Abstract
BackgroundYoung men are less likely than young women to engage with HIV prevention and care, and their HIV-related mortality is higher. We describe HIV incidence and uptake of HIV services in men 20–29 years(y) in rural KwaZulu-Natal, South Africa, before the roll-out of DREAMS.MethodsWe used data from a population-based demographic and HIV surveillance cohort. HIV incidence was estimated from anonymised testing in an annual serosurvey. Service uptake was assessed in 2011 and 2015, through two self-reported outcomes: 1) HIV testing in the past 12 months(m); 2) voluntary medical male circumcision(VMMC). Logistic regression was used to estimate odds ratios(OR) and 95% confidence intervals(CI) for factors associated with each outcome.ResultsHIV incidence in 2011–2015 was 2.6/100 person-years (95%CI = 2.0–3.4) and 4.2 (95%CI = 3.1–5.6) among men 20-24y and 25-29y, respectively, with no significant change from 2006–2010. N = 1311 and N = 1221 young men participated in the 2011 and 2015 surveys, respectively. In both years, <50% reported testing for HIV in the past 12m. In 2011, only 5% reported VMMC, but coverage in 2015 increased to 40% and 20% in men 20-24y and 25-29y, respectively. HIV testing was positively associated with higher education and mobility. Testing uptake was higher in men reporting >1 partner in the past 12m, or condom use at last sex, but lower in those reporting a casual partner (adjusted (a)OR = 0.53, 95%CI = 0.37–0.75). VMMC uptake was associated with survey year and higher education. Men aged 25-29y and those who were employed (aOR = 0.66; 95%CI = 0.49–0.89) were less likely to report VMMC.ConclusionsHIV incidence in men 20-29y was very high, and pre-exposure prophylaxis (PrEP) should be considered in this population. Uptake of services was low. VMMC coverage increased dramatically from 2011 to 2015, especially among younger men, suggesting a demand for this service. Interventions designed with and for young men are urgently needed.
Highlights
Access to anti-retroviral therapy (ART) has expanded considerably in sub-Saharan Africa (SSA), the number of new HIV infections remains unacceptably high
Imputed seroconversion dates which did not fall within a period when the individual was resident in the surveillance area were censored at the latest exit date before the imputed seroconversion date, i.e. the seroconversion event did not contribute to the numerator, and person-time after the residency period did not contribute to the denominator
Periods of non-residency were included in the calculation of incidence
Summary
Access to anti-retroviral therapy (ART) has expanded considerably in sub-Saharan Africa (SSA), the number of new HIV infections remains unacceptably high. Men constitute 44% of these, and 36% of the new infections among young people aged 15–24 years [1]. Young men are less likely than women to engage with HIV services across all stages of the HIV prevention and care cascade [4,5,6]. Estimated ART coverage in SSA among HIV positive women aged 15 years was 62% in 2016, compared with only 44% among men [11]. Young men are less likely than young women to engage with HIV prevention and care, and their HIV-related mortality is higher. We describe HIV incidence and uptake of HIV services in men 20–29 years(y) in rural KwaZulu-Natal, South Africa, before the roll-out of DREAMS
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