Abstract
HIV incidence in sub-Saharan Africa declined substantially between 2000 and 2015. In this analysis, we consider the relative associations of nine structural and individual determinants with this decline. A linear mixed effects model of logged HIV incidence rates versus determinants was used. The data were from mathematical modelling as part of the 2019 Global Burden of Disease Study in 43 sub-Saharan African countries. We used forwards selection to determine a single final model of HIV incidence rate. The association of economic variables and HIV knowledge with incidence was found to be driven by education, while ART coverage had the largest impact on other determinants’ coefficients. In the final model, education years per capita contributed the most to explaining variation in HIV incidence rates; a 1-year increase in mean education years was associated with a 0.39 (− 0.56; − 0.2, t = − 4.48 p < 0.01) % decline in incidence rate while a unit increase in ART coverage was associated with a 0.81 (− 1.34; − 0.28, t = − 3.01, p < 0.01) % decline in incidence rate.
Highlights
The global HIV epidemic underwent a series of transformations since the turn of the century
All covariates improved except non partner sexual violence which increased slightly between 2000 and 2015
antiretroviral therapy (ART) rates were effectively zero on average in 2000 but rose to 38% by 2015, while lagged distributed income (LDI) increased by 62.9%, spending on HIV by 194% and contraception prevalence by 85%, from 12% in 2000 to 23% in 2015 (Table 1)
Summary
The global HIV epidemic underwent a series of transformations since the turn of the century. In Kenya, information campaigns were found to be effective to increase the knowledge required to prevent HIV infection This change was seen to reduce the risk of HIV infection [3]. Other determinants, such as school attendance, years of education completed [4] and lagged distributed income (LDI), a weighted average of Gross Domestic Product per capita [5], impact HIV incidence. These factors have improved substantially in Sub-Saharan Africa since 2000 and can have direct impacts on transmission and access to treatment [6]. High levels of sexual violence have been found to often drives higher HIV rates in women [9]
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