.5–2% more generally across the region [4]. Population HIV prevalence remains relatively low [8], infection levels among brothel-based FSWs are far higher, ranging from 16% to 37% [9,10]. In such ‘concentrated’ HIV epidemic settings, prevention programming is focused on FSWs and their male clients [10,11], with the latter conceived as the main ‘bridging group’ through which HIV spreads to the general population [12,13]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
