Abstract
BackgroundHIV prevalence and incidence among sexually active women in peri-urban areas of Ladysmith, Edendale, and Pinetown, KwaZulu-Natal, South Africa, were assessed between October 2007 and February 2010 in preparation for vaginal microbicide trials.Methodology/Principal FindingsSexually active women 18–35 years, not known to be HIV-positive or pregnant were tested cross-sectionally to determine HIV and pregnancy prevalence (798 in Ladysmith, 1,084 in Edendale, and 891 in Pinetown). Out of these, approximately 300 confirmed non-pregnant, HIV-negative women were subsequently enrolled at each clinical research center (CRC) in a 12-month cohort study with quarterly study visits. Women in the cohort studies were required to use a condom plus a hormonal contraceptive method. HIV prevalence rates in the baseline cross-sectional surveys were high: 42% in Ladysmith, 46% in Edendale and 41% in Pinetown. Around 90% of study participants at each CRC reported one sex partner in the last 3 months, but only 14–30% stated that they were sure that none of their sex partners were HIV-positive. HIV incidence rates based on seroconversions over 12 months were 14.8/100 person-years (PY) (95% CI 9.7, 19.8) in Ladysmith, 6.3/100 PY (95% CI 3.2, 9.4) in Edendale, and 7.2/100 PY (95% CI 3.7, 10.7) in Pinetown. The 12-month pregnancy incidence rates (in the context of high reported contraceptive use) were: 5.7/100 PY (95% CI 2.6, 8.7) in Ladysmith, 3.1/100 PY (95% CI 0.9, 5.2) in Edendale and 6.3/100 PY (95% CI 3.0, 9.6) in Pinetown.Conclusions/SignificanceHIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal.
Highlights
The South African province of KwaZulu-Natal is experiencing one of the worst HIV epidemics worldwide
Our data confirm that HIV prevalence and incidence continue to be high in sexually active women aged 18–35 years living in peri-urban areas of KwaZulu-Natal
Our prevalence rates are similar to those reported in the 2009 and 2010 national antenatal surveys but higher than those reported in the 2008 Human Sciences Research Council (HSRC) population-based household survey (26% for women and men combined and for all districts of KwaZulu-Natal combined) [3,4,5]
Summary
The South African province of KwaZulu-Natal is experiencing one of the worst HIV epidemics worldwide. The epidemic has been described as hyperendemic, generalized and mature, with HIV prevalence rates in the general population of over 15% [1,2,3,4,5]. Data from the Department of Health antenatal surveys and the Human Sciences Research Council (HSRC) cross-sectional population-based household surveys have shown a stabilization of prevalence rates since 2005 [3,4,5]. HIV prevalence and incidence among sexually active women in peri-urban areas of Ladysmith, Edendale, and Pinetown, KwaZulu-Natal, South Africa, were assessed between October 2007 and February 2010 in preparation for vaginal microbicide trials
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