Abstract
BackgroundYoung people are at high risk of HIV and developing appropriate prevention programmes requires an understanding of the risk factors for HIV in this age group. We investigated factors associated with HIV among participants aged 15–30 years in a 2007–8 cross-sectional survey nested within a community-randomised trial of the MEMA kwa Vijana intervention in 20 rural communities in northwest Tanzania.MethodsWe analysed data for 7259(53%) males and 6476(47%) females. Using a proximate-determinant conceptual framework and conditional logistic regression, we obtained sex-specific Odds Ratios (ORs) for the association of HIV infection with socio-demographic, knowledge, behavioural and biological factors.ResultsHSV-2 infection was strongly associated with HIV infection (females: adjOR 4.4, 95%CI 3.2–6.1; males: adjOR 4.2, 95%CI 2.8–6.2). Several socio-demographic factors (such as age, marital status and mobility), behavioural factors (condom use, number and type of sexual partnerships) and biological factors (blood transfusion, lifetime pregnancies, genital ulcers, Neisseria gonorrhoeae) were also associated with HIV infection. Among females, lifetime sexual partners (linear trend, p<0.001), ≥2 partners in the past year (adjOR 2.0, 95%CI 1.4–2.8), ≥2 new partners in the past year (adjOR 1.9 95%CI 1.2, 3.3) and concurrent partners in the past year (adjOR 1.6 95%CI 1.1, 2.4) were all associated with HIV infection.ConclusionsEfforts must be intensified to find effective interventions to reduce HSV-2. Effective behavioural interventions focusing on reducing the number of sexual partnerships and risk behaviour within partnerships are also needed. An increase in risky sexual behaviour may occur following marriage dissolution or when a young woman travels outside of her community and interventions addressing the needs of these subgroups of vulnerable women may be important.Trial RegistrationClinicalTrial.gov NCT00248469.
Highlights
Young people aged 15–24 years account for an estimated 40% of new adult HIV infections worldwide [1]
Previous studies in Tanzania and elsewhere have identified a number of factors that are commonly associated with increased risk of HIV infection such as age [4,5,6], socio-economic status [4,7,8], educational status [9,10]; marital status [4,6,9,10], mobility [6,11], high risk sexual behaviours [4,5,6,10] and coinfection with other sexually transmitted infections (STIs) [6,9,12,13,14]
(4) Biological: blood transfusion during the past 5 years, reported number of injections during the past year, whether circumcised and timing of circumcision, reported abnormal genital discharge or genital ulcers during the past year, seropositive for herpes simplex virus type 2 (HSV2) or syphilis, infected with Chlamydia trachomatis, or Neisseria gonorrhoeae
Summary
Young people aged 15–24 years account for an estimated 40% of new adult HIV infections worldwide [1]. The relative contribution of these factors varies between locations and can vary over time as the epidemic matures and prevention efforts intensify [7,8] The majority of these studies were carried out in the late 1990’s and early 2000’s and few focused on young people. Between 1998 and 2008 a community-randomised controlled trial was conducted in rural Tanzania to evaluate the impact of the MEMA kwa Vijana (‘‘Good things for young people’’) adolescent sexual and reproductive health intervention on biological, behavioural, attitudinal and knowledge outcomes. We investigated factors associated with HIV among participants aged 15–30 years in a 2007–8 cross-sectional survey nested within a community-randomised trial of the MEMA kwa Vijana intervention in 20 rural communities in northwest Tanzania
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